MHM Magazine

20 | MENTAL HEALTH MATTERS | 2023 | Issue 3 MHM • Intimate partner violence / domestic violence • Alcohol or substance abuse • Past history of mental health problems • Serious physical problem in mother or baby • Being a refugee, asylum seeker, displaced person • Previous or current pregnancy loss, miscarriage, still birth and neonatal death • Preterm birth, birth defects or physical illness in neonate 3. Incorporate mental health screening as part of routine maternity care. First develop rapport with the woman: the way in which screening is offered is linked to how a woman will respond. If the screener has a gentle and kind attitude, the woman is much more likely to respond openly and take up any referrals. • A brief three-question mental health screen is available in the Maternity Case Record. • Use your clinical judgement and refer women that you’re worried about for support, even if their screening test is negative. 4. Enable access to evidence based interventions. This may include psychosocial care, psychotherapy, medication or a combination of these. It is helpful to do a mapping exercise of resources in your location – keep a record of names, numbers and other relevant details. Get to know the providers. This can save valuable time! If some time is spent in making a quality referral, the woman is more likely to take up the opportunity. Give the woman reasons, options and explain the service in as much detail as possible and follow-up. • Connect women to social support services (social grants, community services, relevant NGOs) and other activities to strengthen social support (women’s groups, support groups, faith-based activities and include partners and families). • Become trained in one of the evidence-based ‘talking therapies’ or refer to someone who can provide these. • Become comfortable with prescribing anti-depressants for moderate to severe depression and anxiety. See the algorithm in the Hospital Level (Adults) Standard Treatment Guidelines (2019), Chapter 15 on Mental Health. 5. Mother-infant matters. Assess mother-child interaction as part of post-natal care and refer when appropriate and resources available. • For women with existing mental health conditions, a multidisciplinary approach to care is essential, with a clear treatment plan and continuity of care across different clinical settings. • Arrange for observation of infants exposed to psychoactive medications or illicit substances during pregnancy. • If a mother with a severe postnatal episode requires hospital admission, avoid separation from her infant, where possible. • Provide gentle breastfeeding support to all women with mental health problems. Breastfeeding challenges are common in women with mental health conditions. • Women (and their partners) who have experienced a pregnancy loss, miscarriage, stillbirth or neonatal death, require special attention and support for bereavement. Perinatal mental health problems are a significant public health issue in South Africa with substantial economic and societal costs. We have a responsibility to address these conditions and provide appropriate care and support to affected women and their families. This will help to improve the well- being of mothers and children and contribute to a healthier, more productive society. References available on request.