Poverty and mental health
A review to inform the Joseph Rowntree Foundation’s Anti-Poverty Strategy
“Poverty increases the risk of mental health problems and can be both a causal factor and a consequence of mental ill health. Mental health is shaped by the wide-ranging characteristics (including inequalities) of the social, economic and physical environments in which people live. Successfully supporting the mental health and wellbeing of people living in poverty, and reducing the number of people with mental health problems experiencing poverty, require engagement with this complexity. […]
Although mental health problems can affect anyone at any time, they are not equally distributed and prevalence varies across social groups.”
Although this policy review is based on UK data it is relevant for everybody working in the mental health sector
Perinatal depression and anxiety are serious mental health problems and are among the leading causes of maternal morbidity and mortality worldwide!
Pregnant women are at higher risk for suicidal ideation and behaviours compared to the general population.
Suicide has been identified as one of the major contributors to the global mortality burden and there is a growing concern over the increase in suicidal ideation and behaviour among pregnant women.
Studies in low- and middle-income countries put the rate of maternal death due to suicide at somewhere between 0.65% and 3.55%. In such cases, risk factors include poverty, lack of support, lack of trust in health systems and coexisting mental illnesses.
Suicidal thoughts experienced during pregnancy can continue beyond the initial postpartum period, affecting the well-being of both mother and child.
More about pregnancy and suicidal ideation in our infographic
“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 […]
Members of the Perinatal Mental Health Project (PMHP) presented to delegates at the International Marcé Society Biennial Scientific Meeting in Swansea and the World Congress of Psychiatry in Madrid last month. Here are some highlights and insights from our two presenters:
Presentation by Director, Simone Honikman
Simone was invited to speak about the PMHP as part of a symposium entitled “Born this Way: finding solutions to global challenges in Perinatal Mental Health”. The symposium convenor, Professor Carlos Zubaran, of the University of Western Sydney, had also arranged for speakers from Norway, Spain, Israel and Portugal to present. The PMHP presentation was unique in that our project was able to present solutions to high levels of depression and anxiety in contexts where resources are limited. The symposium was well attended, generated vibrant discussion as well as potential connections for future collaborations.
Read the abstract of the presentation ‘Maternal mental health and health service design‘ by Simone Honikman here: MMH_abstract
Presentation by Research Associate, Thandi van Heyningen
Thandi’s presentation was about screening for maternal depression and anxiety in a low-resource primary care antenatal setting in South Africa. She spoke about the use of various screening instruments as well as potential psychosocial risk factors. The results of this research from Hanover Park, have shown that a short, binary-scoring screening instrument that is easy to administer and score, performs as well as longer, more complex screening tools in detecting maternal anxiety and depression. The Whooley depression screen, which consists of two questions about mood symptoms and a third “help” question shows promise as a screening tool for the early detection of maternal depression and anxiety in these settings.
Read the abstract of the presentation: ‘Development of a mental health screening instrument for low-resource, primary-care antenatal settings in South Africa’ here: MentalHealthScreening_Abstract
Mental health leaders and advocates gathered in Geneva, Switzerland this past week as the “Preventing Suicide, A Global Imperative“ report was publicly released by the World Health Organization (WHO) after the WHO launched implementation discussions of the Global Mental Health Action Plan adopted by the United Nations 66th assembly last year. Today, leaders join together under a new group #FundaMentalSDG to advocate adding clear, measurable mental health targets to the United Nations Post Millennium 2015 development goals currently in development and about to be negotiated by UN member states, following the UN High-level Stocktaking Event on the Post-2015 Development Agenda in New York on 11 – 12 September 2014.
According to the report by WHO, suicide is preventable, mental health disorders are treatable, and yet because we don’t significantly address it we lose over 800,000 lives annually, it is the second leading cause of death globally for youth ages 15-29, and is estimated to cost the United States alone over 100 billion dollars every year. #FundaMentalSDG invites other organizations, institutions, and world leaders to unite by collectively asking the United Nations to include a specific mental health target and two indicators in this critical post-millennium agenda.
The #FundaMentalSDG group was developed as world leaders agree we must take a collaborative, multi-sectoral approach in elevating the work done in mental health. Dr. Shekhar Saxena, Director of the Department of Mental Health and Substance abuse, states in the Global Suicide Report: “This report, the first WHO publication of its kind, presents a comprehensive overview of suicide, suicide attempts and successful suicide prevention efforts worldwide. We know what works. Now is the time to act”.
The July 19th 2014 United Nations draft of the Post-Millennium Goals includes an overall Health Goal: ‘Proposed goal 3. Ensure healthy lives and promote well-being for all at all ages’. A recent Editorial in the British Medical Journal (BMJ) by Professors Graham Thornicroft and Vikram Patel, of King’s College London and London School of Hygiene and Tropical Medicine respectively, calls upon colleagues worldwide to include within this Health Goal the following specific mental illness target:
‘The provision of mental and physical health and social care services for people with mental disorders, in parity with resources for services addressing physical health.’
