By: Smita Gaith, Women Deliver
Maternal health and mental health are inextricably linked – pregnant and postnatal women often suffer from common mental disorders like anxiety, depression, and other issues. But, all too often, these disorders go undiagnosed and untreated. Maternal suicide is the leading cause of death in the perinatal period, and there is a growing body of evidence to support the need for maternal mental health support in low- and middle-income countries.
In South Africa, the Perinatal Mental Health Project (PMHP), ongoing since July 2008, created an intervention that integrates mental health care services with primary care services. PMHP addressed mental illness among pregnant and postnatal girls and women in disadvantaged communities affected by poverty, HIV/AIDS, violence, abuse, social exclusion and refugee status. The organization found that postnatal depression, which affects 10-15 percent of women in developed countries, was as high was 35 percent in Cape Town, and that antenatal depression was as high as 41 percent in KwaZulu-Natal.
According to a PMHP report, the perinatal period is an opportune time to discuss mental health with women. Among other reasons, there is an increased rate in the onset of depression at this period, with socio-economic factors complicating the risk. Furthermore, pregnancy is usually a time of increased contact with health professionals, with most women in the country accessing antenatal services at least once during pregnancy.
PMHP is a collaborative 3-year effort that bolstered existing primary care resources and infrastructure, housed in a primary-level antenatal clinic of a secondary-level maternity hospital. Midwives in the antenatal clinic are trained to screen women for maternal mood disorders during their antenatal visits. Women who screened positive for disorders were referred directly to on-site counselors/case managers. For women who required specialist services, psychiatrists were also on-site, as were facility managers and health workers.
A stepped care system offered all women mental health screening at their antenatal visit, with monitored results, and supplemented counseling free for one year to those who tested positively. Finally, each woman had a follow-up phone call to find how she was doing after birth and to monitor whether further counseling was necessary.
Out of all the women who saw PMHP psychiatrists, 75 percent reported inadequate partner or family support, 45 percent reported past psychiatric problems, 40 percent reported past or present abuse (any form), and 5 percent had problems with substance abuse.
The impact of the Project has been inspiring. For three years, 6,347 women were seen at the antenatal clinics, and more than 90 percent were offered counseling services. The need for this service is clear, as 95 percent of those women accepted the counseling, and 32 percent of counseled women were qualified for psychiatric services. Of the 6,347 women seen, 1,079 qualified and agreed to use psychiatric services. Although there are still noted areas of improvement, such as creating PMHP centers in rural areas, and using a shorter mental health screening tool, the possibility for scale-up is clear, as the model has shown the feasibility of building capacity even in low resources, and take up has been enthusiastic.
For more information, read the study results or take a look at the PHMP website and resources.
Flickr photograph via Steve McNicholas.