A new model of care for screening and treating women around the time of childbirth for mental health disorders shows promise according to researchers from South Africa reporting in this week's PLoS Medicine as part of the newly launched series in global mental health practice.
There is no routine screening or treatment of maternal mental disorders in primary care settings in South Africa so the researchers, led by Simone Honikman from the University of Cape Town, implemented a program (the Perinatal Mental Health Project) in Cape Town, South Africa. This program included training for health care workers, implementing routine antenatal screening for maternal mental distress, and establishing referral networks to on-site counsellors and mental health professionals. It represents one of the first attempts to develop and implement a mental health programme for pregnant women in the developing world, where there is an extremely high (and often unrecognized) prevalence of maternal mental disorders.
The authors say: "The Perinatal Mental Health Project developed an intervention to deliver mental health care to pregnant women in a collaborative, step-wise manner making use of existing resources in primary care."
Over three years, the project achieved high levels of uptake and acceptability. From July 2008 to the end of June 2011, 90% of 6,347 women who attended the facility for primary level care were offered mental health screening and of the 5,407 screened, 32% qualified for referral to a counsellor, and 62% (1,079 women) agreed to be referred. A total of 1,981 counselling sessions were conducted and a small proportion (2%, 20 women) were referred to a psychiatrist. Importantly, most women (88% of those sampled) reported that they were more able to cope with their presenting problem as a result of the counselling.
The authors say: "Through routine screening and referral, the [Perinatal Mental Health Project] model demonstrates the feasibility and acceptability of a stepped care approach to provision of mental health care at the primary care level."
They continue: "These principles may inform the development of services in similar primary health settings."
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Honikman S, van Heyningen T, Field S, Baron E, Tomlinson M (2012) Stepped Care for Maternal Mental Health: A Case Study of the Perinatal Mental Health Project in South Africa. PLoS Med 9(5): e1001222. doi:10.1371/journal.pmed.1001222