PATHWAY TO MATERNAL MENTAL HEALTH & WELLBEING SINDILE DLAMINI, MDIV_ THE CHICAGO SCHOOL OF PROFESSIONAL PSYCHOLOGY MARCH 17, 2017

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1 USE OF STEPPED CARE FOR MATERNAL MENTAL HEALTH ASSESSMENT IN LOW INCOME WOMEN IN KWA-MANZINI, SWAZILAND: A SOUTHERN AFRICAN PERSPECTIVE OF CONNECTING THE DOTS PATHWAY TO MATERNAL MENTAL HEALTH & WELLBEING SINDILE DLAMINI, MDIV_ THE CHICAGO SCHOOL OF PROFESSIONAL PSYCHOLOGY MARCH 17, 2017

2 TABLE OF CONTENTS ABOUT THE PRESENTER SWAZILAND PROFILE (3 & 4) HEALTHCARE SERVICES IN SWAZILAND PRIVATE CLINIC (EXAMPLE OF AN EFFICIENT HEALTH CENTER) ABSTRACT WHY THIS TOPIC RESEARCH NEEDS METHODOLOGY (8 & 9) VIGNETTE PATHWAY TO WELLNESS CONCLUSION REFERENCES

3 BACKGROUND COUNTRY: BORN IN SWAZILAND, RAISED IN SOUTH AFRICA CHAPLAIN: HOWARD UNIVERSITY MATERNAL CHILD HEALTH DIVISION RESEARCH ASSISTANT: EFFECTS OF MATERNAL MOOD & ANXIETY DISORDERS ON FETAL & NEW-BORN DEVELOPMENT IN PREDOMINANTLY AFRICAN-AMERICAN POPULATION; MEASURE GRIEF AND TRAUMA PATTERNS; AND DETERMINE RECOVERY, RESILIENCY & SUPPORT TOOLS TO PREVENT FURTHER RISK AND LOSS MOTHERS: PSYCHO-SOCIAL CHALLENGES, SOME ARE VULNERABLE TO PERINATAL STRESS, MOOD AND ANXIETY CHALLENGES BABIES: HEALTHY, PRETERM, PREMATURE DEATH SERVICES: PROVIDE PASTORAL CARE SUPPORT, COUNSELING & COMMUNITY RESOURCES HYPOTHESIS: THERE IS PREVALENCE OF PERINATAL MENTAL HEALTH CHALLENGES IN LOW INCOME KWA-MANZINI COMMUNITIES IN SWAZILAND.

4 SWAZILAND PROFILE AUTONOMY FOR THE SWAZIS - GUARANTEED BY THE BRITISH IN THE LATE 19TH CENTURY INDEPENDENCE WAS GRANTED GOVERNMENT ABSOLUTE MONARCHY ETHNIC GROUPS - AFRICAN 97%, EUROPEAN 3% LANGUAGE SISWATI (NGUNI)

5 POPULATION 1.5 MILL (2016 EST.) UNEMPLOYMENT, 40% AGE STRUCTURE: 0-14 YEARS: 35.5% MALE 260,507, FEMALE 254, YEARS: 22.19% MALE 162,880, FEMALE 159, YEARS: 34.12% MALE 256,696, FEMALE 238, YEARS: 4.28% MALE 24,758, FEMALE 37, YEARS AND OVER: 3.9% MALE 21,842, FEMALE 34,835 Google Images

6 SWAZILAND HEALTHCARE SERVICES 1. BULEMBU CLINIC 2. MAGUBHELENI CLINIC 3. MANKANYANE GOV. HOSPITAL 4. MANZINI CLINIC 5. MATSAPA HEALTHCARE 6. MBABANE CLINIC 7. MEDISUN CLINIC 8. MKHIWA CLINIC 9. PHILANI CLINIC(MATSAPA) 10. SIPHOFANENI CLINIC 11. ST. THERES S CLINIC 12. MATSANJENI HEALTH CENTER 13. THE CLINIC GROUP INTEGRATED HEALTHCARE

