The Secret History method and the development of an ethos of care: Preparing the maternity environment for integrating mental health care in South Africa

Abstract

South Africa, like many low-and-middle-income countries, is integrating mental health services into routine Primary Health Care (PHC) through a task-shifting approach to reduce the gaps in treatment coverage. There is concern, however, that this approach will exacerbate nurses’ abuse of patients currently common within PHC in the country. To address this concern, the Perinatal Mental Health Project developed its Secret History method, a critical pedagogical intervention for care-providers working within maternity settings. This article describes the method’s theoretical underpinnings and practical application amongst nurses. Drawing on Augusto Boal’s Theatre of the Oppressed and contrary to traditional nursing training in South Africa, the method creates a space for nurses to interrogate and reimagine nurse–patient relations. By introducing nurses to a counter ideology of empathic care, the method seeks to prepare the maternity environment for mental health task-shifting initiatives and ensure these initiatives are more democratic, responsive and humane.