Category Archives: Mental Health

Mental health interventions in pregnant women and new mothers

There are clear economic and societal arguments for investing in mental health interventions for women during pregnancy and immediately after birth.

This report examines the economic case for investing in early interventions that reflect best practice in England. Best practices that can and should be transferable to a cost-benefit analysis for perinatal mental health care in Low- and Middle Income Countries.

 

Source: The London School of Economics and Political Science

Reflections from Cape Town, South Africa by Dr Robert Nettleton

The second in a series of blogs by Dr Robert Nettleton, Education Advisor, Institute of Health Visiting, on his travels to Cape Town, South Africa through his Florence Nightingale Foundation Travel Scholarship 2017. He met our director, Simone Honikman, and our clinical team at Mowbray Maternity Hospital:

“The connection between a ‘trauma-informed’ approach and infant and perinatal mental health was obvious from my visit to the Perinatal Mental Health Project team at Mowbray Maternity Hospital, led by Simone Honikman.

There is an ‘epidemic of mental distress among women living in adversity’. Alongside wealth, there are extensive townships or informal settlements that are a legacy of the apartheid era in which, for example, 50% of women are HIV positive and levels of domestic, gender-based and sexual violence are high, as is poverty. Providing for accessible front-line assessment of mental health distress is a priority, through providing training to a range of workers and also within the community through ‘social connectors’ (I’ll learn about this more next week).

A challenge that resonated for me was about promoting quality and consistency in a fragmented system where there is also a heavy reliance on separate NPOs (not-for-profits) as providers of services.

Two key learnings for me were:

  1. The importance of what Simone calls ‘self-care’ – what we might call supervision with a substantial restorative component. I met, briefly, Charlotte who provides counselling out of a cubby-hole of an office in a maternity hospital. Her heart was bigger than her office! Maintaining resilience is something that we know is important, and the ‘Sollihull Approach’, while not rolled out in Cape Town, was something that colleagues recognised as applicable.
  1. The dilemma of seeking to deliver a quality service within a very low-resource environment. This resonated with me as we face resource pressures in the UK. We discussed and reflected on what would be the essential elements of a service (the ‘active ingredients’ or ‘programme mechanisms’) and what could be delegated or substituted without placing effectiveness at risk. The ability to form effective empathic relationships is one of those essential elements common to both South Africa and the UK, as is support and supervision.”

Source: Reflections from Cape Town, South Africa – week 2 – IHV

Integrating Maternal Mental Health into Maternal and Child Health Programmes

Misconceptions regarding maternal depression are obstacles to the integration of mental health initiatives in Maternal and Child Health (MCH) programmes.

The myths about maternal mental health include the beliefs that: maternal depression is rare, not relevant to MCH programmes, can only be treated by specialists, and its incorporation into MCH programmes is difficult.

Fact is that: Maternal Depression is the second-leading cause of disease burden in women worldwide, following infections and parasitic diseases

In the second article of a five-part series providing a global perspective on integrating mental health, Atif Rahman and colleagues argue that integrating maternal mental health care will help advance maternal and child health.

This can be achieved by collaboration between policy makers in mental health and those in MCH for action that will advance maternal and child health status. And by linking strategies to improve maternal mental health to broader development goals, including poverty reduction and gender empowerment.

 

Source: Grand Challenges: Integrating Maternal Mental Health into Maternal and Child Health Programmes

Inspiring African innovations: Perinatal Mental Health Project, South Africa [#WHD2017 Africa Blog Series]

This blog is part of our series celebrating World Health Day 2017. This year’s theme is Depression: Let’s Talk and we’re showcasing inspiring innovations addressing depression across Africa.

Source: [#WHD2017 Africa Blog Series] Inspiring African innovations: Perinatal Mental Health Project, South Africa | Mental Health Innovation Network

Every $1 invested in mental health yields $4 of value

Mental disorders affect up to 450 million people worldwide, and depression alone is one of the leading causes of disability. Stigma, inadequate funding, and poor healthcare systems prevent people from accessing much-needed treatment.


Photo: Basic Needs

This in turn has serious economic consequences, costing the global economy some US$2.5 trillion per year, an amount that is expected to increase to US$6 trillion by 2030. Yet funding for critical interventions remains scarce. Mental health is allocated less than two percent of health spending in most low- and middle-income countries.

Without action now, the social and economic impact of mental illness in the coming years will be huge.

A recent study found that every $1 invested in #mentalhealth yields $4 of value.

