MHM Magazine

Issue 3 | 2023 | MENTAL HEALTH MATTERS | 19 MHM from cohort studies, as well as epidemiological and economic data from South Africa, and international studies, when local data wasn't available. We modelled the financial impact on a hypothetical cohort of women giving birth within one year. Impacts were accounted for 10 years for women, and 40 years for children. The economic consequences costed that were linked to mothers included losses in quantity and quality of life and losses in financial productivity. For children, costs were calculated in the same way and we also included the costs of increased hospital care. For every year of births, South African society bears economic costs of R 49.3 billion! About 48% of these costs may be attributed to the consequences related to the mother and 52% may be attributed to the consequences related the child. There were relatively low costs falling on the health system (R59,5 million) as little is currently being offered to address perinatal mental health problems in public health sector. The costing calculations are summarised in the image below. Inaction has intergenerational impactsand costs R6 800 million loss of quality of life R15 300 million loss of income R23 800million loss of quality of life R3 400 million loss of income Total losses: R49.3 billion each year Economic loss attributed to child (52%) Economic loss attributed to mother (48%) That’s just under R 51 000 per baby. It’s too costly to do nothing! By investing in evidence-based strategies to address maternal mental problems, we may alleviate transgenerational suffering, and also save on the costs of inaction. There are several approaches that have shown impact. The status of care in South Africa In South Africa, mental health care is not currently routinely provided to women as part of maternity. However, we have a new Maternal, Perinatal and Neonatal Health Policy (2021) which centres maternal mental healthcare as one of 16 ‘Essential Life-Saving Intervention Packages’. From this policy, maternal, perinatal and neonatal guidelines are currently being developed that include substantive content on mental health, including the introduction of routine mental health screening into primary-level antenatal care. For this, a locally developed and validated screening tool has been integrated into the Maternity Case Records booklet (the standard public sector obstetric care document that includes investigation, clinical notes and care provided to pregnant and labouring women). The Standard Treatment Guidelines (Hospital Level) includes specific advice for managing mental health conditions in pregnant and breastfeeding women, including a prescribing algorithm for antidepressants for women with moderate to severe depression and anxiety. The role of the frontline provider General healthcare providers (nurses, doctors, OTs, social workers, community health workers etc.) have a vital role to play in preventing and managing common perinatal mental health problems in the primary care setting. Mental health providers may play a vital role in supporting non-specialists to do this work and may themselves be suited to addressing moderate to severe conditions. What can you do to help? 1. Promote awareness and reduce stigma. Healthcare providers can play a significant role in promoting awareness of mental health problems and reducing the stigma associated with mental illness. Educate perinatal women, their families and the broader community about the importance of well-being during and after pregnancy. • Share useful information about mental health issues and self-care. • Explain that emotional difficulties are not a sign of weakness (or any other myth, e.g. laziness). • Explain that symptoms may be similar to those experienced by many others in the same circumstances. • Explain that too much stress can affect how people think and their actions. It can affect their work and relationships and is not good for the baby. This is true for all people in the home. • Provide a reminder that people living with mental health problems can and do get better with good support and/or treatment from trusted family, friends and health workers. • Give the person the chance to talk about how they feel about their mental health challenges and treatment and effect on their life. • Provide information on treatment, prognosis and coping methods. 2. Be aware of the risk factors associated with perinatal mental health problems. These include • Poverty and food insecurity • Being a teenager • Living with a chronic disease, including HIV • Poor support / poor relationships with partner, family or community • Unwanted / unintended pregnancy • Difficult life events / trauma (e.g. bereavement and current or past abuse)