Mel Child – any stories?
Post natal depression/Post partum depression
Hutchinson p. 128
Evidence suggests that between 10-15% mothers around the world experience post partum depression. Believed to be related to the huge changes in hormones at birth. Some women are particularly sensitive. Often undiagnosed. Impacts on the development relationship between mother and child. Often requires both social support and medical treatment (i.e. antidepressants). At first, most men are confused by their wives condition, however supportive. Less supportive if PND lasts many months. They often become more involved with the infant and daily nurturing tasks which can add to the mother’s feelings of inadequacy. Risk of communication breakdown. Recommended to have Doug involved in the process.
P. 131 - NOFTT stands for nonorganic failure to thrive. Usually refers to infants aged between 3 to 12 months, show poor weight gain. Lack of medical cause, thought to be related to lack of stimulus and nurturing.
Parental mental illness can lead to children being less expressive of joy and happiness than others, and less attentive in play p. 131. Can also lead to insecure attachment, mothers being negative with regard to their infants.
Treatments:
Psychotherapies – supportive technique, includes bolstering Marlene’s morale “by strengthening expectations of help and hope for the future”, helping to enlist the support of others, set realistic and achievable goals, to educate about the illness, monitor for suicide risk, provide continuous feedback on the patient’s progress (on p. 529 of Meadows)
Cognitive behavioural therapy (CBT) – uses a combination of behavioural and cognitive therapies to bring about change (own words). It is a collaborative approach which would empower Marlene to recognise that she does in fact have the ability to change certain thinking patterns, to make small changes and experience small successes in her day to day life. In essence it involves taking a bleak and negative view of oneself and reconstructing it in a more positive way. It also helps the client to increase their skills for future situations.
Education about the condition – for the community, women with PND and medical practitioners whose responsibility it is to refer women and their families for treatment and support services.
Relieving Marlene of some of her current responsibilities, extra emotional and physical support
Anti-depressants
STIGMA – social worker role to dispel
Shame, guilt
Part Two
What the social worker would do to assist Marlene.
PANDA
www.panda.org.au
Recovery process
Important to talk about feelings, not feel ashamed about it, accept PND as a possible aspect of pregnancy and birth.
Women with PND DO recover. The earlier women get in touch with relevant services the better.
Need to educate the community and health professionals about the condition, how to recognise it etc.
Direct from panda: Ideally treatment should address all aspects of her functioning - physical, psychological, emotional, social, spiritual - and be offered to her by services that understand PND and her needs for recovery
Direct from panda: Antidepressants do not 'change the personality', they correct the chemical imbalances in the brain that are thought to be responsible for the symptoms of depression and anxiety. Antidepressants are not addictive and some can be safely taken while pregnant and breastfeeding. The doctor needs to provide accurate information about the medication and careful monitoring of their effectiveness and symptom reduction.
Direct from panda: A woman with the very serious Postpartum Psychosis (in the case that there is suicide risk or risk of harm to the baby) are usually admitted to a psychiatric unit without her baby until her psychosis has been treated. She may then be admitted into a mother and baby unit with her baby.
Once the medical treatment has been organised, counselling is the next step, both one on one with a counselling, and a support group with other women experiencing similar situations – opportunity to share stories and ways of coping with PND.
Can take weeks or months to bond with a new child. It is important that a mother has the time and place for her own needs, fulfilment, creative expression.
Negative and dysfunctional thinking styles and self talk, established earlier in life, are known to contribute to depression. Unrealistic expectations, reinforced by critical and negative thinking about how well a mother feels she is meeting up to her expectations, are a common part of PND.
Building awareness of the relationship between thinking, feeling and behaviour and challenging these is the basis of Cognitive Behavioural Therapy, commonly used to treat depression. More realistic and less rigid thinking and self talk is then taught, to replace the unhelpful thinking patterns.
NEGATIVE EMOTIONS: Really strong feelings such as anger and irritability can be very difficult to control. Being absorbed by these difficult and negative emotions is a part of depression. The woman may endlessly focus on trying to understand her emotions or try to work out where they came from, in an effort to make them go away.
As recovery progresses with counselling and talking about her feelings it usually gets easier for the woman to stand back from these emotions and to gain a greater acceptance of them. Periods of more positive emotions increase with recovery.
Perhaps important for Doug and Marlene to go to counselling together to understand the issues and recovery process together and create a stronger bond.
Goal setting
Sometimes the woman with PND benefits from being given 'permission' to re-ignite her dreams and visions for her own life. These are often lost in her efforts to meet her expectations of herself as a mother and the depression process.
Self care:
For example, resting when her baby is sleeping and not doing housework, sitting to eat her lunch everyday or having a shower every morning can help to restore some normality and self care to her day, even if she doesn't feel like doing these things. Trying to go for a walk when she can or leaving the baby with her partner, a trusted family member or friend can allow her to take some time for herself. Other things such as reducing her commitments and the external demands on her for a while can help her to focus her limited energy on herself and her family. There may also be a need for her partner to reduce his work hours or defer study, training or sport commitments for a short time to be more available for support and assistance.
Support
Support and patience from family and friends is often identified by women with PND as the most crucial factor in their recovery. This support can be practical in the house or with the baby/children, or it can be emotional and social support.
ME as social worker:
Marlene, you are fortunate in that you and your family have the benefits of good nutrition, general health and access to doctors, maternal health nurse, you have a good standard of living with a husband who loves you, provides for the family and is actively involved in care-giving and family acitivies. You also have parents who are interested in you and your family and friends who care about you.
Connection to friends and other mothers – even just ringing a friend for a chat can
Small amounts of exercise when possible.
Little things to make her feel better. Suggest one or two things at a time, rather than an overwhelming list of tasks.
Knowing she WILL recover. Positive thinking. Empowerment for small achievements.
Council home help once a week to help with home chores, based on referral from sw or psychiatrist.
Accept help from friends and family and don’t feel guilty about it.
Notice when there are good days and acknowledge them.
Post and Ante Natal Depression Association Inc.
Assume I am employed at a Community Mental Health Service (CMHS) at PANDA.
The concept of mutual support underpins these services and refers to the positive effects of people with similar problems, solutions and experiences, working together in order to support each other. This may involve people identifying and sharing their knowledge and experiences about the impact of mental illness in their lives that contributes to the overall understanding of the issues for themselves, their families and carers and the broader community.
The concept of self help refers to the ability of individuals that have been affected by mental illness to take control over their own lives. People have access to information, referral and support to assist them to learn and understand the effect of mental illness in their life, in order to improve their understanding and quality of life.
References:
Hutchison, E. D. (2008), Dimensions of Human Behavior, The Changing Life Course, 3rd Ed., Sage Publications, USA.
Meadows, G., Singh, B. & Grigg, M. (2007), Mental Health in Australia, Collaborative Community Practice, 2nd Ed., Oxford University Press, Australia.
Post and Ante Natal Depression Association Inc. (PANDA), retrieved from www.panda.org.au on 15/03/09
Leis, JA, Mendelson, T., Tandon, S.D. & Perry, D.F. (2008), “A systematic review of home-based interventions to prevent and treat post partum depression”, Women’s Mental Health, no. 12, pp. 3-13