The following is a conversation between Sean Mayberry, the Chief Executive Officer of StrongMinds, and Denver Frederick, the Host of The Business of Giving.

Denver: Many people believe that mental health is last or at least should be last on the list of priorities when it comes to international aid and development, but my next guest maintains that it shouldn’t be last, rather it should be first, and making it so would be a very wise investment. And here with us to explain that reasoning is Sean Mayberry, the founder and CEO of StrongMinds. Welcome back to the Business of Giving, Sean.

Sean Mayberry, the Founder and Chief Executive Officer of StrongMinds

Sean: Great to see you again, Denver. Thank you for having me.

Denver: So, we have poverty, education, health, environment, nutrition, lots of really urgent needs out there. What is a case for putting mental health at the top or near the top of that list?

Sean: I’m so glad you asked that, Denver. I’ve been working for about mental health in Africa for almost a decade now. And before that, I was doing things in Africa like Malaria, HIV, sexual reproductive health, and I’ve really seen firsthand over these last 10 years just why mental health needs to be first.

When you think about a mom, let’s say in Kampala in Uganda, she’s 35, she has two kids and she’s suffering from depression, her whole life suffers at that point, and her family suffers as well. She can’t work, she’s not productive, she can’t focus, she can’t take care of her kids.

And when you think about it, all these other potential interventions in terms of reducing poverty or teaching a new livelihood or clean water, all of that in a way really goes wasted when you try to talk to that woman and change her behavior about cleaning her water or making sure her kids attend school.

She really can’t hear you when you’re trying to change the behavior because of the symptoms of depression. She can’t focus, she’s very tired, fatigued, anxious. And so, what we’re really seeing, and we have the data now at StrongMinds to show this that when in this case that mom is no longer depressed, she thrives, she goes back to work, her productivity increases, the kids go back to school, nutrition improves in the house, everything gets much better. The entire family starts to thrive.

So, for us, we’re really seeing that good mental health and, in this case, being what we call depression-free is such a strong lever that impacts so many aspects of that woman’s life and her family’s life. And so, for us, it’s about focus on mental health first, help that woman to be mentally strong, depression-free.

And then, we can build layer to layer, help her to reduce her poverty level, help her to be a better mom in terms of vaccinating her kids, help her to be a better community member, things like that. So, that’s been the huge learning that we’ve really accumulated almost over the last decade.

Denver: Yeah, it makes an awful lot of sense, but how successful are you in making that case? We live in a world where if people can’t see something, it’s really hard to convince them that they need to put that at the very top of the list. I mean, it’s one of the reasons sometimes we don’t deal with infrastructure in this country because we’d rather cut a ribbon of a brand-new school opening or whatever when things can’t be seen that easily.

Sometimes we have a way of just putting them to the side and doing something which can be visible. It sounds to me you’re looking at data. Not to measure impact, but to drive impact in trying to convince people. Would that be fair to say?

Sean: That’s entirely the case and that’s really the core of how StrongMinds works. It’s all about being data-focused. It’s making sure that we can measure depression quantitatively using diagnostic tools. It’s making sure that we can measure those changes in the depression suffers life and her family, measuring productivity, income increases, measuring attendance at school, measuring improvements in nutrition in the house.

It’s about having that data and then sitting down and showing and sharing and explaining that data to potential supporters, be it donors in the west, be it the Ministry of Health in Uganda, as we work to get them to really integrate depression treatment in their curriculum. So, for us, it’s about using that data, making the case.

 It doesn’t happen overnight. There’s so much stigma about mental health and depression, so we have to break down those barriers. We have to remove those bricks one by one from the wall. But we’re definitely making progress in the countries we work in Uganda and Zambia, where we’re really seeing a lot more collaboration and excitement by the different governmental ministries so that we can work together.

But at the end of the day, it comes down to having data, speaking with facts.

Denver: Tell us a little bit more about depression. Let’s dig deeper on that because depression to a lot of people is being sad, maybe really sad. In reality, so much more than that. Explain to us what it is and the prevalence of it.