7 MANZINI CLINIC SERVICES PRIVATE CLINIC OUTPATIENT CONSULTATION SERVICES WITH QUALIFIED PRACTITIONERS: GENERAL PRACTITIONERS AVAILABLE 24H/7 SPECIALISTS INPATIENT SERVICES FOR PATIENTS WHOSE CONDITION REQUIRES HOSPITALIZATION 15 BEDS HIGH CARE CERTIFIED UNIT OBSTETRIC UNIT & NURSERY ASSISTANCE FOR PRE-AUTHORIZATIONS WITH MEDICAL AID/INSURANCE ASSISTANCE FOR TRANSFERS TO SOUTH AFRICAN HOSPITALS WITH

8 ABSTRACT OBJECTIVE: USE STEPPED CARE MODEL TO ASSESS PREVALENCE OF PERINATAL MENTAL HEALTH CHALLENGES IN LOW INCOME WOMEN IN KWA-MANZINI, SWAZILAND; AND USE OF FAITH & CULTURAL IDENTITY AS A RECOVERY & RESILIENCY TOOL

9 PROBLEM STATEMENT 1 IN 3 WOMEN¹ HAVE MENTAL ILLNESS IN AT RISK COMMUNITIES 1 IN 3 WOMEN SUFFER FROM POSTNATAL DEPRESSION PREVALENCE IS THREE TIMES HIGHER THAN IN DEVELOPED COUNTRIES GLOBALLY 30%²SUFFER FROM MENTAL DISORDERS WITH DEPRESSION, ANXIETY WHICH LEADS TO SUBSTANCE ABUSE THESE STATISTICS REVEAL PERINATAL³ MENTAL HEALTH NEEDS OF WOMEN DURING AND AFTER PREGNANCY ARE NOT BEING MET

10 METHODOLOGY EDINBURGH POST-NATAL DEPRESSION SCALE (EPDS) IN ENGLISH, AFRIKAANS, XHOSA, AND FRENCH IMMIGRANT WOMEN FROM FRANCOPHONE REGIONS & OTHER WEST AFRICAN COUNTRIES RISK FACTOR ASSESSMENT (RFA) YES/NO TICK FORM WITH 11 RISK FACTORS FOR MENTAL HEALTH DISTRESS TAKES INTO ACCOUNT LOCAL CONTEXT SUPPORT GROUP MIDWIVES COUNSELLORS PSYCHIATRIST NO PASTORAL CARE!

11 METHODS (CONT) Honikman et al (2012). Stepped care for maternal mental health: a case study of the perinatal mental health project in SA. PLOS Medicine, Public Library of Science.

12 GLORIA MASEKO S STORY GREW UP IN A SINGLE PARENT HOUSEHOLD, LATER ADOPTED BY HER MOTHERS FAMILY NO ONE TO DISCIPLINE OR RAISE HER, BECAME PREGNANT AT 14, BEGAN HISTORY OF DEPRESSION WHEN SHE BECAME A MOTHER THINGS CHANGED, HAD TO LEAVE SCHOOL & BE A DOMESTIC WORKER, AND GO TO SCHOOL IN-BETWEEN AT 21 GOT MARRIED, GOT PREGNANT AND SUFFERED FROM POSTNATAL DEPRESSION BUT DID NOT KNOW IT HAD AN OPPORTUNITY TO BE PART OF A PERINATAL MENTAL HEALTH PROJECT AND WAS ABLE TO EXCESS MENTAL HEALTH COUNSELING AND HER LIFE CHANGED

13 RESEARCH NEEDS EFFECTS ON FETUS AND BABIES EFFECTS ON MOTHER DECREASE IN PRENATAL CARE SELF MEDICATION-SMOKING, ALCOHOL, SUBSTANCE ABUSE DECLINE IN BONDING WITH BABY IMPACT ON FAMILY LIFE BREASTFEEDING CHALLENGES NEGATIVE MOOD & MODELING INCREASE PRE-TERM LABOR PREMATURE BIRTH & LOW BIRTH RATE FETAL DEMISE NEONATAL COMPLICATIONS N.I.C.U. ADMISSIONS WITHDRAWAL LONG-TERM: SIGNIFICANT SCHOOL OUTCOMES, COGNITIVE FUNCTIONING, BEHAVIOR PROBLEMS 50% OF ADOLESCENTS HAVE MENTAL HEALTH CHALLENGES

