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