Improving maternal mental health in South East Asia through assets based approaches.

Perinatal mental illness (mainly depression and anxiety during pregnancy and the first year after childbirth) is a major global health problem. Without the right kind of support and treatment, it can have long-term negative effects on the mother's and the child's health and wellbeing. Severe mental illness is one of the main causes of maternal deaths in the first year after childbirth and perinatal mental illness can negatively impact both the physical (low birth weight babies, reduced breast feeding, severe malnutrition and hampered growth), behavioural and social development of the infant, potentially creating a trans-generational cycle of poor mental and physical health.

Perinatal mental illness disproportionately affects women who are already vulnerable, for example women exposed to violence, poor social support and low income. Although high quality information on LMICs is limited, it suggests that the occurrence of perinatal mental illness in LMIC may be three times higher than in high income countries. Therefore, effective and early treatment of perinatal mental illness is essential for the long-term welfare and wellbeing of populations in LMICs.

South East Asia comprises countries that are highly diverse in terms of ethnicity, language and culture and economic status, with several countries categorised as lower-middle and lowest income categories. In this region, perinatal mental illness is poorly understood and may be considered socially and culturally unacceptable with affected women and families experiencing stigma and blame.

Further, there is inequity of access to skilled mental healthcare professionals, and lack of care guidance appropriate to perinatal mental health. This means that perinatal mental ill health is largely under recognised and under treated. We have established a South East Asian Perinatal Mental Health Research Network (SEAPMHRN) (currently involving members from Malaysia, Myanmar, Indonesia and Thailand) which includes researchers, clinicians, and a health Ministry in the region to develop a long-term research programme in perinatal mental health.

This network has already conducted a 2-day workshop (Kuala Lumpur July 2019) to scope and establish research priorities as defined by the LMIC country participants. We aim to further expand and develop this network, bringing together multi-disciplinary experts (including NGOs and community workers) and lay people/women, to develop a context relevant research agenda for understanding and improving perinatal mental health.

The research prioritisation workshop participants identified 3 key areas to address: understanding women's experiences of perinatal mental health problems, and preferences for care; improving screening and detection; and addressing the problem of low (perinatal) mental health literacy among professionals, and the public.

This proposal is for funding to cover the following related activities:

1. To support further networking meetings, encouraging expansion of the current network to include more links to policy makers, NGOs, patient and public involvement and community development organisations, and the continuing development of research priorities; setting up appropriate communication structures e.g. website and exchange visits; supporting grant writing groups which build local research capacity.

2. Conduct foundation research for each of the 3 priority areas identified: To test the methods for digitally capturing a range of women's experiences or perinatal mental illness from across participating countries; to conduct a literature review on the validity of existing translated screening tools for detecting perinatal mental health problems in SE Asian women; to assess and adapt (if possible) existing resources for future delivery of perinatal mental health awareness training in the region.