14 PATHWAY TO MENTAL HEALTH WELLNESS CHANGES AT HOME: IMPROVE SLEEP, NUTRITION, SUPPORT, SELF-CARE SPIRITUALLY: SOURCE OF INNER HEALING, COPING & RESILIENCE SOCIALLY: SOCIAL SUPPORT & PSYCHO EDUCATION GROUPS COMMUNITY LEVEL: MENTAL HEALTH CARE ADOPT A PREVENTATIVE APPROACH CLINICALLY: IMPROVE ACCESS TO PSYCHOTHERAPY & MEDICATION CULTURALLY: IMPROVE SENSITIVE SERVICE DELIVERY POLICY FRAMEWORK DEVELOPMENT AT GOVERNMENT LEVEL OVERALL: MENTAL HEALTH SERVICES INTEGRATED INTO PRIMARY & GENERAL ENVIRONMENT

15 CONCLUSION THROUGH THIS RESEARCH THE FOLLOWING OUTCOMES ARE EXPECTED: 1. MENTAL HEALTH NEEDS FOR WOMEN AT RISK WILL BE PRIORITIZED 2. MENTAL HEALTH SCREENING WILL BE PART OF ROUTINE PRENATAL VISIT 3. QUICK PREVENTION AND INTERVENTION ASSESSMENT 4. MINIMIZE MENTAL HEALTH STIGMA 5. EMPOWER WOMEN TO EXERCISE CHOICES OVER ALL ASPECTS OF THEIR LIFE, FAMILY AND COMMUNITY.

16 "WHAT WOULD YOU LIKE ATTENDEES TO DO IN ORDER TO SUPPORT YOUR EFFORTS?" SUPPORT WITH FINE TUNING DISSERTATION TOPIC [DOABLE] ASSISTANCE TO FIND THEORETICAL BASIS RELATED TO DISSERTATION TOPIC ASSEMBLE A RESEARCH TEAM TO PROVIDE FEEDBACK ON PROGRESS SUPPORT TO IMPROVE PRESENTATION SKILLS SUPPORT TO DEVELOP JOURNAL ARTICLES AND PAPERS

17 REFERENCES BERRY, J.W., POORTINGA, Y. H., BREUGELMANS, S.M., CHASIOTIS, A., AND SAM, D.L. (2011). CROSS-CULTURAL PSYCHOLOGY: RESEARCH AND APPLICATIONS (3RD EDN.). CAMBRIDGE: CAMBRIDGE UNIVERSITY PRESS. CAVALLI-SFORZA, L.L., AND FELDMAN, M (1981). CULTURAL TRANSMISSION AND EVOLUTION: A QUANTITATIVE APPROACH. PRINCETON: PRINCETON UNIVERSITY PRESS. CRESWELL, J. W. AND PLANO CLARK, V. L. (2011). DESIGNING AND CONDUCTING MIXED METHODS RESEARCH. (2ND ED.). THOUSAND OAKS, CA: SAGE. HONIKMAN ET AL (2012). STEPPED CARE FOR MATERNAL MENTAL HEALTH: A CASE STUDY OF THE PERINATAL MENTAL HEALTH PROJECT IN SA. PLOS MEDICINE, PUBLIC LIBRARY OF SCIENCE. U.N. SUSTAINABLE DEVELOPMENT GOALS. RETRIEVED FROM W/POST DEVELOPMENT-AGENDA/GOAL-10.HTML

18 REFERENCES (CONT.) COUNTRY PROFILE FACTBOOK/GEOS/WZ.HTML HIV PREVALENCE IN SWAZILAND MONG_WOMEN_ATTENDING_ANTENATAL_CARE_CLINICS_SWAZILAND WHO COMPREHENSIVE ANALYTICAL PROFILE /SWAZILAND:INDEX THE CLINIC GROUP - MANZINI PRIVATE CLINIC MINISTRY OF HEALTH SWAZILAND TICLE&ID=751&ITEMID=599