Screening as the entry-point to accessing mental health care
The PMHP model aims to identify those women at risk or currently experiencing symptoms of depression and anxiety at our service site.
When women register 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. About 30% of women attending the PMHP service site screen positive for psychological distress.
When possible, the PMHP aims for 80% screening coverage. This is the proportion of all women attending their first antenatal visit who undergo screening. Universal coverage (screening all women) has not been possible during COVID, nor during times when the counsellors have heavy case-loads. During these times, the PMHP targets screening for teenagers, HIV-positive women, and those identified by the nursing staff as particularly vulnerable, such as those experiencing domestic violence, or other key risk factors for mental health conditions.
What is ‘screening’?
Screening is a strategy used to detect symptoms of a condition 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 a mental illness, but this is not definite.
If someone screens negative (below cut-off score), it is likely that she does not have a mental illness, but this is not definite. 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) as well as suicidality at their first antenatal visit using the brief tool, developed and validated by PMHP, and incorporated into the standard maternity stationery (the Maternity Case Record).
Read more about screening in our Maternal Mental Health guide here. And read the PMHP policy brief here that enabled the tool to be incorporated into routine maternity care practice across South Africa.
Promotion, Prevention and Prep for service (PPP)
Our adapted Maternal Support Service model includes PPP sessions, which are conducted every day in the waiting room of the Midwife Obstetric Unit. The purpose of these talks is to provide information about maternal mental health ill-health, self-care strategies and the PMHP service, itself. The talks have been well received by most women, who often openly ask for copies of the pamphlets being handed out. We have also found that women are more open to using our service after receiving a PPP session.
In the picture below, Liesl Hermanus, the Clinical Services Co-ordinator, is conducting a PPP session.
The screening process
In the context of routine history taking at the first antenatal visit, and with their written consent, women are offered screening by clinic staff (nurses, midwives or the Health Promotions officer) or PMHP counsellors. Screening questionnaires are administered in private and are scored by the screener. Women who screen positive are offered a referral for further assessment (Engage, Assess, Triage).
Read our screening advisory here.
Engage, Assess, Triage (EAT)Women who screen positive for depression, anxiety and/or suicidality, are immediately referred to a PMHP counsellor who conducts an EAT session with them. During the EAT session, the initial responses to the screening questionnaire are validated, and women are screened for additional risk factors. This step identifies social problems that may be contributing to their mental distress and enables the counsellor to assess and triage for the level of care required. Women with lower-risk or milder symptoms are offered supportive counselling. Those with more severe symptoms or a greater number of risk factors are offered psychotherapeutic counselling with the Clinical Services Co-ordinator, a more experienced counsellor.