Sean: Depression, internationally, has nine major symptoms, which include loss of appetite, inability to focus, fatigue. And, for us, what we see in Africa is we’re seeing rates of depression up to about 25%, so one in four women. Now, here in the west be it the United States or Europe, typically, you’re seeing depression rates in the local population of about 10%.

So, it’s really about up to two and a half times more prevalent at least in the African countries where we are. Depression is the number one mental illness on the planet. It actually affects women at twice the rate of men. So, if you’re in a room of a hundred depressed people, about 66 of them in the perfect world would actually be depressed.

Denver: Why is it more prevalent among women? Is that biological or is it the fact that society places so much burden on women?

Sean: There’s actually not a clear answer to that. There’s a lot of different sets of hypotheses on that. Is it biological, hormonal? Is it societal? I would tell you the answer is in the middle somewhere, and it’s probably a mulligan stew collection of all those kind of societal and biological factors.

Denver: What’s the danger of ignoring mental health?

Sean: The danger of ignoring mental health, think of that mom I was talking about earlier, who’s depressed. If we ignore mental health, she will continue to suffer episodes of depression her entire life. Some of those episodes might last a few weeks or a few months, then she may get a little better, and then she’ll become depressed again.

So, the danger there is by not addressing mental health, by not treating depression, not just in Africa, but really globally, by not treating depression, you’re allowing individuals to suffer their entire life with a mental illness, you’re not allowing them to achieve their full potential. You’re not allowing them to be the strong mothers and leaders of families that they really want to be and that they need to be.

By not treating depression and ignoring mental health, we as a society allow people to just spend a life of suffering. And, for me, as a fellow human being on the planet, I just can’t accept that.

Denver: Yeah, and you’ve had depression in your family, right? Not you personally, but at least you’ve experienced it indirectly.

Sean: Yeah. Somehow, I am just blessed that I have bad days, sad days. To my knowledge, I’ve never actually been depressed. But yeah, my story is out there. Grew up in a poor family and both my mom and dad were severely depressed. I didn’t know that as a child. For me, how they behaved and their symptoms was normal.

Their inability to really fully embrace parenthood and inability to really lead the family as perhaps strongly as our neighbors. And, as an adult, as a married man with four amazing kids, I still have depression in my house today. I’d say I’ve really had a front row seat to depression throughout my life. So, I understand what it does to the sufferers and the people around him or her.

Denver: One of the ways StrongMinds works is through something called Group Interpersonal Therapy, and you stumbled across that, correct?

Sean: Yeah. It’s such an interesting story. It was 2013, I was working in Manhattan as a CEO of a Swiss anti-poverty organization, literally stumbled across the New York Times article by Tina Rosenberg. She used to have a column called Fixes, and it talked about a randomized control trial that tested this form of psychotherapy to treat depression in Uganda in 2002. So, this was 10, 11 years later.

And the article talked about how wildly successful that psychotherapy was, and then really nothing happened. And luckily, those researchers who led that 2002 RCT were at Columbia University in Manhattan and Johns Hopkins down in Baltimore. So, literally, the next day at lunch, I ran up to Columbia, barged into the office of those researchers, with the article in hand, is this true?

Because I was amazed that it was so effective and that it was group-based, which for me was so potentially, economically effective. And I had already worked in Africa, at that point, about 12 years. So, I had a good understanding of the need for mental health care, depression treatment.

And, to speed up the story, those researchers, one researcher in particular, really became my mental health mentor because I had an MBA, I’m not trained in mental health. And she was instrumental in helping me to really come up with the idea of let’s do group-based depression treatment in Africa.

And so, I naturally did what anyone would do. I quit my high-paying CEO job, launched StrongMinds in 2013 in my lovely attic in New Jersey, spent all my family’s savings in the first two years to get it going until we got initial results that could then bring in initial funding and that wheel could get moving, but that’s the story.

Denver: That is a great story. And it’s funny the way our life just turns along those lines. You buy the New York Times one day and look what happens.

Sean: Just a little more color to that, really what happened is I had missed The Times that day. My wife knew I was interested in mental health. She forwarded me the article saying, “Did you see this?” If she hadn’t done that, I would’ve missed it. I wouldn’t be sitting here talking to you.

And for StrongMinds, by the end of this year, we will have treated 200,000 depression sufferers. So, those 200,000 people potentially would still be suffering. So, it’s a great impact.

