Problem: What problem is this project trying to address?
The World Health Organization predicts that globally, unipolar depression constitutes the third highest burden of disease. (WHO, The global burden of disease: 2004 update). About one third of pregnant women living in South Africa experience a common mental disorder (depression or anxiety) - more than double the prevalence reported in developed countries (Hartley et al, 2011; Rochat et al, 2011). There is extensive evidence on the adverse effects of untreated common perinatal mental disorders (during pregnancy and the first year following child birth) on the mothers’ health, as well as on the health and development of their children (Meintjes et al, 2010). Stigma and poor mental health literacy mean that very few women seek mental health care, even when mental health services are available (Saxena et al, 2007).
In South Africa, approximately 75% of individuals suffering from a common mental disorder do not receive any form of mental health care (Seedat et al, 2008). In part, this is linked to the shortage of mental health specialists in the country, with only 7% of psychologist working in the public health sector (Day & Gray, 2011). Further, health workers in maternity settings have low mental health literacy and hold stigmatizing attitudes towards those with mental illness (Rahman et al, 2013). Yet, these health workers are the primary interface between vulnerable women and health care. Current health worker training in South Africa does not adequately equip nurses to manage emotional wellbeing, nor are they equipped to manage the stress they experience in the professional setting, with little or no support available to them. It is well documented in South Africa, that health staff is often emotionally and physically abusive towards women in sexual and reproductive health services, especially during labor (Jewkes et al, 1998; Kruger & Schoombee, 2010). With healthcare services already strained by chronic diseases, limited infrastructure and lack of resources, the problem is exacerbated by understaffing, poor training and low morale among health workers.
Mental illnesses result in a range of negative consequences for the mother, the baby and the community at large. Mental illnesses in pregnant mothers increase their vulnerability to abandoning their babies, suicide (especially in teenagers),, substance abuse, HIV infection, the loss of employment, complicated pregnancies, reduced baby-mother bonding and infant malnutrition, diarrheal disease and mortality. Studies indicate that about 80 percent of infants in children’s homes in Western Cape were abandoned and about 2,000 babies were abandoned in Johannesburg between 2007 and 2010 (Child Welfare South Africa, 2010). Furthermore, depression in pregnant women is associated with lowered adherence to antiretroviral medication and poor use of antenatal care, thus exposing both the mother and the baby to additional health risks (Journal of Affective Disorders, 2011).
Although mental healthcare is attracting more attention, maternal mental health still remains ignored in most developing countries. About 95 percent of pregnant women in South Africa obtain antenatal care from public health facilities. However, these are not adequately resourced to incorporate mental healthcare in their services. In addition, health care workers have low levels of knowledge and skills for addressing common mental illnesses and generally hold the view that only psychiatrists can treat these cases. Moreover, because of this misunderstanding and their challenging working conditions, these health workers can often be impatient and aggressive towards pregnant women. The lack of knowledge about mental illness is also prevalent at the community level, and people displaying symptoms of mental health illnesses are stigmatized and thought of as “crazy people” who are of less value to society.
Solution: What is the proposed solution? Please be specific!
Pregnancy and the postnatal period is a psychologically distressing period for many women, particularly those facing other social challenges in their lives like poverty, gender-based violence and HIV/AIDS. The burden of maternal mental illnesses (including pre and post-natal depression and anxiety) in low-income communities is very high. When they are left untreated, the results can be fatal and contribute to maternal mortality and poor maternal and child health. In response to this problem, Simone started the Perinatal Mental Health Project (PMHP), which was registered in 2008 as a fully operational nonprofit organization. PMHP’s vision is to ensure that all women have access to high quality perinatal mental health care (during pregnancy and one year after delivery) as a regular service integrated into the public health system.
Simone’s idea is built on four main components (screening, counseling, referral and training), which together form the foundation of an innovative model for maternal mental healthcare. Based on strategic partnerships with public healthcare centers, the model ensures that 100 percent of women visiting public hospitals for ante and post-natal healthcare get access to maternal mental healthcare as well. Thus, PMHP’s activities are physically and operationally embedded into healthcare centers to ensure a holistic perinatal healthcare package through public health institutions. The screening process is done hand in hand by PMHP and the healthcare center’s midwives and nurses who are specifically trained by PMHP to understand the symptoms and risk factors for maternal mental health illnesses. Those women identified as ‘at risk’ or who present symptoms of mental health illnesses are referred for counseling that is provided by professional counselors employed by PMHP. This is structured to provide individualized emotional support and enable the patient to understand the context of her mental health problems and explore practical solutions for coping with them. This ensures the patient has the right mindset, knowledge and support system to deal with risk factors in the environment and the symptoms of mental health disorders.
Simone understands that there are different social problems that either cause, or make pregnant women vulnerable to, mental health illnesses in poverty stricken communities. Consequentially, PMHP has developed partnerships with various public and citizen sector organizations (HIV/AIDS clinics, psychiatrists, religious and community leaders, gender-based violence organizations, various alcohol and drug support groups) that refer the patients that need assistance to PMHP. This referral renews the patients’ hope because they understand that there is practical help available to them.
The model also includes a training component in addition to the screening, counseling and referral system. Simone trains health care workers (public, private and students) on perinatal mental health issues and how they can be effectively dealt with. Furthermore, through research and advocacy, Simone creates awareness of the existence of perinatal mental health illnesses and how they can be dealt with in communities and within healthcare departments. PMHP currently works directly in four public obstetrics healthcare centers in the Western Cape, reaching almost 55,000 pregnant women. Furthermore, Simone has developed operational guidelines that she uses to train other public healthcare centers in South Africa and beyond (Malawi, Zimbabwe, Zambia, Mozambique and Lesotho) to adopt her model and incorporate it into their systems. This ensures rapid scaling even without PMHP’s physical presence.