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
Emerging evidence suggests that integrated approaches to mental health can help to support improved performance across the wider health system.
- 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.
- 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
Crosspost from World Maternal Mental Health day blog by Josee Grenier
In my experience through Postpartum Depression and Anxiety it felt like every fear and trauma I had ever experienced was fresh in my mind. It’s like PPD’s ugly hand had reached deep into my heart in the ‘trauma’ area and just started pulling at things and ‘stirring the pot’.
I remember some days just laying on the couch completely exhausted from the onslaught of painful thoughts and emotions. I felt like someone also pushed the ‘off’ switch on all my filters and coping skills. I had zero ability to sort through or process all the thoughts and emotions I was experiencing. I remember spending a lot of time trying to process every thought and feeling as though I could solve this problem through understanding my feelings. It was exhausting and often it would make my anxiety so much worse. It also felt like unless I could miraculously heal from every trauma I had ever experienced, I would never be OK.
I felt like I must be experiencing all of this emotional distress because I had done something wrong or had neglected to do something good. I felt broken and like there was no hope that I could ever ‘fix’ this. […]
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.
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.
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.
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
Women’s Voices – Maternal Mental Health
The Royal College of Obstetricians and Gynaecologists (RCOG), supported by the Maternal Mental Health Alliance (MMHA), have published a survey Women’s Voices – Maternal Mental Health which highlights the urgent need to improve maternal mental health-care.
The survey of over 2,300 women who had given birth in the last five years in the UK, explores their experiences of perinatal mental health problems, engagement with healthcare professionals and the quality of care they received. It reveals the impact of low rates of specialist referral, long waits, as well as lack of consensus over medication and little support for their partners.
The results present a stark picture of how services are letting down some of the most vulnerable women in our society, and provides key recommendations for healthcare professionals, managers, providers, commissioners and policy-makers.
– Women reported experiencing low rates of referral, long waits, regional variation of care, a lack of continuity of care, misunderstanding and stigma
– The mental health of women’s partners is also often neglected by healthcare professionals and services
Source: RCOG survey women’s voices
Download the RCOG survey
Download the RCOG infographic
The most common mental health condition to affect perinatal women and mothers worldwide are depression and anxiety.
These illnesses impact thoughts, feelings and behaviours.
Routine antenatal and postpartum health services provide an opportunity for heightened and psychologically informed mental health care. Even in the poorest countries, there is some provision for antenatal, perinatal, postpartum, and infant health care and other primary health care services.
Interventions to improve maternal mental health and related child survival, health and development can be integrated into these existing services.
At the PMHP service delivery sites, we provide routine screening for pregnant women and girls for depression and anxiety at the first antenatal visit. If they show signs or are at risk of depression or anxiety, free on-site psychosocial counselling, follow-up and case management is provided by our trained counsellors for up to one-year post delivery.
The PMHP model is based on a stepped care approach, which means that referrals are made to psychiatric services when necessary
Learn more about our integrated, stepped-care, collaborative service model, implemented through task sharing.
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:
- 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.
- 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.”
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.
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
To commemorate International Youth Day we advocate for better mental health for vulnerable teenagers
Across the world, developing countries are making progress in tackling the HIV epidemic. According to UNAIDS, in 2012 South Africa registered more than 450,000 new HIV infections, a significant drop from the 640,000 new infections registered in 2001. They’ve achieved this radical progress through the provision of antiretroviral therapy (ART) to more than 2.4 million people.
The ‘New Beast’: Mental Illness Among People Living with HIV
In South Africa, 38% of people living with HIV have a common mental health disorder. This is more than triple the incidence of mental health conditions for the general South African population. What’s shocking is that in this era of ART, increased advocacy, and knowledge of the condition, there has not been a decrease in prevalence of mental illness in people living with HIV, but a two-fold increase.
Depression, anxiety and other mental health disorders are of particular concern in patients with HIV because they can lead to:
• Poor treatment adherence
• Lower CD4 counts
• Increased viral load
• A greater chance of developing drug-resistant strains of HIV
Source: Mental Health Innovation Network
HIV and Maternal Mental illness
The enormous emotional strain of living with HIV, including its social and financial consequences, makes women vulnerable to depression and anxiety. On the other hand, those women with mental illness are more vulnerable to becoming HIV positive. A depressed woman is less likely to be able to negotiate safe sex due to low self-esteem, a sense of hopelessness or financial dependency.
Women at risk
• HIV+ mothers are particularly vulnerable to mental illness during and after pregnancy
• Mental illness affects how women use maternity, child health services and HIV services
• Mental illness has been found to have negative impacts on how HIV+ women adhere to their own and their child’s HIV treatment
• Mental health support and social support for HIV+ mothers is vital for the general health of women, their babies and families
Read more on the subject in our Issue Brief
Teenage pregnancy and mental illness
Approximately 30% of teenagers in South Africa report ‘ever having been pregnant’, the majority, unplanned. The likelihood of a subsequent teenage pregnancy nearly doubles when adolescent mothers suffer from depression.
Adolescents at risk
• Adolescents who become pregnant are more likely to have relationships that are coercive and abusive
• They are more likely to have had a forced first sexual experience, or physical or sexual abuse, and tend to experience a loss of support from family, friends or school
• They are also more likely to engage in high risk sexual behaviour or be using substances and alcohol
• Adolescent and young pregnant women are at increased risk of mother-to-child transmission of HIV
Read more on the subject in our Issue Brief