Denver: And it’s really incredible. I think the last time you and I spoke was a number of years ago, I think you had only helped 43,000. So, you’ve done four times, five times as much since then and that is incredible. Walk us through this interpersonal therapy. I know it’s 12 weeks, it goes in three phases. Just give this little idea to listeners as to how this all goes down.

Sean: Sure. So, we used group interpersonal psychotherapy. It was originated in the 1970s here in New York. Really what it comes down to, the whole theory is about helping people to understand their triggers of depression, what is happening in their life, and connecting those triggers of depression to depression itself, helping the individual to understand those triggers; if you can manipulate those triggers, turn those triggers down. Then in essence, you turn down depression.

So, group interpersonal psychotherapy really looks at it as there’s common root causes, triggers of depression. They can be disagreement, social isolation, grief for example. So, it helps individuals first to understand, particularly in Africa, where there’s almost no understanding of depression, it helps sufferers to understand that they have a common mental illness; that it’s, in many cases, treatable, manageable.

And then, right now, actually you had mentioned 12 weeks. That was the case when I last spoke to you years back. We’re actually at eight weeks now. And next year, we’ll actually be at six weeks. We started at 16 weeks in 2013, but we’re very good at reducing, getting the model down to the bare minimum. We keep dialing it back. But regardless, in the six weeks or eight weeks, these groups will meet for once a week, for about anywhere from 60 to 90 minutes.

In-person groups have about 12 people. With the pandemic influence, we also do now groups on the phone that have five people. So, we’ll bring the individuals together. We’ve already had one private session with each individual where we’ve screened them for depression. Really done a case history to understand what’s going on in their life.

We’ve been able to identify their triggers and then we bring the groups together and it’s not about the StrongMinds group leader or the StrongMinds volunteer telling people what to do or what to think, it’s really facilitating groups, helping the depression sufferers to understand their triggers, and then really getting that group to work together to come up with strategies to reduce those triggers and then reduce depression.

So, for example, if there’s a mom in a group and her depression trigger is disagreements, she’s having arguments with her husband over how to spend that limited income they have. They’re probably living on about $2 a day and they’re arguing about it.

She wants to spend it on school fees and food. The husband may want to spend it on other things that are less important and they’re arguing and that’s really driving her into depression. So, in the group, it’s really getting the other group members to come up with ideas and suggestions. It’s leveraging those 12 group members life experience, which cumulatively could be several hundred years, to give that woman ideas on suggestions.

What can she do differently in interacting with her husband to solve those disagreements? Are there aspects that she can negotiate upon, for example? And so, all the group members go back home every week with homework. Let’s try this strategy to reduce your trigger.

Sometimes they’ll come back and it worked. The disagreement is beginning to reduce and the trigger is reducing and she normally will say, “And I’m feeling better.” So, she’s beginning to see the connection between how she feels in those triggers and depression. And it’s really giving her the power to manipulate and manage and reduce her depression. I could go on and on in more detail, but that’s our approach at the top level.

Denver: That was a great description. What’s the measurable impact of this approach and what does it cost per woman to do this?

Sean: Women come to our groups free of charge. It’s zero charge. As an organization, we’re philanthropically-funded, we’re a non-profit. Our cost today to actually treat that woman is about $85.

Denver: Wow. Keeps on going down.

Sean: It is, yeah. It’ll probably finish the year between 85 and 100. I think when I met you, we were probably around 150 or so. Back when we started in ’13 and ’14 with startup costs, we were at about 300 in the early days. We keep driving it down. We’re getting better at it. There’s lots of diagnostic tools to measure and to quantify depression. If you go online and Google “Am I depressed?”, you’ll probably run across some of the same ones. We use what’s called the Patient Health Questionnaire 9, the PHQ 9. It’s a scale of 0 to 27.

So, we measure that for all of our patients repeatedly during the intervention. What we consistently see is that about 75 to 80% of the people we treat are no longer depressed. We call that depression-free. We try to use simple terminology and de-mystify depression when we’re talking.

