Increasingly, civil society organisations are recognising the link between good maternal mental health and improved outcomes for existing programmes addressing human immunodeficiency virus (HIV), tuberculosis (TB), orphans and vulnerable children (OVC) as well as other social and developmental programmes.
Further, maternal mental health interventions are now recognised as an important aspect of First 1000 Days initiatives which seek to address the determinants of child development and health outcomes in this critical period.
SPF is an NGO based in East London, Eastern Cape (EC), who for 28 years, has implemented a wide range of community-based capacity building programmes, focusing on strengthening primary health systems.
We were invited to develop a training package to embed an understanding of maternal mental health (MMH) and empathic engagement skills (EES) into the work being done by SPF’s community health care workers (CW). These CW conduct community outreach and follow-up vulnerable community members, linking them to care at allocated health facilities.
The project was implemented in three phases. Phase 1: all SPF managers, trainers and CW coordinators completed the Bettercare MMH distance learning programme before attending a three-day EES training workshop in Mthatha. Those who achieved over 80% for the Bettercare component, were recruited
to train CW, initially under PMHP supervision. After the Mthatha training, a workshop with senior SPF staff developed strategic plans for integrating MMH services within their routine operations.
Phase 2: the clinics, other government and non-government partners and role players in the Ngqeleni area (Nyandeni municipality, OR Tambo district, EC), were invited to attend a 3-day workshop where they were informed of the project, orientated to MMH and EES. Each clinic was given a Bettercare MMH book and encouraged to complete the distance learning programme. At the end of this phase, pathways for the referral of vulnerable mothers with MMH problems were identified and documented. A Facilitators Training Handbook was produced.
Phase 3: CW in Ngqeleni were trained in basic concepts of MMH, recognition of mothers with common mental problems, they practiced EES and were informed of their local referral pathways. The workshop was conducted in isiXhosa, with a PMHP trainer present to provide support, act as a resource and to evaluate the Facilitators Training Handbook.
This collaboration is ongoing. The next phase is the introduction of Nyamekala4Care, to ensure ongoing support for CW and to monitor that the work is sustained.
Ithemba Lobomi a non-profit organisation based in the community of Thembalethu, outside George in the Eden District of the Western Cape. The organisation works to addresses issues related to HIV/AIDS, TB and chronic diseases and mitigate their negative impacts. This is achieved through the provision of essential health and psycho-social support to individuals, children and families who are affected by HIV and AIDS, chronic illnesses, injuries, neglect, abandonment and child abuse.
IL requested that the we consult towards the development of a mental health programme embedded within IL’s existing operations.
Prior to developing a strategy, we conducted an on-site situation analysis at IL and surrounds. A staff member (a social worker) from IL was identified to lead the service coordination process going forward. This staff member visited PMHP for a week to gain first-hand knowledge of all aspects of our mental health services, while shadowing and speaking with our clinical and monitoring staff.
In addition, a diverse group of IL staff and local stakeholders were recruited to participate in a team-based, distance-learning programme for six weeks, using our “Maternal Mental Health” Bettercare book.
Thereafter, we conducted a knowledge and stigma evaluation and a two-day training workshop on empathic engagement skills for this group.
PMHP then facilitated a strategic planning workshop with key IL staff to assist with the phased design of a maternal mental health service embedded within their home-based programmes. Four key objectives were identified for careful strategy development; the development of a comprehensive, relevant, evidence-based and feasible intervention; the training of providers to deliver the intervention; the raising of community awareness about mental health in order to decrease stigma and increase support for mothers and finally, the integration of mental health care in to all IL programme areas.
The work is on-going, with consultation and support being provided by PMHP.
PMHP volunteer, Trisha Lord, took over facilitating the Retreat MOU staff support group from Beulah Marks in April 2015. The aim of the group is to provide a supportive space and thinking environment for the staff once a month. Trisha also has links with the Compassionate Birth Project.
In addition Dr Simone Honikman, our director, is on the Scientific Advisory Board of the project.