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THE ROLE OF PEER SUPPORT IN THE TREATMENT
OF PERINATAL PSYCHIATRIC DISORDERS (PPD)
RALPH
WITTENBERG, MD
OBJECTIVES
Explain the concept of peer support
Show its place in the treatment of perinatal psychiatric disorders
(PPD)
Demonstrate its unique power
Describe how it works
Describe how to set up a program
THE PPD PUZZLE
How can there be such a catastrophic problem as PPD and no one seems
to know about it?
How can less than 15% percent of patients get any treatment in what
is supposed to be the best medical system in the world?
How is it that even when women are diagnosed they refuse treatment?
THE ROLE OF ANXIETY
PPD (PERINATAL PSYCHIATRIC DISORDERS) are always associated with
intense anxiety
Many patients appear to have pure anxiety disorders;
- Panic disorder
- Obsessive Compulsive Disorder
- Untreated, they all progress to depression
RATIONALIZED ANXIETY
Rationalization
A good reason for doing something that is not the real reason
Anxiety is a feeling of fear for no apparent reason
Anxiety makes people avoid things
Sometimes, as in compulsion, there is not choice but action
ANXIETY OBSTRUCTS CARE
Afraid of spouse's anger and rejection
Afraid of going crazy
Being institutionalized
Having the baby removed
Don't believe that those around them will help: family doctors,
etc.
Afraid of losing control
SOCIAL SUPPORT
- Society, which includes family, church, neighbors
and friends, protects the individual
- The social support network is the system
in which one is cared for and protected
- Role of the extended family (The tribe) Lost
to many city dwellers and Non-existent in impoverished populations
- The marital relationship
- The structure of society
- Mobility
- Uninvolvement
- Societal customs
THE CONVENTIONAL HEALTH CARE SYSTEM
Not set up to provide social support
Aims are generally short term
Not oriented to psychological or emotional needs
Represents societal authority, i.e. definition of what is important,
repository of approval, forced hospitalization, removal of children
NURSING AND OTHERS
Nurses are often the most likely personnel to provide emotional
support to patients
They often run the health care system
Other support personnel include; social workers, psychologists,
case managers, home visitors, lactation consultants, health educators
and doulas
THE MEANING OF NURSING
Nurses originally "nursed" babies
Importance in the history of maternal and child care is from time
immemorial
Nursing has to do with nurturance on many levels (including the
doctors)
Theoretically, then, nurses were peer mothers
THE NURSING EQUATION
Official parts of the medical system
Unofficial executives of hospitals, clinics, etc.
Multiple roles
- Nurse administrators
- Nurse practitioners
- Nursing assistants
- "The patient's friend"
PPD RX COMPONENTS
Identification and referral of patients
- Universal depression screening
- Clinical detection
- Peer contact
Treatment
- Medication
- Psychotherapy
- Peer support
- Follow up and tracking
PEER SUPPORT IN ACTION
Cheryl Hall
In the beginning, I honestly thought that when women told me I had
saved their lives or made such a difference, they were saying it
to make me feel good? It felt a bit make believe. It seemed too
powerful for just talking. But that is just it? It is the power
of talking as a peer, listening, not judging, allowing a woman to
cry on the phone for as long as she needs to, assuring her over
and over that what she is experiencing is not who she is, it is
the illness and when she gets treatment and when she gets better
she will be herself. To be kind to herself, that she is not being
punished, she didnêt bring this upon herself, she is not to blame.
To find the help a woman asks for, to try to ask the right questions,
to not try to practice medicine, and just to listen. And somehow
to the woman suffering this horrific illness on the other end of
a phone line, this feels life saving. All of these women have opened
my eyes and entered my soul.
ASPECTS OF PEER SUPPORT
One to one
- Telephone response
- Reply to consultation
Group
- Entry to treatment system
- Treatment itself
ADVICE
- Suggest group members seek medical care
- "It is not your fault!" Try to
see these problems as your illness rather than about you.
- Empowering activities to relieve depression,
i.e. talk to friends, exercise, etc
- Nothing else! Otherwise it will appear to
be the practice of medicine.
PEER SUPPORT TRAINING
PPD MOMS training
- Active listening
- Recommendations of coping activities
DRADA training
- Learning to tolerate feelings of helplessness
- Use of empathy
PROGRAM COMPONENTS
Telephone access
Recruitment of volunteers
Training programs
For PPD MOMS™
For nurse facilitators Developing treatment sites
Supervision
Tracking and data reporting
Summary
Social support is the key concept
Mothers with PPD avoid the usual sources
Conventional medical care does not meet their needs
Nurses have a unique role to play (as do social workers, lactation
consultantês health educators, etc.)
Peer support helps many mothers who would get none otherwise
CONCLUSIONS
Peer support is an essential component of the treatment of PPD
It can be organized and administered by nurses in conjunction with
survivor volunteers (PPD MOMS™)
These programs are stabilizing, empowering and therapeutic
RESOURCES
PPDHOPE.COM
The FMHI website for mothers.
1(877) PPD-HOPE
Postpartum Support International Website, Postpartum.net
Links to other resources from our website
Brochures
BIBLIOGRAPHY
Jane Honikman: Step by Step, A Guide to Organizing A Postpartum
Parent Support Network in Your Community
Carolyn White: R.N, B.S.N How You Can Build Your Own Social Support
Network
Shoshanna Bennett, PhD and Pec Indman, Ed.D, MFT: Beyond the Blues
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