But yeah, about 75, 80% of the people we treat are no longer depressed. We track that. We know that lasts at least six months later and longitudinally, we’ve measured that up to two years later, and that rate does not go down. So, that stays around 75 to 80%, which is a massive impact.

Denver: Oh, it’s unbelievable. It really is, and particularly for such a relatively short duration in terms of it, it just shows the magic, and it is so women-centric. I don’t know if guys would behave this way, but when you get women together in a group like that, and they share experiences, just magic can happen so often.

What’s been the impact of COVID, both in terms of the levels of depression across Africa in the two countries in which you operate, and also how you’ve pivoted. You talked a little bit about you’re doing some of this remotely and online now. Talk about how that’s really come down.

Sean: Yeah. Before COVID, we did all our groups in person, so you can imagine the impact of not being able to meet. We have a great team. We really were able to respond quickly and put all of our group curriculum and process from an in-person approach to the telephone. And these aren’t smartphones, this isn’t video.

So, in the countries we are in, Uganda, Zambia, we just launched in Kenya as well, the access to smartphones is very low, and the access to Wi-Fi for those phones is even lower. So, we really use just the old flips, simple phones. It’s just audio.

Denver: Yeah.

Sean: So, we created teletherapy groups. So, what we do now is we conduct the groups on the phone. Groups are much smaller. Just, if I’m a group leader, I literally conference-call five people. So, it’s my dime for the call, if you will, and we conduct the groups.

We had thought that we would see lower impact. We just figured, “Hey, this is going to be a less impact, but it’s something that we have to do and it’s our best response to the pandemic.” We’re shocked actually to find out that actually we’re seeing the same level of impact. And with repeated measurement, we still see the same impact.

What we’re learning is that, yes, the in-person groups are important. There’s the power of the group going back to what you had mentioned, Denver, the social bonding that happens in the group.

But we’re also finding, at least on phones, where there’s less social bonding because the people aren’t coming together physically in person and they’re also not looking one another in the eye, so they’re just really just the faceless voices, if you will, but we’re finding that those faceless voices allow group participants to open up much sooner in the group meetings.

Because many times, they’re talking about revealing, sharing very difficult parts of their life, disagreements with their husband, the grief over the loss of a loved one. And by not having to look someone in the eye, we’re finding that group participants on the phone for StrongMinds open up much sooner. And that allows the therapy to sink in and have an impact over that period of time.

So, in that sense, that faceless anonymity was really an unintended consequence that has led to our phone groups being just as effective as our in-person groups.

Denver: Yeah, that is really interesting and it doesn’t surprise me at all. A matter of fact, I had somebody on, we were talking about fundraising and virtual solicitations for major gifts and I’ve been brought up in fundraising and I know you need to do it face to face personally.

Sean: Totally.

Denver: They’ve done the surveys, it turned out it’s more effective virtually.

Sean: I’ve seen the same.

Denver: Yeah. People are focused, and it’s a bit more business-like, you don’t have somebody coming in the restaurant thinking that you want any more water, all those different types of things.

Sean: You’re right.

Denver: Have actually made it more effective. And also, the way you would always try to solicit somebody, you’d have to have maybe six touches.

Sean: Yeah.

Denver: With the pandemic, you can actually ask on the first date.

Sean: As one of the lead fundraisers for StrongMinds, I’ve seen those same results. It’s really sped things up. We had thought at the beginning of the pandemic, “Oh, all of our in-person fundraising conferences are gone. Oh, this is going to be such a hit to our fundraising.” And actually, our fundraising, the graph has really increased. So, I totally support what you’re saying.

Denver: That’s really interesting. Let me ask you about two subsets you work with. One would be refugees in Uganda. Tell us about that.

Sean: Yeah. Uganda is the ground zero for refugees. The refugee crisis in Africa, the last number I saw in Uganda, there was about 1.1 million refugees. A lot of them coming in from Northern Sudan, from Western Congo.

Yeah. And refugees have a lot of mental health challenges, right? They’re suffering with depression, anxiety, PTSD, Post Traumatic Stress Disorder. We began to work with refugees a number of years ago, just being mindful of the suffering that was going on. We felt it was important for us.

