A stepped care model for maternal mental health in Uganda

At the end of September we flew to Uganda for our annual field visit to PCAF, a very strong and committed partner. PCAF is an international agency established by two parents in memory of their son killed in the September 11 attacks. They are dedicated to implementing and strengthening mental health and recovery programs in communities affected by war and armed conflict to “rebuild, recover and thrive”.

We have supported PCAF since 2016 in the implementation of a maternal mental health project in the Eastern region of Uganda (Soroti District). The project is based on data showing that maternal mental health interventions can be effective in preventing or reducing mental illness in mothers and their effects on children.

PCAF promotes a stepped care model and creates a scalable and cost-effective intervention for maternal mental illness by first delivering the most effective, yet least resource-intensive treatments. Psychoeducation, interpersonal therapy groups and specialized care are the three steps provided to pregnant women once they have been screened for depression during their prenatal visit.

PCAF facilitates this model integrating task-shifting, local perspective and evidence-based practice. This approach combines treatment and prevention and promotes a participatory approach among all the stakeholders involved.

Josephine Akellot Ocama, responsible for this project, walked us with her team to the homes of three mothers and their families who have been involved in the project. Caroline, Catherine and Christine* gave us a very warm welcome and openly shared their experiences, their difficulties and how the program has helped them to start on a new and positive path. Caroline fully recovered from depression after attending psychoeducation sessions and Catherine recovered after attending an IPT group. Family therapy has been suggested to the third mother, Christine, which she is to start soon.

It was also touching to see how happy and supportive the husbands of these three wonderful women were about their wives’ recoveries. This is a direct result of the inclusion of the husbands in the health education talks that the team carries out and an innovative component PCAF introduced in July. It has been noticed that if husbands attend psychoeducational meetings with their partners they gain a better understanding of the psycho-psychical problems their wives are going through and become more encouraging during the recovery process.

We highly value the work carried out by PCAF. Their team is always searching for the best solutions while taking the local context, the available resources and the sustainability of the project into consideration. We could not be happier with their results and cannot wait to go back to Uganda for the next field visit.

*The women’s names have been changed.