Category Archives: Substance abuse

We need sustainable solutions to deal with mental health treatment gap

On World Mental Health Day many have thought about mental health status in their countries and the treatment gaps all over the world.

Our blog focuses on articles and statistics around mental health care and in particular around maternal mental health care globally and in low- and middle-income countries.

“Mental health matters because it affects everyone”

“Around 30% of women in low-income countries and 10-15% in high-income countries have a significant mental health problem during pregnancy and after childbirth. And yet most of these women never get diagnosed or receive any treatment” Maternal Mental Health-Global Challenge

“South Africa needs sustainable solutions to deal with its mental health treatment gap, delegates heard at a roundtable discussion ahead of World Mental Health Day (WMHD) – “Economy, Equality and Access to Mental Health Services” Close the mental health treatment gap

“The mental health of pregnant women can be affected by a range of factors, including partner violence and unemployment. But one of the key drivers that adversely affect a pregnant woman’s mental health is food insecurity. Being food insecure is when someone doesn’t have food or has the wrong kinds of food.” How hunger affects the mental health of pregnant mothers

Image: Robin Hammond

“Lack of food security is driving depression, anxiety and suicidal behaviour in poor communities” How hunger erodes mental health

“From OCD to suicide and depression, these numbers will alarm you.” (South Africa focus) 10 Mental Health stats South Africa

“South African children may be affected by a myriad of traumas. According to the South African Journal of Psychiatry, children and adolescents can suffer from post-traumatic stress disorder (PTSD) after being exposed to a range of traumatic events.” Here’s how the Sesame Street’s Muppets help kids

“Crisis issue needs to be priority among developing nations” Mental health treatment a human right

“World Mental Health Day: the need for conversations on the subject in India is as strong as ever, because despite a start, not enough of them are taking place.” A poignant series of films relates the stories of people who fought and won

Sick link between hunger and mental health – linking food insecurity and mental health.

“Future actions should focus on better identification of people in vulnerable situations who may require specific support including people experiencing mental distress, early intervention and culturally appropriate mental health training for all frontline staff.” Mental health is not the problem, it’s the solution

“Children whose mothers are depressed during pregnancy have a small increased risk of depression in adulthood, according to a UK study.” Depression risk ‘starts in the womb’

“What more needs to be done to make mental health care a reality for people worldwide.” Making mental health a cultural priority

“Mental health needs a new narrative. citiesRISE is a global platform committed to transforming the state of mental health policy and practice in cities and beyond to meet the mental health needs of populations across the world.” citiesRISE new website



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



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.


– Teenage pregnancy

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

Impact of maternal depression and anxiety on child development

A number of new studies have found that stress, depression or anxiety during and after pregnancy can have long lasting effects on the development of your child.

We have translated some of those findings into an Issue Brief and added some of our recommendations for evidence based interventions for parents.

maternal mental health care

This Issue Brief outlines not only the risk factors for parents, but also encourages the building of resilience to prevent or lessen the negative impacts for children.

caring for the future

“Caring for mothers and fathers – is caring for the future”

Intimate Partner Violence (IPV) during pregnancy

Prevalence and Risk Factors in South Africa

Violence against women is a global problem which exacts a high burden of suffering on millions of women and families, including women who are pregnant and postpartum.

In South Africa, studies have shown that 36-40% of pregnant women experience physical IPV, while 15-19% experience sexual IPV.

In this vulnerable population, IPV is associated with a range of physical and mental health consequences for the mother including pregnancy loss, depression and post-traumatic stress disorder.

South African data have suggested a direct link between violence and HIV infection, where HIV-positive women are more likely than HIV-negative women to have experienced physical violence perpetrated by their partner. Alcohol and other drug use have been identified as another risk factor for IPV during pregnancy, as intoxication may lead to irresponsible behaviour such as violence

In South Africa, the mortality rate attributed to IPV is the highest globally and is double that of the United States. For the infant, there are increased risks associated with preterm delivery and low birth weight.

Read our policy brief on violence against women in South Africa and how to break the cycle on our website


A midwife in the making volunteering in South Africa

Guest Blog by Jill Davies, student midwife from the UK studying Midwifery (BSc) at the University of Bradford

In January 2015 I was researching perinatal mental health online for my extended literature review when I came across the PeriJillnatal Mental Health Project website. As in many countries, mental health within maternity care in the UK receives little attention. Services within the NHS are restricted by limited funding, and whilst improved in recent years the stigma related to poor mental health in pregnancy still impacts on many women’s decision to disclose their concerns. This had fuelled my interest in the topic and a desire to improve the psychological care and support we offer women as midwives.