It’s certainly more difficult because most of those in Uganda refugee, they call them refugee settlements in Uganda camps, are up in the north on the border, so we’ve created some offices up there, working with some great NGO partners including one, obviously, my understanding is it’s the biggest Italian NGO where they’re as a great partner with us that they work in the settlements.

They’ve helped us to learn how to work in the settlements, and working together with them where we treat depression now in those refugee settlements, helping refugees to overcome and to become depression-free, so it’s been a great success.

Denver: Well, that’s fantastic. The other one is adolescence, which I guess is the cradle of depression because the onset of the illness really begins there. And adolescence can be tough as we know to try to reach when it comes around something like this.

Sean: Very tough. We started StrongMinds in ’13, ’14 just focused on the general population and the general women we were treating then were about age 35. They had two kids. But over time, we’ve added refugees. Now, adolescents are expanding that circle, if you will.

But no, we chose, those years ago to begin to treat adolescence. Just as you mentioned, it’s the cradle of depression. The whole thinking being, “We have a choice, we can first help a woman suffering with depression when she’s 35 or if we reach her when she’s 15, in essence, we can give her 20 extra years of stronger mental health.”

So, yeah, we launched an adolescent program. It took a ton of work, as you can imagine and somewhat alluded to, right? A 15-year-old is very different from a 35-year-old in terms of interests and where they are in life and their attention span, which is true, I see in Uganda or the US.

Denver: Or your own household.

Sean:  Or my own household.

Denver: As a father of four boys.

Sean: Yeah, yeah, those diminishing attentions, where everything, I have to speak in 140 characters. But, yeah, it took us a good year. A lot of research, a lot of human-centered design approach to working with adolescents, focus groups, understanding what’s going to work, what’s not going to work.

Ultimately, we’re able to design groups for adolescents that are a lot more interactive. I say, they have a lot more bells and whistles to really keep the attention of, say, a 15-year-old. and great success over the years. We started some small programs, conducting groups in schools now, and those were run by our own StrongMinds staff.

Now, a couple years later, we have a memorandum of understanding and agreement with the Ministry of Education in Uganda to do this. We’re running a lot more groups in schools. We see schools coming back to us, the teachers, the administrators saying that they’re really seeing the positive impact in their school.

When kids are no longer depressed, they’re able to focus better. The whole school classroom is stronger. And for that reason, we’re really seeing schools really give us dedicated time in their day for depression groups, so the kids don’t have to stay after school, we get like the seventh period, if you will, because they really value it.

And we’re dropping the age down. So now, we’re down to age 12, treating depression for 12 years and up. We’re not running the groups anymore. Now, we’re actually able to train teachers to run the groups themselves. We’re about to start training older adolescents, like someone who’s 18 or 19 to potentially treat a 12-year-old. We have to see if that works.

And we’re not just in schools anymore. There’s a lot of adolescents in Uganda who can’t afford school or out of school, so we’re actually treating adolescent depression in out-of-school setting. And the program is very impactful and the changes that we’re seeing and we’re really excited. As we said, we’re really giving 20 extra years of mental health to these individuals, which is really the right thing to do.

Denver: That’s great, Sean. And also, it sounds like the way you’ve gone about scaling is making this open source that you realize that with your own organization and the amount of money that you can raise with your team, you can only reach so many people. But when you can plug into established entities like schools, you can really get a multiple going.

Sean: You totally hit the nail on the head. That’s exactly how we’re doing it. We’ve gotten good as an organization to raise funds for mental health in Africa. But we’re never going to be able to be that giant to save the children or care kind of NGO, and we wouldn’t want to be. But with that, how do we still generate massive impact?

There’s at least 66 million women suffering with depression in Africa based on our own conservative estimates. We’ve only reached about 200,000 of them and even less because actually, part of that 200,000 now includes some adolescents and some males, refugees, et cetera. But for us, it’s about how do we find those levers in the system to do more with our somewhat small team.

So, using teachers in schools, we’re using volunteers. And really now, we’re really shifting more and more away from StrongMinds group leaders, from them actually conducting groups to becoming trainers and supervisors. So, in Uganda, for example, we have roughly about 1000, what in Africa is called, community health workers.

Denver: Yeah.

