Perinatal Mental Health Project (PMHP)
In South Africa, one out of every three women experience depression during and after pregnancy. In addition, routine HIV testing during pregnancy has meant that many women learn their HIV status at a time when they are most vulnerable to mental health problems.
The Perinatal Mental Health Project’s vision is for all women to have access to routine mental health care during and after pregnancy as part of their regular maternal care. The Project has recognized a unique opportunity: during pregnancy, women access health services for their antenatal care on a regular basis. The Perinatal Mental Health Project (PMHP) partners with public maternal care services to provide a routine and integrated service at maternity units. The Project model increases the capacity of health workers to intervene when mothers are experiencing psychological distress.
Maternal mental illness is treatable. In low-income settings, strong evidence exists showing that child-focused interventions need to be combined with mother-focused interventions that target maternal mental health. Research also shows that mental health interventions improve antiretroviral adherence, antenatal care uptake, and the overall health of HIV-positive women.
- Maintain screening, counseling, and psychiatric services for pregnant and postnatal women who are vulnerable to mental illness, as part of an ongoing pilot program.
- Train a range of health workers to: build capacity; promote a supportive, empathetic service for pregnant and postnatal women; create demand; and advocate for roll-out of maternal mental health services in the public sector.
- Engage in research aimed at informing development of maternal mental health services on a broader scale and improvement of systems within the Project.
- Engage proactively with a range of stakeholders to advocate and contribute to the development of improved mental health policy and high-quality integrated practice.
- Enable the development of working networks within the health and development sectors and strategic use of media. These activities act to overcome stigma, encourage positive attitudes toward mental health issues, and strengthen the ability of these sectors to achieve the necessary change for maternal mental health service delivery.
- Provide mental health services to women in maternity settings, on site and free of charge. Service includes screening for mental illness and risk factors, providing counseling services and psychiatric services where necessary.
- Train health workers and other service providers to empower, affirm, raise awareness, and shift attitudes and practices toward supporting integrated maternal mental health care.
- Generate and disseminate iterative research that informs scale-up of service delivery in the broader context.
- Develop creative advocacy strategies for developing improved mental health policy and high-quality integrated services.
- The PMHP has screened 8,000 women, provided counseling to more than 1,200 women, and provided psychiatric consultation to over 100 women, all on site and free of charge at a maternity facility.
- In 2009, more women were screened, referred for counseling, and attended counseling sessions, despite increasing numbers of women attending for maternity care at the service site.
- Uptake of screening has improved. In 2009, the proportion of women who declined screening decreased by more than half (4% in 2009 compared to 11% for 2008).
- In 2009, Project counselors saw 254 new clients. The average number of sessions per woman remains steady at 2.3 per woman. The overall number of women referred and receiving counseling continues to increase. There was a 9% increase in the number of women who received counseling in 2009 over 2008.
- Of the 588 sessions provided during 2009 by the on-site psychologist, 85 were for women in the postnatal period. This is significant because there is very limited postnatal care in South Africa.
- To ensure uptake of maternal mental health services, a dedicated counselor is required to be on site. In low-income settings, women face many barriers to health care. Travel costs or time away from employment or child-care responsibilities often prevent women from accessing health care. However, most women in impoverished settings access health services more frequently during pregnancy. A full-time, dedicated counselor is more able to be flexible with appointments that coincide with antenatal appointments.
- Pregnancy is a particularly vulnerable time for women, especially those living in poverty. Abuse and violence increase during pregnancy, with the severity increasing as the pregnancy progresses. Local research has shown that women with HIV are more likely to experience abuse, and those that are abused are more likely to contract HIV. Treating mental illness has therefore been identified as an important intervention for mitigating the consequences of abuse. Unaddressed, consequences are far-reaching and intergenerational.
- A valid short mental health screening tool, suitable for low-resource, busy health facilities is necessary. The PMHP is conducting a study to develop and validate a short screening tool in 2010. It will also assess the impact of HIV testing and knowledge of HIV status on pregnant women’s mental health.