The PMHP model aims to identify those women at risk or currently experiencing symptoms of depression and anxiety at our service sites.
When women book for maternity care, mental health screening is offered as part of their regular care. This is voluntary, and women have the option to decline screening. Overall, the PMHP aims for 80% screening uptake. About 30% of women attending the PMHP service sites screen positive for psychological distress.
What is ‘screening’?
Screening is a strategy used to detect an illness in a large group of individuals, such as mothers attending antenatal clinics. Mental health screening is usually done using a questionnaire. If someone screens positive (above a cut-off score), it is likely that she has mental illness, but this is not definite.
If someone screens negative (below cut-off score), it is likely that she does not have mental illness, but this is not definite. Your certainty in either case depends on the screening tool used and the population being screened. A mental health diagnosis can only be made by a mental health professional or by a diagnostic assessment.
The PMHP screens women for the common mental disorders (depression and anxiety) at their first antenatal visit.
Read more about screening in our handbook here.
The screening process
With their written consent, women are offered the mental health screen by nurses, midwives or counsellors in the context of routine history taking at the first antenatal visit. The tools have been formally validated in the South African context.
- Screening questionnaires are administered in private.
- Staff provide assistance when necessary.
- Questionnaires are available in the 4 most commonly spoken languages among PMHP beneficiaries: English, Afrikaans, isiXhosa (local languages) and French (due to a significant refugee population attending the facilities in the Western Cape).
- Questionnaires are scored by the screeners according to protocol for each site.
- Women are offered referral for counselling if scores meet the cut-off on the questionnaires.
Browse the screening tools we use here.
Screening coverage refers to the proportion of women booking at the maternity clinic who participated in mental health screening. The PMHP’s screening coverage over time is reflected below:
- 2015: 90%
- 2014: 95%
- 2013: 91%
- 2012: 83%
- 2011: 81%
- 2010: 92%
- 2009: 89%
- 2008: 84%
- 2007: 77%
Find more details on our monitoring pages here
Screening as the entry-point to accessing mental health care
In South Africa, the Edinburgh Postnatal Depression Scale (EPDS) has been validated to screen for maternal mental illness. The PMHP uses this as well as a questionnaire on risk factors for distress. However, these are long, cumbersome questionnaires, and staff in busy clinics do not find them easy to use.
The PMHP identified this as a major obstacle to providing mental health care. The PMHP is addressing this challenge by developing and field testing a brief risk factor screening tool at its Hanover Park site.
Read more about this short mental health screening tool in our Policy Brief here
The PMHP offers a solution to a clinical conundrum. The Project’s research has taken technologies, questionnaires and methods of diagnosis that have been developed around the world and that are not appropriate for an African context, has adapted them, is evaluating them, is testing them through research programmes, and I believe will create instruments that will be useful across the continent. The project also fulfills UCT’s promise to answer the needs of local communities. What better way of doing that than moving out of the ivory towers at the foot of Devil’s Peak, and into Hanover Park and other communities.
Dr Max Price
University of Cape Town
– At the launch of the PMHP service site at Hanover Park Midwife Obstetric Unit