Sean: So, these are volunteers who work for the Ministry of Health out on the ground delivering health services, CHWs. In Uganda, they’re called the volunteer health team but sorry for all the acronyms. But that said, we have 1000 of those volunteers in Uganda working with us to deliver depression treatment.

And so then, I have my staff who is supervising these individuals who then go out to run groups. So, the math is quite simple. If I’m a StrongMinds group leader, the most people that I could treat in a year is maybe about 400, and that’s doing a couple groups a day every day, and you risk burnout.

I can have that group leader for someone to do that or I can have that leader actually, in place of running the group, he or she can be supervising 10 volunteers who are each doing a couple groups and reaching several hundred. So, the math becomes quite compelling. But, yeah, it’s a huge lever that we’re getting better at moving in the direction.

And last point on that is I think that’s really why our numbers are taking off. We’ve mentioned 200,000 cumulative depression sufferers treated through the end of this year. This year alone, it’s 90,000. So, if you were to see a graph of our patient impact, it’s really taking off through that; the multiplicity, as I call it, of volunteers helping us.

Denver: Exponential. You mentioned a moment ago, the US. And you’ve started some operations here, haven’t you?

Sean: We did. We did. We launched, what we call, StrongMinds America this year.

Denver: I love it.

Sean: It’s super exciting. We just began reaching patients this month in September.

We’ve launched in Newark. My office is about 10 minutes away. But Newark is a high-need location. We’re focused on black indiginal people of color, by pack individuals, 18 to 25, male and female. A huge need in Newark, and treating depression, yeah, it’s very exciting. We are exporting our depression treatment model from Uganda to the United States, and we’re really excited about it.

Denver: Reverse innovation . You, were founded in 2013, so you’re coming up on about 10 years.

Sean: We are.

Denver: And we’re thinking about that because I’ve had so many people on this program who have founded organizations and are at that 10-year mark. And maybe this doesn’t apply to you, but something happens, I think a lot of the excitement of having founded the organization and the kind of the skin you were in, you begin to shed a little bit because you’re getting, I don’t want to call it a mid- life crisis or adolescence, but there’s an evolution of an organization right around that 8 to 13-year mark or something like that where you begin to think differently. Have you gone through that or are you in the midst of that? Do you have any observations?

Sean: I’ve seen that as well in my sample size of colleagues around that 10-year mark. I don’t know. I am still as enthused about StrongMinds today as I was in 2013.

Denver: Sound like you are, that’s for sure.

Sean: When I was like sitting in a sweltering attic in August in New Jersey trying to get this going without airconditioning. Oh my gosh. No, I’m still as enthused. We’re very different now, but I think I’m as enthused because we really see the model growing so much more in terms of the impact. And that drives me. Some days, you think it’s about numbers, but it’s really about those faces behind the numbers.

Denver: Yeah.

Sean: And the lives that we’re improving. So, for me, it’s a gift. I’m blessed that I’m able to spend my life like this. I’m blessed that I’m surrounded by an amazing team of almost 200 people here and in Africa that can generate this change. And I look to the future of we just keep changing our model from 16 weeks to 6, changing but improving.

And every time we change it, we see more impact. The launch here in America, I think, can show the world that StrongMinds has a very simple, cost-effective depression treatment model that can be used globally. So, for me, when I look at the next 10 years of what we can accomplish really based on the first 10 years foundation, yeah, I’m not going anywhere soon.

And it’s funny you ask that because every once in a while, my US Board of Directors will check in, “How are you feeling, how are you feeling?” And I feel fantastic.

“And for us, I view it as anyone I work with at StrongMinds, I’ve only bought 40 hours of your life this week, and that’s all I want. If you want to give me 41 hours, Well, I appreciate the donation, but I don’t expect it. I want people to be able to go home and embrace their families or their personal lives, and I just believe you know, a rich personal life allows them to be even better at work.”

Denver: Let me ask you about your team, especially the wellbeing of your team, because this is the challenge that we have all, the course of the last two and a half or three years with this pandemic, and I think particularly in your case, you do difficult work. This is challenging work in terms of the circumstances. What have you done to really assure that your team is taking care of itself and you’re taking care of them?

Sean: I think we’ve always been good at taking care of the team as a mental health organization.

Denver: Yeah.

