Mental health and new care models – The King’s Fund lessons from the vanguards

Emerging evidence suggests that integrated approaches to mental health can help to support improved performance across the wider health system.

Key findings

  • Knowledge and skills around psychology and mental health are important features of integrated care, whatever the client group.
  • Despite this, the level of priority given to mental health in the development of new models of care has not always been sufficiently high.
  • Some areas report that new models of care have made it easier for local professionals to obtain informal advice from mental health professionals without making a referral, creating a more seamless experience for patients.
  • Working closely with voluntary sector organisations has allowed integrated care teams in some vanguard sites to better support the mental health and wellbeing of people with complex needs.

Policy implications

  • Testing the mental health components of existing vanguard sites must be a central part of the evaluation strategy for the new care models.
  • Other local areas rolling out multispecialty community providers, primary and acute care systems and related care models should go further than the vanguard sites in four key areas:
    • complex needs: enabling local integrated care teams to draw on and incorporate mental health expertise to support people with complex care needs
    • long-term care: equipping primary care teams to address the wide range of mental health needs in general practice (including among people presenting primarily with physical symptoms)
    • urgent care: strengthening mental health support for people using A&E departments and other forms of emergency care
    • whole-population health: placing greater emphasis on promoting positive mental wellbeing in the population, in particular among children and young people, and during and after pregnancy.
  • All sustainability and transformation plans should set out ambitious but credible plans for improving mental health and integrating mental health into new models of care.

Source: The King’s Fund

Breaking the link between gender-based and intimate partner violence and HIV

Intimate partner violence (IPV) during or before pregnancy is associated with many adverse health outcomes.

Pregnancy-related complications or poor infant health outcomes can arise from direct trauma as well as physiological effects of stress, both of which impact maternal health and fetal growth and development.

Antenatal care can be a key entry point within the health system for many women, particularly in low-resource settings. Interventions to identify violence during pregnancy and offer women support and counselling may reduce the occurrence of violence and mitigate its consequences.

This research will provide much-needed evidence on whether a short counselling intervention delivered by nurses is efficacious and feasible in low-resource settings that have a high prevalence of IPV and HIV.

Source: BMC Health Services ResearchBMC series

Follow the project: BioMed Central

Let’s talk about mental health of pregnant teenagers

It’s Teen Pregnancy Prevention Month in some parts of the world

We want to emphasise that sex-education can prevent teenage pregnancy, but let’s not forget a teen mom is not only struggling with the normal issues of being a teenager, yet another part is facing the responsibilities of an adult!

Teenage pregnancy rates in South Africa are high, with around 30% of teenagers in the country reporting ever having been pregnant. According to the 2015 annual school survey, over 15,000 pupils fell pregnant during the academic year. This is nearly triple the worldwide rate of pregnancy in teenagers.

The psychological impact of pregnancy on teenagers is pronounced; adolescents are twice as likely as adults to experience postpartum depression. Another concern is the lack of education, with only about a third of pregnant girls in South Africa going on to finish their schooling. Incomplete education and lack of skills make it difficult for these young women to find work in order to support themselves and their children.

There are a number of physical ramifications to teenage pregnancy – unsafe abortions, for example, can cause injury or death. As a whole, complications during pregnancy and birth are the second leading cause of death for adolescent girls worldwide. But it’s not only them that face serious risks during this period – their babies also have a much higher risk of dying than those born to older mothers.

One way of decreasing the risks to both mother and child is by making skilled antenatal, childbirth and postnatal care available in a safe, teen-friendly environment. This should include counselling with the intent of providing emotional support, mobilising potential resources, and teaching important information about childcare.

Further readings: Pregnancy – a guide for teens

A guide to pregnancy, giving birth, and life as a mom for teens

Alcohol and other substance use during pregnancy

Alcohol and other drugs (AOD) use among pregnant women is associated with poor health outcomes for mothers and children.

Research has found that South Africa has one of the highest prevalence rates for Fetal Alcohol Spectrum Disorders (FASD) in the world. Alcohol, crack/cocaine, heroin and methamphetamine are the most abused substances in South Africa, with alcohol abuse being the most significant problem.

Maternal mental distress and AOD use in pregnancy often result in a cycle of dependency.

BUT, there are new the cross-cutting approaches that can maximize engagement and positive outcomes while mitigating potential harms.


Mothers who take alcohol and other substances during pregnancy often don’t attend antenatal clinic because they fear judgement by healthcare workers.  If a mother does attend it’s important to keep her in the system by making a special effort to create a positive relationship with her, through empathic communication.  You can encourage her to return to the clinic more frequently than other mothers, affirm the things she is doing well and help her to make informed choices.  

Healthcare workers are better able to mitigate harm if the mother is retained in the system!

