Breaking the negative cycle of mental ill-health and poverty during the perinatal period

The negative cycle of mental ill-health and poverty is particularly relevant for women and their infants during the perinatal period. During this time, major life transitions render women more vulnerable to mental illness from social, economic and gender-based perspectives.

Those with the most need for mental health support, have the least access. Overburdened maternal and mental health services have not been able to address adequately this significant unmet need. There have been limited attempts at a programmatic level, to integrate mental health care within maternal care services.

The perinatal period, where women are accessing health services for their obstetric care, presents a unique opportunity to intervene in the event of mental distress. Preventive work involving screening and counselling may have far-reaching impact for women, their offspring and future generations.

Mental health care is a notoriously neglected area – even more so in “healthy” pregnant and postnatal women. The focus on the physical to the detriment of the emotional is particularly felt now against the backdrop of HIV and AIDS. The public health service has been unable to address the mental health needs of women from poorer communities – neither within maternity services nor within mental health services. This is despite a wide body of evidence showing that distress in the mother may have long-lasting physical, cognitive and emotional effects on her children.

Integrating mental health into maternal care in South Africa

The PMHP aims to integrate mental health service routinely, within the primary maternal care environment.
Based at selected government MoU facilities in Cape Town, we offer counselling and support services focused on the emotional wellbeing of pregnant women with a strong focus on postnatal and clinical depression.

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Psychological Treatments for the World: Lessons from Low- and Middle-Income Countries

A recent systematic review and metanalysis reported that psychological treatments for common mental disorders in a range of primary care settings in LMIC, and delivered by non-specialist providers, had moderate to strong effects in reducing the burden of these disorders. Notably, 12 out of the 27 eligible randomized controlled trials took place in maternal or reproductive service settings. 

A key finding relates to the analsysis of ‘nonspecific’ therapeutic elements, called ‘engagement elements’ which includes collaboration, empathy, active listening, normalization, Involving significant other/family. These elements predicted trial effectiveness independently of and comparably to specific elements, e.g. interpersonal, cognitive and behavioural (Singla et al. 2017). This provides critical support to PMHP’s hypothesis that maternity care staff may meaningfully employ empathic engagement skills to reduce the effects of common mental disorders in their clients.

Find this and more relevant research here: http://pmhp.za.org/resources/for-researchers/

Perinatal mental health: Fathers – the (mostly) forgotten parent

dads mental healthIntroduction

The importance of parental mental health as a determinant of infant and child outcomes is increasingly acknowledged. Yet, there is limited information regarding paternal mental health during the perinatal period. The aim of this review is to summarise existing clinical research regarding paternal mental health in the perinatal period in various contexts, and its possible impact on infant development.

Results

Men are at increased risk of mental health problems during the transition to fatherhood, as well as during the perinatal period. Paternal mental health during the perinatal period has been shown to impact on their child’s emotional and behavioural development. However, research addressing the needs of fathers with mental illness and the impact of their illness on their infant and family has been limited.

Conclusion

A paradigm shift is required, from a focus on women following childbirth and women with pre-existing psychiatric disorders to a broader family perspective with the focus firmly on parent-infant relationships. This paradigm shift needs to involve greater research into the fathering role and paternal mental illness during the perinatal period, including further studies into risk factors, impact on the family system, and the most appropriate form of intervention and service provision.

The full research review is available on Wiley Online Library

In our resource library, you can find information for future fathers in four different languages

EnglishisiXhosa • Afrikaans • French

MMH campaign summary and other news from the PMHP

Want to know how the Maternal Mental Health awareness campaign went this year?

Or want to check out our latest resources and developments in and around the PMHP?

Read our latest newsletter here

International Day of Action For Women’s Health: Ensuring Respectful Maternity Care

Crosspost from Maternal Health Task Force blog by Kayla McGowan, Project Coordinator, Women and Health Initiative, Harvard T.H. Chan School of Public Health

“As we celebrate International Day of Action for Women’s Health on May 28, we reflect on the physical, emotional and psychosocial dimensions of women’s health as well as the reasons to support girls’ and women’s health throughout the lifecycle.

With Sustainable Development Goal (SDG) 5 calling for an end to all forms of discrimination against all women and girls everywhere, the elimination of all violence against women and girls and universal access to sexual and reproductive health and rights by 2030, now is the time to draw attention to the many elements of and impediments to women’s health and rights […]

Read the full blog entry: International Day of Action For Women’s Health: Ensuring Respectful Maternity Care | Maternal Health Task Force

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

Written by: Meagan Dill, PMHP volunteer

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

 

 

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