Sean: And I think that really helped us to get through the pandemic less scathed, if you may, than maybe some other orgs. We really focus on, particularly out in the field with our individuals who are treating groups or really working with our depression sufferers day in and day out.

It’s a lot of just self-care. It’s really making sure that they have enough free time, that we’re not working them 24/7 or Monday through Friday, 9 to 5, giving them enough free time, giving them the right level of support, giving them opportunities to just vent and to share if they’re suffering, if they’ve just come out of a really difficult depression group or something like that.

So, really giving them the space to be strong. It’s about having mental health experts on the team here. And it’s also, I think, something we’ve always done for StrongMinds. It’s really pushing that work-life balance. Everybody talks about it but, few people, not enough really walk the talk.

And for us, I view it as anyone I work with at StrongMinds, I’ve only bought 40 hours of your life this week, and that’s all I want. If you want to give me 41 hours, I appreciate the donation, but I don’t expect it. I want people to be able to go home and embrace their families or their personal lives, and I just believe a rich personal life allows them to be even better at work.

And I think just lastly, when we hire people at StrongMinds, it’s always about trying to find people who are passionate about mental health. We don’t want someone just coming in and checking in the clock and just doing 9 to 5. We want people who are excited and who really want to change lives and make mental health better for so many.

And I think that passion drives us. So, I think, we’ve got a good kind of formula for keeping our team strong.

“And that was a long genesis. So, I think, on the leadership side, I’ve been able to understand just the value of patience, that it does take time to create other leaders. But yeah, those would be some of my observations if helpful.”

Denver: Yeah. Yeah. No, I would agree. I talked to a lot of organizations and often for so many people, work isn’t work. They really enjoy what they’re doing and they enjoy the people they’re doing with.

And that just makes it a lot easier because we can only do things that we don’t like for so long, not cursing in front of our grandmother. You can keep it up for a while, but after every soon you’re going to slip. How do you think the nature of leadership is changing?

And how have you changed as a leader? The world has changed, the Gen Zs have changed. Everything has changed. What has happened with your leadership over the last 10 years that you would say, “Hey, this is how I have evolved?”

Sean: Oh, what a great question. I should have reflected on this more walking to work. Yeah, definitely, I’d like to say, that I’m a better leader than I was 10 years ago. I think I am more able now to step back from details.

In the early days, I always use the restaurant analogy, right? I was cooking the meal, I was washing the dishes, I was taking reservations at the front of the restaurant but now, I’m just doing one job. So, I just have a much stronger team, so I’m able to really delegate more. I’m able to, as opposed to the first year is what it’s really about, doing and getting done. Now, I’m able to facilitate and help others to do that. So, I’m getting more done through others and really coaching those others, if you will, to become leaders themselves.

I’m 55. I have some leadership lessons that sometimes I know in my mind and sometimes I’m not able to verbalize, but you start to see when you’re chatting with younger folks who are becoming leaders, we have a lot of wisdom at our life stage, Denver, you and I and others that is really helpful to share with these younger leaders and just letting them know the importance of just certain approaches.

Like I believe, for example, you can never make a bad decision, right? When you make a decision, you’re creating movement in the organization. And even if it is a bad decision, at least you’re learning from it. Just don’t not make the decision, make it.

You’ll either learn or you’ll move things forward, but just being caught in the headlights is really just not productive. So, yeah, it’s just about I share more with my team to really answer your question. I’m a lot more comfortable in my skin. I’m able to delegate more. And it’s really exciting when I look at that and helping my own team to lead.

And I think a little more detailed on the leadership is just last year, interestingly, we actually finally moved our headquarters for StrongMinds from the US to Kampala, Uganda, where it needs to be because really, we’re African-based. It took us eight years to get to that point because it took us that long to really have the team ready in Kampala to accept the COO responsibilities and things like that.

And that was a long genesis. So, I think, on the leadership side, I’ve been able to understand just the value of patience, that it does take time to create other leaders. But yeah, those would be some of my observations if helpful.

Denver: Yeah. Good observations. Funny, part of what you’re doing is exactly the way your model is working in terms of getting those, you’re absolutely modeling what you’re doing with the organization itself and what you say about decision-making is so right.

