#remains the most profoundly impactful part of my mental health journey

[wh0rganic]

I need some sort of mantra reminder app that will just send me regular push notifications saying “progress never linear, DBT is going to fix me, just trust the process” because goddamn even though this program just takes a year, it feels so goddamn slow.

Ultimately I do think that DBT is going to be the most effective in the long-term out of all the therapy modalities I’ve tried. I did CBT for years and got absolutely nothing out of it. I figured out coping skills that never mattered because I was always too distressed to use them. Really, I think the root of this feeling is my overall learned mentality that therapy doesn’t really work for me. But I’ve already learned so many DBT skills that I’m actively practicing on a regular basis. I really feel like that’s something that I’m going to carry over once I graduate from therapy.

Also, yes, I’m going to get to graduate from therapy someday. It doesn’t feel possible, but I will get there.

#also I cannot talk about therapy without acknowledging that #ketamine assisted therapy #remains the most profoundly impactful part of my mental health journey #I will probably always be a KAT patient but it means I don’t have to take antidepressants anymore #and that’s all I’ve ever wanted anyway #(not that I think antidepressants are bad; I have a bad response to all of them)

[amiallbon]

Promoting the health of our future generations

The bond between a mother and child is profoundly spiritual, emotional, psychological, and physical. This bond sets up the foundation for a lifelong journey towards wellness, balance, and all-inclusive health. All mothers need to understand this bond because it provides mothers with the necessary information and knowledge to make important decisions for herself and her family. It is also important for the occupational therapist to understand the importance of this bond because they are in a position that will affect how an individual’s relationship with their mother develops over time.

In our South African communities, mothers and children make up a large percentage of our population, a population that nurtures and raises the future Elon Musk’s and Maya Angelou's that make up our next generations. In the context of South Africa, a mother's mental health is influenced by a variety of factors, many of which are linked to social determinants of health. The community's women are living in a post-apartheid socioeconomic context marked by high unemployment and a lack of career options. According to Brown et al., “30% HIV prevalence among pregnant women” (2020). “Importantly, the prevalence of intimate partner violence during pregnancy varies between 15% and 38%.” Brown and colleagues, 2020

Despite improvements over the last decade, Uganda's maternal death rate remains high, owing in part to a shortage of maternal health care. – ( Morgan et al, 2017). The effects of maternal mortality have a significant negative impact on the child and the surrounding family members. There is an unspoken burden placed on caregivers to replace the vital role a mother plays in a child's life. When using Erikson's theory of stages of development, this maternal mortality plays a large role in the development of a child's psyche. There is the possible development of mistrust, shame and doubt, and isolation leading to possible educational and behavioural issues that are not recognized as a result of maternal mortality.

Gender inequity has been demonstrated to have a negative impact on maternal health and access to and utilization of maternal health care in a variety of ways, according to research (Tolhurst et al. 2009; Namasivayam et al. 2012; Singh et al. 2012; Kraft et al. 2014). Gender divisions of labor, lack of access to and control over resources (e.g., cash, information, transportation, supplies), gender norms, restricted autonomy, and lack of decision-making authority all hinder women's capacity to receive maternal health care services on the demand side (Tolhurst et al. 2009; Singh et al. 2012, 2015). This gender inequality leads us to the topic of feminism and why the advocation of women and mothers' rights plays a vital role in occupational therapy health promotion and prevention. How am I able to assist this mother who has no autonomy over her own occupational choice let alone her child? What is my role in helping this mother and child improve their quality of life whilst respecting their context and environment?

Women in the community are living in a post-apartheid socio-economic environment with high levels of unemployment and very limited occupational choices in work.

"Occupational therapists and other health workers should be aware of the challenges faced by rural mothers and children and advocate for strategies that would improve the psychosocial and physical well-being of these women and their families.”- (Moses, 2005)

Access to health facilities for mothers and children in community practice is a significant challenge most mothers face. Clinics are understaffed and saturated with anxious, tired mothers resulting in long waiting hours, possible missed wages, and a lot of physical and emotional strain on a mother. Another challenge many women face in South Africa is the lack of accredited occupational therapists in most rural areas. Occupational therapists are uniquely placed to help mitigate these effects on the mother and her child by providing access to appropriate services for mothers to promote maternal and child health.- ( OTRSA, 2013)

Heron discusses the negative effects untreated or poorly treated depression and anxiety during pregnancy can have on a child's development. He discusses how this can lead to possible cognitive delays, behavioural issues, decreased language development, and social skills and ability. So who do we naturally gravitate towards when treating a child?

Personally, I gravitate towards the child immediately without hesitation. Inherently, they are my priority. Could this be due to the nature of my education of my strong maternal draw to children? Fortunately, I recognized this flaw within myself when treating children on my paediatric block as I was prescribing home programmes to mothers who work 22 hours a day and not seeing any progress upon follow.

Why didn’t I ask the mother how she was? What challenges she was facing and how I could make things easier for her? I found myself making excuses, “ there just isn’t enough time”, “the mother isn’t my patient”…..

My approach changed quickly and there was a huge difference seen in the progress of my patients. the mother felt heard and understood and treatment was always based around the mother's skills, needs, and resources.

To this end, the occupational therapist has a positive role to play in ensuring women, men, and children have access to the resources necessary to promote maternal and child health. We NEED to start treating children and mothers as a package deal. When one falls, so does the other.

References

1. Tachibana, Y., Koizumi, N., Akanuma, C. et al. Integrated mental health care in a multidisciplinary maternal and child health service in the community: the findings from the Suzaka trial. BMC Pregnancy Childbirth 19, 58 (2019). https://doi.org/10.1186/s12884-019-2179-9

2. Spedding, M., Stein, D., Naledi, T., & Sorsdahl, K. (2018). Pregnant women's mental health literacy and perceptions of perinatal mental disorders in the Western Cape, South Africa. Mental Health & Prevention, 11, 16-23. doi: 10.1016/j.mhp.2018.05.002

3. Cockburn, L., & Trentham, B. (2002). Participatory Action Research: Integrating Community Occupational Therapy Practice and Research. Canadian Journal Of Occupational Therapy, 69(1), 20-30. doi: 10.1177/000841740206900102

4. Spedding, M., Stein, D., Naledi, T., & Sorsdahl, K. (2018). Pregnant women's mental health literacy and perceptions of perinatal mental disorders in the Western Cape, South Africa. Mental Health & Prevention, 11, 16-23. doi: 10.1016/j.mhp.2018.05.002