The Perinatal Mental Health Project (PMHP) uses a stepped-care model and operates as below at its primary service site:
At their first antenatal booking at the maternity unit, women are screened for psychological distress and for risk factors for common perinatal mental disorders. Screening is self-administered in private and scored by nurses, and available in three local languages (English, Afrikaans and isiXhosa) and in French.
Pregnant women with psychological distress and/or at least three risk factors are offered referral to an on-site counselor for individual, face-to face counseling, which coincides with their antenatal visits. Where appropriate, counselors can refer women to a psychiatrist who attends the clinic twice a month, and to on-site services, such as HIV/AIDS peer counselors, social workers etc.
Counseling is provided by non-specialized health workers: sessions are client-centered and include techniques such as containment, psycho-education and problem-solving. At 6-10 weeks, counselors conduct telephonic or face-to-face assessments to evaluate women’s mood and whether further counseling is necessary. Women can receive counseling for up to one year postpartum.
In order to implement this model successfully, PMHP provides the following services:
Monitoring and supervision
All counselors receive weekly, individual supervision by the clinical services coordinator, a clinical psychologist, and attend a group meeting bi-monthly to debrief and receive on-going education from the clinical services coordinator.
PMHP also provides training and workshops to staff in order to attend to health workers’ emotional well-being, increase awareness of common perinatal mental disorders among health workers and equip health workers with empathic engagement skills.
Research and advocacy
PMHP operates complementary research and advocacy programs which act to refine and promote scale up of the service.