[#WHD2017 Africa Blog Series] Inspiring African innovations: Perinatal Mental Health Project, South Africa

This blog is part of our series celebrating World Health Day 2017. This year's theme is Depression: Let's Talk and we're showcasing inspiring innovations addressing depression across Africa.

MHIN Africa innovation on depression 1: The Perinatal Mental Health Project (PMHP)

PMHP is a collaborative, stepped-care model featuring counseling for mothers with mental health problems by non-specialist health workers.

Tell us about your country’s context and the circumstances that inspired your innovation

The World Health Organization (WHO) states that depression is the leading cause of disability as measured by Years Lived with Disability (YLDs) and the fourth leading contributor to the global burden of disease. In South Africa, approximately 75% of individuals suffering from a common mental disorder do not receive any form of mental health care. In part, this is linked to the shortage of mental health specialists in the country, with only 7% of psychologists working in the public health sector.

About one in five pregnant women living in South Africa experience a common mental disorder (depression or anxiety) - more than double the prevalence reported in developed countries. There is extensive evidence on the adverse effects of untreated common perinatal mental disorders (during pregnancy and the first year following child birth) on mothers’ health, as well as on the health and development of their children. Stigma and poor mental health literacy mean that very few women seek mental health care, even when mental health services are available.

The Perinatal Mental Health Project (PMHP) was founded to address the crisis of mental disorders among pregnant & postpartum women and girls from some of the most disadvantaged communities in Cape Town. These mothers face extreme hardships, experience multiple, severe traumas and have little or no support.

The PMHP innovation is to address the high prevalence of perinatal mental disorders and the shortage of mental health specialists in South Africa, by integrating maternal mental health care into routine antenatal and postnatal health care, through the use of a collaborative stepped-care approach, task-sharing strategies and training of care providers.

What aspect of your project are you most excited about? How is the project innovative or unique

Our integrated approach is unique in that mental health care is typically regarded as a specialist, vertical component of healthcare and is thus inaccessible to those with common mental disorders who may not overtly manifest the symptoms or associated functional disabilities.

The PMHP approach is novel because it integrates physical and mental health care in primary maternity care settings, at a point when the majority of women access health services. It provides preventative as well as curative care, and routine integration allows women to access care without their incurring the additional costs of extra appointments and without exposure to stigma.

Have you noticed an impact ‘on the ground’? What is the best feedback you have received (from service users, team members, or otherwise)?

The direct beneficiaries of our service program are pregnant and postnatal women using the public healthcare service. A prior service user currently sits on our advisory board and is involved in strategic planning and advocacy work for the PMHP. Some of the mothers’ stories and feedback can be accessed on our programmes page: Mothers Stories

The beneficiaries of our training and development program include health and development workers in in-service training; undergraduate and postgraduate courses at tertiary institutions and in the non-governmental sector. The PMHP usually conducts needs assessments with members of organizations for whom we provide training. Training participants are routinely surveyed for their opinions of the content and form of PMHP training. Some of the participants’ feedback can be accessed on our website:

What’s next?

Replication in other settings:

The PMHP is currently providing services in three community maternity units in and around Cape Town. The monitoring and evaluation data from these sites have generated several new health systems lessons. However, in South Africa, the availability of resources and the quality of health care vary quite substantially between rural and urban areas. As all of the current PMHP sites are situated in urban areas, there is a need to field test the service in a rural site. This will provide the opportunity to evaluate the stepped-care approach and service model in settings where fewer resources and different challenges exist.

To our knowledge, the PMHP is the only example of its kind in South Africa. However, there are similar models that have been tested and are operational in high income settings. Some of the elements used in the PMHP service model have been evaluated in other low- and middle-income countries. These include: a stepped-care approach in Chile, the use of non-professional health workers to provide a mental health intervention while providing routine maternal and child care in Pakistan, and the use of brief psychological interventions in India.

What is the one message about depression you want people to take away from your innovation

Mental health problems don't discriminate and neither should we – depression can be experienced by anyone, anytime. Depression can lead to unhealthy behavioural changes and depression during pregnancy is no exception. As a result, the children’s growth and development may be negatively affected as well. But maternal mental disorders are detectable and treatable. Integrated maternal mental health care provides the necessary support to empower women to identify resources and personal capabilities. This can enhance their resilience to difficult life circumstances and support them to nurture their children optimally. Caring for mothers is a positive intervention for long-term social development.

For more African innovations featured in this series, please visit the [#WHD2017 Africa Blog Series].

Maternal and neonatal health
Primary care
Task sharing
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