They also propose that this is directly supported by 2 indicators related to the WHO Mental Health Action Plan 2013-2020, adding that it is very difficult to achieve results without specific measurements:
- ‘To ensure that service coverage for people with severe mental disorders in each country will have increased to at least 20% by 2020 (including a community orientated package of interventions for people with psychosis; bipolar affective disorder; or moderate-severe depression).’
- ‘To increase the amount invested in mental health (as a % of total health budget) by 100% by 2020 in each low and middle income country’
According to Thornicroft and Patel’s article in the BMJ, there is compelling evidence to show that improved global mental health is a necessity for overall human and societal development. For example, “poorer mental health is a precursor to reduced resilience to conflict,” and not only that, “it is also a barrier to achieving the suggested goal for promoting peaceful and inclusive societies for sustainable development, providing access to justice for all, building effective, accountable and inclusive institutions at all levels.”
In a Policy Brief produced by #FundaMentalSDG entitled “Call to Action: The Need to Include Mental Health Target and Indicators in the Post-2015 Sustainable Development Goals”, it reviews the high prevalence of mental illness (1 in four people experience mental illness in their lifetime), the global emergency mental illness is causing insofar as human rights violations, stigma and discrimination, and the fact that mental illness can reduce lifespan by 20 years. Further, the brief points out that in low and middle income countries, up to 98 percent of people with mental health problems do not receive any treatment, as evidenced research proofs. Mental health has impact across the whole range of SDGs, and thus can be seen as a cross cutting issue.
#FundaMentalSDG is an initiative which aims to include a specific mental health target in the post-2015 SDG agenda. The initiative is committed to the principle that there can be no health without mental health, and no sustainable development without including mental health into the post-2015 SDG agenda. The #FundaMentalSDG initiative is led by the #FundaMentalSDG Steering Group, composed of leaders in the field of global mental health, drawn from a wide range of service user, caregiver, advocacy, policy, service delivery and research organizations.
To support the initiative, visit www.fundamentalsdg.org/show-your-support and take action today.
For more information, see
Sixty-seventh World Health Assembly
19–24 May 2014
The World Health Assembly is the decision-making body of WHO. It is attended by delegations from all WHO Member States and focuses on a specific health agenda prepared by the Executive Board. The main functions of the World Health Assembly are to determine the policies of the Organization, appoint the Director-General, supervise financial policies, and review and approve the proposed programme budget. The Health Assembly is held annually in Geneva, Switzerland.
Follow the discussion on Twitter: #WHA67
To view and download the main documents check WHO website
a multi-country study by the World Health Organization (WHO)
published in ‘BJOG: An International Journal of Obstetrics & Gynaecology’
Special Issue: Maternal and Perinatal Morbidity and Mortality: Findings from the WHO Multicountry Survey
Volume 121, Issue Supplement s1, pages 40–48,March 2014
Adolescent pregnancy was associated with higher risks of adverse pregnancy outcomes. Pregnancy prevention strategies and the improvement of healthcare interventions are crucial to reduce adverse pregnancy outcomes among adolescent women in low- and middle-income countries.
To access the full article go to the Wiley Online Library
.. despite Prevention of Mother-To-Child Transmission (PMTCT) success in South Africa
article by Keith Alcorn @ ‘aidsmap’
Read the final paragraph of this sobering article. The PMHP asks why are mothers defaulting their antiretrovirals or not engaging with care?
Could the fact that more than one third have depression or anxiety have anything to do with it? Providing the testing and treatment protocols is not be enough. The health system needs to address the distress experienced by HIV positive pregnant women.
For the full article go to aidsmap
IMPUMELELO Social Innovations Centre
“Innovative Strategies and Systematic Interventions to Improve Health-Care in South Africa”
on 14 March 2014
The Impumelelo Social Innovations Centre has been awarding innovation and best practice in various sectors aimed at improving the quality of life of the poor for 13 years.The PMHP will have the opportunity to present at the closing panel.
Watch Simone Honikman, the PMHP director’s, presentation
on You Tube (at 1h 38 min)
“In advance of International Women’s Day on 8 March 2014,
WHO is launching new guidance to help countries ensure human rights are respected in providing more girls, women, and couples with the information and services they need to avoid unwanted pregnancies.
An estimated 222 million girls and women who do not want to get pregnant, or who want to delay their next pregnancy, are not using any method of contraception. Access to contraception information and services will allow better planning for families and improved health.
The guidance recommends that everyone who wants contraception should be able to obtain detailed and accurate information, and a variety of services, such as counselling as well as contraceptive products. It also underlines the need for no discrimination, coercion or violence, with special attention given to assuring access to those who are disadvantaged and marginalized.”
via WHO Media Centre
Download WHO guidance here