Maternal mental illness can be addressed: it is predictable, identifiable, treatable and in many cases, preventable.
Maternal mental health interventions are critical not only because of the high level of need, but because of the preventative and protective impact they have on the social, economic, political and health inequalities faced by women. A significant body of evidence demonstrates the benefits for mother, child, family and society of integrating maternal mental health services into the primary care setting.
Ongoing monitoring and evaluation shows that problems relating to primary support, social environment and lifestyle transition are most commonly reported by distressed women during pregnancy.
Statistical analysis of client logs and counselling data at the postnatal follow-up assessment shows that, on average clients report
that their main problem is ‘much improved’ or ‘resolved’ after counselling
successful bonding with their baby
view their life as positive after counselling
Key clinical services outcomes
Since inception up until the end 2016 the PMHP has
mothers in distress
Promoting maternal mental health has benefits across sectors
Maternal, reproductive and infant health
- Promotes optimal access to health and social services by vulnerable groups of women and girls, which improves functioning, capabilities and quality of life
- Promotes positive obstetric outcomes
- Promotes successful and longer breastfeeding, which in turn prevents diarrhoea episodes and improves mother-infant bonding
- Promotes completion of infant immunisations
- Reduces rates of infectious illness and hospital admissions
- Increases resilience, agency, and care-giving capacity of mothers living in poverty
Early childhood development
- Mental ill-health can compromise parental functioning and care-giving capacity which is central to child development. The ‘1000-day’ window from conception to two-years is a particularly sensitive period in child development and maternal mental health interventions are protective, preventative and promotive of optimal infant, child and maternal health outcomes.
- Mental wellness in the primary caregiver is associated with better development in children, as well as better nutrition. Under-nutrition is the single most deleterious determinant of poor child development – a factor also strongly linked to children’s diminished mental health.
- A mother with positive self-esteem and an ability to work towards a better future will better be able to negotiate the hardships in her life, care for herself and optimally nurture the development of her children.
- Prevents default and improves adherence to ARV (and TB) treatment regimens
- Immune status improves when depression and anxiety is managed
- Promotes optimal PMTCT outcomes
Addressing gender-based violence
When women are listened to and validated in a safe and therapeutic environment they begin to restore their self-esteem and locus of control. Women may be empowered to identify what actions they can realistically take to change their circumstances.
- Provides the necessary support to empower women to identify resources and personal capabilities; this enhances resilience to difficult life circumstances and supports them to nurture their children optimally
- Improves outcomes related to MDG 4: reduce under-five mortality, MDG 5: improve maternal health and MDG 6: combat major diseases such as HIV/AIDS and TB.
- Reduces general health care costs through early detection and referral of mental health problems
- Increases rate of return of investment in human development and requires less investment for interventions timed at later stages
Public Health Sector
- Prevents nurse abuse of clients in maternity settings and promotes empathic care in supportive maternity environments
Addresses upstream causes of ill-health and burden of disease
- Contributes to achieving Department of Health objectives as outlined in the Mental Health Care Act (2002), the Primary Health Care Re-engineering Plan, the Comprehensive Service Plan for the Implementation of Healthcare 2020 and the Negotiated Service Delivery Agreement
- Addresses the gap in maternal mental health knowledge
- Reduces general health care costs through early detection, prevention or referral of mental health problems
- Addresses major stressors on the public health system, such as
- health worker burnout
- human rights abuses in public obstetric facilities
- Builds capacity within the public sector to address maternal mental illness which
- combats stigma, shifts attitudes and increases morale
- empowers health workers to identify and manage maternal mental health problems and improves their ability to handle personal crises
- maximises scarce resources
- These factors simultaneously contribute to improved quality of service delivery.