For more information see our Issue Brief on Alcohol and other drug use in pregnancy

 

 

[#WMMHday Blog Series #4] “Falling Over the Edge”

This post is crossposted on the WMMHday campaign site by  Liz Shane

In the summer of 2013, my life was going great. I’d married my high-school sweetheart two years earlier and we had just moved into to an amazing rental house with our dog. It seemed like the perfect time to expand our family and I soon became pregnant with our first child. While I was initially ecstatic about the pregnancy, several weeks later, I started experiencing some very troubling symptoms.

I had a history of episodic anxiety and depression, usually centered around major life transitions, but this was something far beyond anything I had experienced in the past. I remember sitting in my office one day when I started to feel completely and utterly terrified, even though nothing was objectively wrong. I felt like crying all the time, could not focus on my work, and there was nothing that anyone could say or do to alleviate my anxiety. […]

Source: Falling Over the Edge – WMMH Day

[#WMMHday Blog Series #3] “Coming Up for Air”

This post is crossposted by Kathy Schommer

I feel like I’m drowning.” It was 7:00 a.m. on a weekday morning and my husband had just left for work. I was already sobbing on the phone to my mother, 1,800 miles away in North Dakota.

My then seven-month-old twin girls were bouncing away in their ExerSaucers. “I feel like I am treading water and trying so hard to keep my head up, but I keep sinking further down,” I cried to my mom. ”I’m trying to come up for air, but I feel like I can’t catch my breath.” […]

Source: Coming Up for Air – WMMH Day

A brief, valid mental health screen for mothers living in adversity

The PMHP identified a major obstacle to providing mental health care: the relevant mental health screening tool validated for our setting

The high prevalence of maternal depression in South Africa requires that maternal mental health screening, performed routinely and on-site, be logistically feasible and responsive to the local risk factors which may influence mental distress. To address this gap, we have developed a brief 5-question screening tool to identify symptoms of depression, anxiety and suicidal ideation.  

The study was based at our Hanover Park site. Women attending the maternity service were screened, offered counselling if required and referred to social support services where appropriate. Screening included the PMHP’s risk factor assessment, as well as several other risk and mood screens which are being assessed against a diagnostic gold standard. The most robust screening items were identified for inclusion in a valid, responsive and pragmatic new tool which may be used in limited-resource settings.

Overview of the Hanover Park maternal mental health screening study

Looking beyond depression

Call for greater global focus on improving quality of mental health care for women in the perinatal phase

Researchers and healthcare services have focused on depression, particularly postnatal depression, but a growing evidence base has accrued on the importance of other primary and comorbid disorders, particularly bipolar disorder, anxiety disorders (post-trauma stress, obsessive-compulsive, panic and generalized anxiety disorders), psychosis, eating disorders and personality disorder in both the antenatal and postnatal period.

The World Psychiatric Association urges all health care professionals and policy makers to improve pregnancy outcomes, reduce maternal and infant morbidity and mortality, improve care of the infant and enhance the mother infant relationship.

The WPA calls for all health professionals and other care providers to look beyond depression and also focus on other symptoms of anxiety, PTSD, somatic symptoms (as potential indicators for depression) and psychotic disorders. Women with severe mental illnesses need to be recognised as a high risk group requiring co-ordinated obstetric, paediatric and mental health care.

Read the full statement by the World Psychiatric Association (WPA)

Perinatal depression and anxiety: Let’s talk about moms and dads in Africa

In low- and middle-income countries (LMICs), competing health priorities, civil conflict, and a lack of political will mean that expenditure on mental health is a fraction of that needed to meet the mental health care needs of the population.

For mothers, this treatment gap is most notable in regions where health agendas focus on maternal mortality indicators.

Source: Essentials of Global Mental Health

Who is at risk of perinatal mental health disorder?

Common mental disorders during pregnancy and in the first year after birth are associated with certain risk factors. These include poverty, migration, extreme stress, exposure to violence (domestic, sexual and gender-based), previous history of mental disorders, alcohol and other drug use as well as low social support.

– Migration
– Violence and abuse
– Alcohol and drug use

In South Africa, there is a very high prevalence of adolescent pregnancies with 39% of 15- to 19-year old girls being pregnant at least once. When adolescent mothers suffer from depression, the likelihood of a subsequent teenage pregnancy nearly doubles.

SAsouthAfrica

– Teenage pregnancy
– HIV/AIDS

How to address maternal mental illness among economically disadvantaged parents? 

Integration of services!

Mothers in many settings are using maternal and child health services as well as social services. Thus, detection and access will increase if maternal health screening and services are integrated into these public care platforms.

How to implement a maternal mental health intervention in low-resource settings?

We are sharing our lessons learned in this learning brief. 

We have also developed a Service Development Guidelines which demonstrates how to develop a mental health intervention at your facility, even with limited resources.

Find more free & open access resources for professionals on our website

And what about dads?

Postnatal depression can affect dads too. Find out about common concerns for new dads and discover helpful tips on how they can become more involved. We compiled a leaflet with information that could help you be better prepared for what is happening. The leaflets are available in

EnglishisiXhosa • Afrikaans • French

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