The PMHP’s background in research meant that the website provided a valuable resource, not only for my academic work but also in practice. The wide scope of the project, supporting both screening and counselling for women in pregnancy, as well as training for healthcare professionals was very inspiring. With the opportunity to arrange an elective placement at the end of my final year I contacted PMHP counsellor Bronwyn Evans to see if it would be possible to join the PMHP team for this placement and was very happy when they agreed. So in July 2015 I departed for Cape Town to join the team for a 4-week placement excited to find out more about the project and maternity care in South Africa.

My time with the PMHP team presented a wide range of opportunities to develop my knowledge of the issues effecting the mental health of women in South Africa, how healthcare staff can support women, and how their own mental health is important in providing compassionate care. I was able to attend a couple of training sessions held with both hospital healthcare providers and community support workers. Observing the PMHP ‘secret history’ training provided a though-provoking insight into the challenges midwives and nurses face in their own lives and how these can impact on and influence the care they provide to women. It was interesting watching the staff enthusiastically taking on the role of the woman and advocating for her needs, then whilst acting as the ‘Sister’ reflecting on occasions when their own emotions and personal situation had influenced the way they had cared for a woman.

As well as training and clinical services, research is an important program for the PMHP. The team recently conducted research into the factors that affect women who use alcohol and other drugs in pregnancy. I was set the task of interpreting the academic research into non-academic publication and interviewing the PMHP counsellors to identify evidence-based recommendations for health and social care workers. The information has been condensed into an issue brief providing a summary of the research findings and recommendations. From this task I was able to develop my understanding of the research process and writing for publication, as well as developing my own confidence in engaging women who use alcohol and drugs in maternity care.

I would like to thank everyone at the Perinatal Mental Health Project for making my elective placement such a fantastic experience. In a country where an estimated 1 in 3 women experience a common mental health disorder such as anxiety or depression during the perinatal period (compared to 1 in 10 women in the UK!), it was incredibly inspiring to see the hard work and innovation they are using to improve the lives of so many women. I will take their energy and passion for perinatal mental health care back to the UK and share this with colleagues to consider how we can improve care in maternity services.

You can find out more about the PMHP on our website:

You can read the mentioned Issue Brief on our resource pages here

You can also follow us on Twitter @PMHPatUCT

Women using alcohol and drugs in pregnancy are often influenced by other difficulties in their lives.

Issue Brief

Alcohol and other drug use in pregnancy

This issue brief was developed as a result of a recent research study looking at alcohol and other drug (AOD) use among pregnant women at Hanover Park (Cape Town, South Africa).

In this study we looked at the profile of women who were using AOD and what factors in their lives were associated with alcohol and drug use. We then interviewed our counsellors to get a better understanding of how they recognise women who are AOD users, and what they do to help them.

This brief summarises some of the findings, such as risk factors, implications for women and advice for healthcare workers to support pregnant women using substances.


(Graph: Risk Factors relating to women’s use of alcohol and other drugs during pregnancy)

“Alcohol and other drugs (AOD) use among pregnant women is associated with poor health outcomes for mothers and children during and after pregnancy. Frequent AOD use has also been linked with low weight gain during pregnancy, less fetal growth, and premature birth. 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.”

Read our latest issue brief here
Interested in other issues relating to pregnancy? Find more briefs on our research pages here.

New and exiting opportunity to join the PMHP team

The Perinatal Mental Health Project (PMHP) requires the services of a Research Officer / Senior Research Officer. This is a full time post for a one year contract with appointment, starting as soon as possible. The appointee will be based at the PMHP offices on UCT’s Sawkins Road campus, but may need to travel locally, nationally and internationally.

Qualifications required:

  • Masters degree in Public Health or Psychology (or similar training and skills set).
  • Track record of publications in peer-reviewed journals
  • Thorough working knowledge of statistical packages for data analysis and ability to interpret results 

Additional qualification required for Senior Research Officer:

  • PhD in relevant discipline (e.g. Public Health, Psychology, Development studies
  • Evidence of successful research grant awards
  • Experience in liaising with international researchers and programmes
  • Experience of research project management

The main purpose of this position is to:

  • Co-ordinate PMHP research activities
  • Contribute to other research projects with which the PMHP partners
  • Pursue research grants for the PMHP

Find more details and how to apply at the UCT Vacancy pages

Alcohol and Other Drug Use during Pregnancy among Women in the Cape Metropole, South Africa

Use of alcohol, illicit drugs and other psychoactive substances during pregnancy can lead to multiple health and social problems for both mother and child, including miscarriage, stillbirth, low birthweight, prematurity, physical malformations and neurological damage.

But only little is known about the nature and extent of alcohol and other drug (AOD) use among pregnant women in Cape Town, South Africa.

According to this research article there are high levels of substance use among pregnant women attending public sector antenatal clinics.
And there is a need for routine screening for AOD use and appropriate responses depending on the women’s level of risk.

Read the full open access Research Article

Alcohol and Other Drug Use during Pregnancy among Women Attending Midwife Obstetric Units in the Cape Metropole, South Africa

by Petal Petersen Williams et al


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