“You are nothing” – that’s what Nosipho, a 19-year-old woman, was told by her mother on a regular basis. Nosipho’s stepfather was abusive and raped her over the course of four years. Eventually, she became pregnant and was diagnosed as HIV-positive. She told no-one about her story because she believed that no-one would care.
Sadly, many women in low-middle-income-settings have stories similar to that of Nosipho. The Perinatal Mental Health Project (PMHP) has a service site at the Hanover Park Midwife Obstetric Unit (MOU). When Nosipho attended the MOU for her first antenatal check-up she was also screened for depression, anxiety and suicidality. She was then referred to the PMHP counsellor, Liesl Hermanus.
Women living in disadvantaged communities, that are exposed to extreme hardship, multiple traumas and little social support, have a high chance of experiencing depression or anxiety around the time of pregnancy and childbirth. These mental health conditions can result in a higher chance of social exclusion, financial difficulties and vulnerability to experiencing violence. Women who are especially at high risk are those living with food insecurity, HIV/AIDS, intimate partner violence and insecure refugee status.
As a PMHP counsellor, Liesl provides support to women and girls who experience emotional distress during and after pregnancy. Since its inception in 2002, the PMHP is addressing the need for integrated mental health care for pregnant and postpartum women and girls in South Africa through research, advocacy and its clinical engagement with vulnerable women and their families.
Liesl can see the results of her efforts walking down the street, when former clients and their children approach her with gratitude, like this SMS one of the mothers sent “I finished my job application today. I want to say thanks for everything you did for me. You must continue to help other people, other people who are suffering, just like I was.”
About the PMHP
Based at the University of Cape Town, within the Alan J Flisher Centre for Public Mental Health, we provide mental health services for perinatal women (clinical services), train those who work with mothers in order to improve the quality of their care (training), form partnerships to promote the improvement of services and inform global interventions through robust research and advocacy.
How we operate
We envision mental health support for all mothers to promote their well-being and that of their children and communities. Our mission is to develop and advocate for accessible maternal mental health care that can be delivered effectively at scale, in low resource settings.
Overlapping programme activities targeting several goals simultaneously
Our four programmes
We provide screening for pregnant women and girls for psychological disorders (depression and anxiety) at their first antenatal visit at our service site in Hanover Park. For those who are at risk, we offer free on-site psychosocial counselling, follow-up and case management for up to one year after birth.
In 2018, the PMHP team screened 1860 clients, counselled 224 women and girls through 672 individual counselling sessions. At follow-up, 57% of the women who had received counselling stated that their problem was ‘much improved’ or ‘resolved’; 93% report successful bonding with their baby; 69% view their life as positive after counselling.
Training and Capacity Building
We provide training in the public health and social development sectors for all levels of staff in the community, social development and health care settings including the use of interactive methods, multi-media resources, distance-based learning opportunities and train-the-trainer courses. Our goal is to integrate maternal mental health into the routine practice of frontline providers in order to increase access to care for marginalised women. Our training aims also to shift negative attitudes, reduce stigma and eliminate client abuse.
We train between 700 and 1000 service providers annually in face-to-face seminars, workshops or courses. Our Training and Capacity Building programme works closely with our Research programme and partners with other academic and civil society organisations. Together we develop innovative, relevant and practical mental health training modules for use in urban and rural contexts.
We develop a range of open access multi-media resources to support our capacity building initiatives.
To determine the effectiveness and efficiency of all elements of the PMHP intervention package we conduct integrated, independent research. The research focusses on the distribution and determinants of several aspects of maternal mental health including depression, anxiety, suicidality, alcohol and substance abuse, food insecurity and domestic violence. We have recently developed and validated a brief mental health screening tool. We also partner with cutting-edge research initiatives that seek to address the knowledge gap for maternal mental health in resource-constrained settings. Our research work is coupled with uptake-strategies to ensure that the new knowledge produced is translated into policy and evidence-based practice.
We are currently involved in the evaluation, in distinct service contexts, of our Nyamekela4Care intervention which we have piloted and developed to embed in regular practice, care provider team knowledge generation, empathic skills practice, case sharing and self-care.
Advocacy and Policy Development
Our aim is to influence and change perceptions and awareness about maternal mental health. We translate the evidence-based research and experiences we gained in our clinical services and from others’ work in resource-constrained settings to engage with local and international change agents, including policy and programme makers and senior officials of governmental organisations.
Through several media platforms and public engagements, we focus on raising awareness among the general public, including mothers and families.
We actively support a range of government policy and implementation processes in health and social development.
Click here for an interview with our counsellor Liesl.
We are a non-profit entity and need funding to do our work. Your donation will help us build a more positive future for women, their children and the communities in which they live. If you want to support us, follow this link to donate here