Assessing the approach to perinatal mental health screening and treatment in maternal-child health clinics in Western Kenya.

Integrating mental health care into well-attended health services, such as maternal-child health (MCH), offers a promising approach to increasing access to mental health care. To inform integration, we assessed the current approach to screening and treatment of perinatal mood and anxiety disorders (PMAD) in MCH facilities in Western Kenya. We conducted a cross-sectional survey among the facility managers ("in-charges") at 20 MCH facilities in Western Kenya. Trained data collectors administered questionnaires to assess facility infrastructure and human resources, perinatal mental health screening, psychological interventions, psychiatric medication availability, and level of perinatal mental health integration into standard MCH services. Across 20 MCH facilities, the majority were located in rural areas (16,80%), 2 peri-urban (10%), and 2 urban (10%). Facilities had a median of 37.5 medical staff (IQR: 31.0, 45.5); the most common cadre was nurses (median: 9.0, IQR: 6.0, 12.5). Under half of the facilities (8, 40%) screened for PMAD using a validated tool and documented results; most (19, 95%) reported diagnosing PMAD (not necessarily through a systematic approach), yet only half (10, 53%) documented the diagnosis. The most common psychotherapy reported across the sites was supportive counseling (15, 75%). Some facilities offered evidence-based psychotherapies (e.g., cognitive behavioral therapy, problem-solving therapy, etc.), but did not report on training, supervision or guidance from the evidence-based intervention manual. Across all facilities, the availability of mental health medications was limited. Only (12, 60%) had any antidepressant available, (16, 80%) had antiepileptics, (9, 45%) had antipsychotics, and (2, 10%) had mood stabilizers available. Mental health services in MCH clinics in Western Kenya are currently not offered in a structured and systematic manner to effectively alleviate PMAD. Available infrastructure and human resources offer an opportunity to integrate an evidence-based treatment model to improve perinatal mental health in the MCH clinics in Western Kenya.