The Secret History method and the development of an ethos of care: Preparing the maternity environment for integrating mental health care in South Africa

Honikman, Simone; Field, Sally; Cooper, Sara

doi:10.1177/1363461519844640

Cited by 8 publications

(7 citation statements)

References 40 publications

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“…Routine enquiry into mental health may require careful consideration of how to prepare the maternity environment, particularly for mental health task‐shifting initiatives in LMICs 178 . In HICs, most women welcome the opportunity to talk about mental health 179 , and there are no differences in acceptability of different modes of screening tool (e.g., paper vs. iPad) 179,180 , as long as women are given the opportunity to talk and are referred appropriately 179 .…”

Section: Service Deliverymentioning

confidence: 99%

Perinatal mental health: a review of progress and challenges

2020

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Perinatal mental health has become a significant focus of interest in recent years, with investment in new specialist mental health services in some high‐income countries, and inpatient psychiatric mother and baby units in diverse settings. In this paper, we summarize and critically examine the epidemiology and impact of perinatal mental disorders, including emerging evidence of an increase of their prevalence in young pregnant women. Perinatal mental disorders are among the commonest morbidities of pregnancy, and make an important contribution to maternal mortality, as well as to adverse neonatal, infant and child outcomes. We then review the current evidence base on interventions, including individual level and public health ones, as well as service delivery models. Randomized controlled trials provide evidence on the effectiveness of psychological and psychosocial interventions at the individual level, though it is not yet clear which women with perinatal mental disorders also need additional support for parenting. The evidence base on psychotropic use in pregnancy is almost exclusively observational. There is little research on the full range of perinatal mental disorders, on how to improve access to treatment for women with psychosocial difficulties, and on the effectiveness of different service delivery models. We conclude with research and clinical implications, which, we argue, highlight the need for an extension of generic psychiatric services to include preconception care, and further investment into public health interventions, in addition to perinatal mental health services, potentially for women and men, to reduce maternal and child morbidity and mortality.

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Section: Service Deliverymentioning

confidence: 99%

Perinatal mental health: a review of progress and challenges

2020

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“…Healthcare providers reported a compromised ability to engage in identification of mental ill-health in patients due to the stigma of mental illness and their own unaddressed mental health issues, which reportedly constrained their capacity to screen women - even when guidance indicated they should routinely screen women for CPMDs. Unaddressed mental ill-health in providers shapes their ability and willingness to address mental ill-health in patients [ 52 , 53 ]. Importantly, deeply embedded beliefs of providers towards mental illness affect how and why providers choose to screen for CPMDs and/or have conversations about mental health with perinatal women during patient visits [ 38 ].…”

Section: Discussionmentioning

confidence: 99%

Health care providers’ perceptions of barriers to perinatal mental healthcare in South Africa

Brown

Sprague

2021

BMC Public Health

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Background Perinatal mental disorders are a leading contributor to morbidity and mortality during pregnancy and postpartum, and are highly treatable when identified early. However, many women, especially in low and middle-income countries, lack access to routine identification and treatment of mental illness in public health settings. The prevalence of perinatal depression and anxiety disorders, common mental disorders, is three times higher for South African women relative to women in high-income countries. The public health system has begun to integrate mental health into maternal care, making South Africa a relevant case study of perinatal mental healthcare. Yet studies are few. We sought to investigate healthcare providers’ perceptions of the barriers to early identification and screening of common perinatal mental disorders in public health facilities in South Africa. Methods Employing qualitative methods, we used purposive sampling to identify study participants, supplemented by snowball sampling. From September 2019–June 2020, we conducted in-depth interviews with 24 key informants in South Africa. All interviews were recorded and transcribed verbatim. We used a thematic approach to generate initial analytical themes and then conducted iterative coding to refine them. We adapted a delivery systems’ framework to organise the findings, depicted in a conceptual map. Results Reported barriers to early identification and treatment of mental illness in the perinatal period encompassed four levels: (1) structural factors related to policies, systems and resources; (2) socio-cultural factors, including language and cultural barriers; (3) organisational factors, such as lack of provider preparation and training and overburdened clinics; and (4) individual patient and healthcare provider factors. Conclusion Barriers act across multiple levels to reduce quality mental health promotion and care, thereby creating an environment where inequitable access to identification of mental disorders and quality mental health services was embedded into systems and everyday practice. Integrated interventions across multiple levels are essential to improve the early identification and treatment of mental illness in perinatal women in South Africa. We provide recommendations derived from our findings to overcome barriers at each of the four identified levels.

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“…This special issue of Transcultural Psychiatry provides a snapshot of current interdisciplinary work that reflects the complexity and ongoing evolution of GMH. The authors reflect on the histories and colonial legacies of violence inscribed in mental suffering and programming (Capella, Jadhav, & Moncrieff, 2020;Hickling, 2020;Ortega & Wenceslau, 2020), on current models of culturally responsive intervention and implementation (Bustamante Ugarte et al, 2020;Hatcher et al, 2020;Honikman, Field, & Cooper, 2020;Mascayano et al, 2020;Shehadeh et al, 2020;Verhey et al, 2020) and on the challenges to mental well-being from the impending conditions of catastrophic climate change (White, 2020). Another set of contributions challenge established narratives on psychological suffering and trauma after war (Medeiros, Nanicha Shrestha, Gaire, & Orr, 2020), natural disaster (Newnham et al, 2020), and cultural practices of female genital cutting (Omigbodun, 2020).…”

Section: Moving Beyond a Polarized Debatementioning

confidence: 99%

“…A different kind of legacy of violence is addressed in the work of Simone Honikman and colleagues (2020), who, like Hickling and colleagues, draw inspiration from Paolo Freire’s Theater of the Oppressed to develop a culturally sensitive intervention that empowers nurses and midwives in South Africa to reflect on the obstetrics violence that has become normalized in clinical maternal environments. Nurses, themselves chronically overworked and stressed, were trained under apartheid to be subordinate to doctors, but superior to patients, in a fragile “mix of power and marginalization” that continues to play out in patient abuse.…”

Section: Histories Of Violence: Colonialism and The Asylummentioning

confidence: 99%

Global Mental Health: Interdisciplinary challenges for a field in motion

Bemme

Kirmayer

2020

Transcult Psychiatry

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In recent years, efforts in Global Mental Health (GMH) have evolved alongside critical engagement with the field's claims and interventions. GMH has shifted its agenda and epistemological underpinnings, increased its evidence base, and joined other global policy platforms such as the Sustainable Development Goals. This editorial introduction to a thematic issue traces the recent shifts in the GMH agenda and discusses the changing construct of ''mental health'' as GMH moves away from a categorical biomedical model toward dimensional and transdiagnostic approaches and embraces digital technologies. We highlight persistent and emerging lines of inquiry and advocate for meaningful interdisciplinary engagement. Taken together, the articles in this special issue of Transcultural Psychiatry provide a snapshot of current interdisciplinary work in GMH that considers the socio-cultural and historical dimensions of mental health important and proposes reflexive development of interventions and implementation strategies.

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The Secret History method and the development of an ethos of care: Preparing the maternity environment for integrating mental health care in South Africa

Cited by 8 publications

References 40 publications

Perinatal mental health: a review of progress and challenges

Perinatal mental health: a review of progress and challenges

Health care providers’ perceptions of barriers to perinatal mental healthcare in South Africa

Global Mental Health: Interdisciplinary challenges for a field in motion

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