Addressing mental health in maternal and child health services

Integrating perinatal mental health care into maternal and child health services is key to improving the health of both mother and baby during pregnancy, childbirth, and up to one year after birth. The World Health Organization's (WHO) Guide to Integrating Perinatal Mental Health into Maternal and Child Health Services reinforces this importance and provides information and recommendations on how to promote mental health, prevent and address perinatal mental health problems within these services.

According to WHO data, one in five women experience some form of mental health problem during the perinatal period, especially anxiety and depression. Poor mental health during this time can negatively impact both the woman's health and the well-being of her babies and families. Early parenting can be stressful for mothers due to the changes it brings to their identity, physical health, and financial situation. It can worsen symptoms in women with pre-existing mental health problems, and others may experience such problems for the first time.

Maternal and child health services can be an important protective factor for the mental health of these women. According to the Guide, to provide high-quality care, these services must:

• Offer supportive, respectful, and non-stigmatizing environments . We must remember that up to 7 out of 10 women hide or minimize their symptoms .
• To provide mental health promotion and prevention of mental health problems through psychoeducational programs, stress management, social support for mothers, partners and family members, promoting good daily functioning and daily living skills, and identifying situations of mental health problems
• Mental health problems should be addressed through maternal and child health services when symptoms are mild or moderate, and referred to specialized services when they are moderate or severe. Treatment should always be provided by a professional with specialized training.

To effectively integrate perinatal mental health into maternal and child health services, a continuous, cyclical process is necessary, which includes:

1. Planning. This includes screening all women with perinatal mental health problems, identifying which of them could benefit from mental health support, and also identifying services that could offer additional support.
2. Preparation for implementation. The Guide highlights the importance of working with local health and social service providers, such as those offering services for victims of gender-based violence, specialized mental health services, home-based care, social services, substance abuse programs, third-sector organizations, and community support groups. Likewise, training for professional teams in maternal and child health services and establishing supervisory processes are crucial at this stage of integration.
3. Providing support and addressing special needs. It is important to ensure that all women who need it receive mental health support, and that the care they receive is tailored to their needs, taking into account any pre-existing mental health problems, substance abuse or dependence, self-harm or suicidal thoughts, disability, situations of gender-based violence, risk of social exclusion or insufficient economic resources, teenage pregnancy, etc.
4. Monitoring and evaluation. The regular and planned collection of information and its subsequent analysis allow for the evaluation of the impact of mental health services on the women served, the achievement of objectives, and the making of necessary adjustments to meet established quality standards.

The Guide itself points out that this integration of perinatal mental health into maternal and child health services represents a paradigm shift, so making the changes gradually and in a planned way requires time and the commitment of all the agents involved.