Interfacing Infant Mental Health Knowledge Systems: Reflections on the Narratives of Lay Home Visitors’ Experiences of Learning and Applying Relational Concepts of Development in a South African Intervention Program

Abstract

The question of interfacing research and clinically generated knowledge in the field of infant mental health (IMH) with local cultural knowledge and belief systems has provoked extended discussion in recent years. This article explores convergences and divergences between current research-based, relational IMH mental health models and "community" knowledge held by a group of South African lay home visitors from a socioeconomically deprived township. These women were trained in a psychoanalytic and attachment-informed infant mental health program that promotes a relational model of infant development. They provide an intervention that supports high risk mother-infant relationships in the same locality. A two-tiered approach was taken to the analysis of the home visitor interviews and focused on the home visitors' constructed narratives of infant development posttraining as well as the personal impact of the training and work on the home visitors themselves. The study found that psychoanalytic and attachment-informed thinking about development makes sense to those operating within the local South African cultural context, but that the accommodation of this knowledge is a complex and challenging process.

Lay counselors: Thoughts on the crossing of ecological frameworks and the use of lay counselors in the scale up of early infant mental health interventions

“…In contexts of historical and current trauma and violence, the answer to this question may include a collective denial of infant sentience, given the immense pain entailed in the recognition of infant trauma and deprivation. The experiences of lay mental health workers on the ground attest to this (Baradon & Bain, ). In the microcosm of the mother–infant–home visitor triad, there is significant difficulty experienced in “keeping a focus on the baby” among the mother's stresses, traumas, and contextual demands.…”

“…Working with mothers and infants also requires the home visitors to constantly process their own experiences of infancy and having been parented as well as their experiences of parenting their own children. This is often painful, evoking intense feelings of sadness, anger, regret, and envy (Baradon & Bain, ). To remain aware of an infant's emotional pain, the home visitors are required to become far more conscious of their emotions, intention, and motivations, and to contain their own feelings as well as feelings expressed by the mothers.…”

“…It is evident that training and supervision of lay counselors inevitably trigger a process of introspection and self‐reflection around experiences of being parented and parenting of their own children that is often painful (Baradon & Bain, ). Moreover, home visitors often share similar personal histories and traumas to their clients.…”

“…Many barriers to effective intervention are associated with cultural and contextual factors. These include stigma associated with mental illness, women's lack of autonomy in more patriarchal cultural settings, cultural beliefs that diverge with program teachings, lack of engagement or avoidance of counselors by some high‐risk mothers, and resistance to program participation from extended families (Atif et al., ; Baradon & Bain, ; Munodawafa et al., ). Within the two South African programs, cultural interfacing challenges have presented themselves within the day‐to‐day practicalities of the interventions as well as within the interactions between the home visitors and the mother–infant dyads, and also the home visitors and their supervisors and program management.…”

The challenge to prioritise infant mental health in South Africa

“…Within already overburdened mental health services, the introduction of a whole new set of potential caregiver and infant service-users is daunting. Work with infants, in particular, requires additional skills and knowledge, since much of the work is non-verbal, and work with at-risk infants demands an emotional toll – feelings of helplessness and fear are intense (Baradon & Bain, 2016; Jones, 2018). Thus, the work also requires regular reflective supervision for infant mental health practitioners (Bain & Baradon, 2018).…”