People in high-income countries often face a lack of mental health services, but in middle and low-income countries the scale of the problem can be much worse.
Millions with conditions like depression, anxiety and schizophrenia struggle to get treatment due to lack of resources and the stigmatisation of mental health problems.
Pregnant women are a particularly at-risk group.
In Kenya, for example, symptoms of depression such as fatigue and sleep problems are sometimes dismissed as purely symptoms of pregnancy, or even blamed on witchcraft.
This lack of medical attention, combined with high rates of domestic violence contributed to a 0.5% maternal mortality rate in 2015, one of the highest in the world.
Depression in pregnancy is also associated with low birth weight, maltreatment and problems breastfeeding.
Kenya has only two mental health professionals for every 100,000 people, and they are concentrated in urban areas. This means some rural counties have a population of millions, but no psychiatrists.
An estimated 75% of people with mental health conditions in poorer countries can’t access medical treatment. This means many to turn to non-specialist traditional healers, faith healers and community health workers instead.
We discovered that training these groups to screen for mental health conditions could drastically reduce the number of people who can’t access treatment.
Building on these findings, traditional birth attendants were trained to screen for depression in more than 1,700 pregnant women in a pilot study by the Africa Mental Health Research and Training Foundation.
The study took place in Makueni County, a largely rural part of south-eastern Kenya. One of the country’s poorest counties, it has no resident psychologists.
The results of the screening were striking.
A quarter of the mothers in the study were found to have mild to moderate depression. Three-quarters had experienced intimate partner violence, whether physical, sexual or emotional abuse, or controlling behaviour. Half are victims of at least two forms of this violence.
Nearly 60% of the mothers diagnosed with depression received treatment from their birth attendant based on a World Health Organization programmedesigned for use by non-specialists.
The mothers were 26 years old on average, with almost half aged between 12 and 24.
One young mother involved in the study, Ndanu*, was diagnosed with depression.
She said: “If it were not for this programme and the help of a birth attendant, I would not have kept this baby to term and perhaps not gone for all the antenatal visits.
“The birth attendant counselled me, encouraged me to keep the baby by telling me that it was not my fault and children are a blessing and that I should visit the health centre for antenatal care. She promised to check on me and opened her house for me to talk to her whenever I wanted”
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