And I think the classic case is that there’s two-door decisions, you’ve heard about that, and one-door decisions.

Sean: I don’t know that term actually.

Denver: Yeah, it’s actually very interesting. I don’t know if it came from Amazon or whatever, But about 99% of the decisions we make are two-door decisions, and going back to your restaurant analogy, just imagine walking through that swinging door into the kitchen, that’s your decision. And if your decision is bad, you just go out the other door very quickly. And you’ve made it because you’ve learned from it.

About 1% of our decisions are one-door decisions, which means that if you go through that door, you’ve got to live with that consequence for a while. So, you really have to be thoughtful about those decisions. About one out of a hundred, most people take the same amount of time for a two-door decision.

And if you’re a one-door decision, make it and be thoughtful about it, but make it fast. Learn and you can reverse it in a heartbeat, And people don’t, and you just can’t learn. You sit in the boardroom when used to, and actually what’s happened is the decision is made for you by the events.

Sean: I love that. I’m going to use that. Yeah. That’s so true.

Denver: Final thing. What are you excited about? You have so much going on, Sean, right now, when you really get that adrenaline pumped up, what are you thinking about that does it for you?

Sean: I’m just seeing it, the next 10 years for StrongMinds, with the launch in the US, the US is also a non-profit, I’m thinking a lot more about how do we launch for profits, how do we start charging for these services to maybe middle-income, upper-income people, not just in Africa, but globally, how do we continue to get this model more prevalent globally, how do we start charging for it, cross-subsidizing.

So, for profit entities that make a profit, that profit can be used to fund other StrongMinds non-profits as well, how do we really start to take this off. As I mentioned earlier, Denver, I’m just such a believer that we have a great simple model that can make such a difference in treating depression that’s so needed globally.

That is really a huge responsibility for us is to get it out. It almost goes back to when I found that RCT that’s sat on a shelf for 10 years, and I joke with the researchers. I’m like, if you guys cured cancer, would you let that sit on a shelf for 10 years? And we can’t let our models sit on a shelf. It needs to get out there, which is one reason why we’re in Newark now.

So, I’m just so excited in the next 10 years, what we can do to get our model out there through non-profit and for-profit approaches because at the end of day, women in Uganda always tell me, when they have depression, they thought they were the only one.

They don’t understand that it’s so widely prevalent. And then once they become depression-free, so many of our volunteers are people who have been depressed. They can’t stand the thought, they say, if someone else is still suffering. And I like to think that I feel the same way, that I can’t stand the thought that someone is suffering from depression here on one side but we have a simple model here on the other side.

And so, I’m excited over the next 10 years of how do we connect that and how do we just make depression treatment simpler, faster, easier on our planet.

Denver: Yeah. And simpler is the key word there. Remember it was David Packard that said that most businesses fail from indigestion and not starvation.

And often what we try to do, we always think by adding and adding and adding, and we make it so complex, it just falls off its own weight.

Sean: I know. Yeah. We keep stripping ours down. From 16 to 6, how do we get it simpler because when you have volunteers doing it, it’s something complex, that’s not going to work.

Denver: For listeners who want to learn more about StrongMinds or maybe financially help support this work, tell us a little bit about your website, what they’ll find there, and how they can help support your cause.

Sean: Yeah, please go to There, you can learn all about what’s going on, really see a lot more of our numbers. You’re able to make online donations. You can also see there a link to our work in Newark for StrongMinds America as well, which is a very small startup and would love your donations as well. You can also find information there on how to contact me or others on our team. If you have questions, I’m very happy to hear from anyone.

Denver: Fantastic. Well, thanks, Sean, for being here today. It was a real pleasure to have you on the show.

Sean: So good to see you, Denver. Thank you so much.

Denver Frederick, Host of The Business of Giving serves as a Trusted Advisor and Executive Coach to Nonprofit Leaders. His Book, The Business of Giving: New Best Practices for Nonprofit and Philanthropic Leaders in an Ever-Changing World, will be released later this year.Listen to more The Business of Giving episodes here. Subscribe to our podcast channel on Spotify to get notified of new episodes. You can also follow us on TwitterInstagram, and on Facebook.

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