Source: Skoll World Forum

Perinatal Mental Health Toolkit

Perinatal Mental Health Toolkit by the Royal College of General Practitioners

Up to one in five women and one in ten men are affected by mental health problems during pregnancy and the first year after birth. Unfortunately, only 50% of these are diagnosed.


Photo: RCGP

Without appropriate treatment, the negative impact of mental health problems during the perinatal period is enormous and can have long-lasting consequences on not only women, but their partners and children too. However, this is not inevitable. When problems are diagnosed early and treatment offered promptly, these effects can be mitigated.

This toolkit provides a set of relevant tools to assist members of the primary care team to deliver the highest quality care to women with mental health problems in the perinatal period.

Source: Perinatal Mental Health Toolkit

Domestic violence during pregnancy

Domestic violence is any physical, sexual, psychological or economic abuse that takes place between people who are sharing, or have recently shared a home.

In Africa, there is more violence against women than on any other continent. Three women are killed by their partners in South Africa every day, thats twice as many women than in the United States of America. Violence during pregnancy has negative effects for both the mother and the child. Abused women are more likely to delay getting pregnancy care and to attend fewer antenatal visits.

Our recent research study looked at pregnant women who experience domestic violence in Hanover Park, Cape Town. We looked at the profile of women who reported domestic violence and what factors in their lives were associated with this abuse.

domestic_violence_during_pregnancy

We found that women who were experiencing domestic violence were more likely than those without domestic violence to:

– have a current mental health problem like depression, anxiety, suicidal thoughts or behaviours, alcohol or drug abuse

– have had past mental health problems
– have experienced past abuse
– not feel supported by their partner
– not likely feel pleased about being pregnant
– more likely experience food insecurity and not have a job

Out of this study with developed a learning brief which targets any service providers who interact with vulnerable women and children, especially those service providers who work with pregnant women. Such services providers can arise from nongovernmental organisations (NGOs) or civil society organisations and may be healthcare providers or social service providers.
Find this and more on our resources for professionals pages.

How can we screen for perinatal depression – globally!

Source: https://womensmentalhealth.org/posts/can-screen-perinatal-depression-developing-world/

While perinatal mood and anxiety disorders (PMAD) have a global footprint, the majority of research related to this group of illnesses has come largely from more affluent, Westernized countries.  Similarly, the tools used to detect and screen for PMADs were developed and tested in these Westernized countries.

The instrument most commonly used to detect PMADs is the Edinburgh Postnatal Depression Scale (EPDS), which was originally developed in Great Britain.  While it has been translated into many different languages and used in many different countries, it is unclear if these translated versions of the EPDS accurately identify PMAD in disparate, non-English speaking countries.  Specifically there has been concern that simply translating the EPDS may not fully capture the cultural determinants of mood and anxiety disorders.

Asian mother holds her newborn baby

Asian mother holds her newborn baby

Particularly vulnerable to mental health problems are the women who are pregnant or have recently given birth living in resource-constrained, low- and lower-middle-income countries (LALMICs) as defined by the World Bank.  A  recent systematic review appraised formally validated local language versions of the EPDS used in resource-constrained settings (Shrestha et al., 2016).

 

Mental health care ‘chronically underfunded’ in SA

Source: Mental health care ‘chronically underfunded’ in SA | University of Cape Town News

Mental health care in South Africa has been chronically underfunded for many years, which is reflected in inadequate care in primary clinics, community residential care facilities and acute mental health units in district and national hospitals, says Professor Crick Lund.

Lund, director of the Alan J Flisher Centre for Public Mental Health (CPMH) in UCT’s Department of Psychiatry and Mental Health, issued a statement in the wake of the Health Ombudsman Professor Malegapuru Makgoba’s report into the deaths of more than 94 mentally ill patients from Life Esidimeni in Gauteng.

Health Ombudsman Prof Malegapuru Makgoba’s report into the deaths of more than 94 mentally ill patients from Life Esidimeni in Gauteng elicited an outcry when it was released this week

Integrating mental health care into maternal and infant care can help low-income families

Integrating therapy, other services, or information into routine visits can make getting help easier and chip away at the stigma regarding postpartum depression.

Photo: Shuttershock Image: Shuttershock

Unlike the “baby blues,” which are commonly associated with mild feelings of worry and fatigue after having a baby, postpartum depression is a mood disorder characterized by a broad range of symptoms including anxiety, extreme sadness, and exhaustion.

Source: How Folding Mental Health Services Into Maternal and Infant Care Can Help Low-Income Families – Rewire

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