8 Resources


1. Screening tools for common mental disorders

Mental Distress Tool (English)

(ONLY to be conducted if there are resources available for referral, e.g. mental health nurse, social worker, NGO, medical officer.)

Suggested words to use before screening: “We would like to know about all the women who come here: how they are doing physically and emotionally. This helps us to understand the best sort of care we can offer. Please may I ask you three questions about how you are emotionally? Please answer ‘yes’ or ‘no’ to each question.”

In the last 2 weeks, have you on some or most days felt unable to stop worrying or thinking too much? ☐Yes (1) ☐No (0)
In the last 2 weeks, have you on some or most days felt down, depressed or hopeless? ☐Yes (1) ☐No (0)
In the last 2 weeks, have you on some or most days had thoughts and plans to harm yourself or commit suicide? (The self harm question will require urgent referral if there are both thoughts AND plans. If there is a history of previous attempt, referral is required even if there are thoughts alone.) ☐Yes (1)
☐No (0)
☐ 1
☐ 2 > Refer
☐ 3 > Refer
Offered counselling ☐Yes (1) ☐No (0)
Accepted counselling ☐Yes (1) ☐No (0)

Mental Distress Tool (Afrikaans)

(Hierdie gesprek moet SLEGS gedoen word as daar hulpbronne beskibaar is waarheen vrouens verwys kan word, bv. ’n geestelike gesondheids verpleegster, maatskaplike werker, NPO of mediese beampte.)

Voorgestelde inleiding tot die gesprek: “Ons wil graag uitvind oor al die vrouens wat hierheen kom: Hoe is hulle emosionele en fisiese welstand? Dit help ons om vas te stel watter tipe sorg ons kan bied. Kan ek jou asseblief drie vrae oor jou emosionele welstand vra? Antwoord asseblief ‘ja’ of ‘nee’ op elke vraag.

In die laaste 2 weke, het jy op sommige of meeste van die dae gevoel asof jy jou nie kan ophou bekommer (worry) oor goed nie of dat jy te veel dink? ☐Ja (1) ☐Nee (0)
In die laaste 2 weke, het jy op sommige of meeste van die dae depressief / af en hopeloos gevoel? ☐Ja (1) ☐Nee (0)
In die laaste 2 weke, het jy op sommige of meeste van die dae gedagtes gehad en planne gemaak om jouself seer te maak of om selfmoord te pleeg? (Verwys dringend na hulp as daar beide gedagtes EN planne is vir die vraag oor selfskade en selfmoord. As daar in die verlede reeds ’n poging was, is ’n verwysing noodsaaklik, selfs al is daar net gedagtes) ☐Ja (1)
☐Nee (0)
☐ 1
☐ 2 > Verwys
☐ 3 > Verwys
Berading aangebied ☐Ja (1) ☐Nee (0)
Berading aanvaar ☐Ja (1) ☐Nee (0)

Mental Distress Tool (IsiXhosa)

Isixhobo sokuphelisa uxinzelelo kwabakhulelweyo

(Eyokuqhutywa KUPHELA ukuba zikhona izixhobo zokuthumela, umz. umongikazi wempilo zasengqondweni, unontlalontle, NGO, ugqirha)

Amagama acetyiweyo okusetyenziswa phambi kokuhlola: “Singathanda ukwazi ngabo bonke omama abaza apha: ukuba baziva njani emzimbeni nasemphefumlweni. Oku kusinceda siqonde olona hlobo lululo loncedo esingalunikeza.

Kweziveki ezimbini ezigqithileyo, ubukhe kwezinye iintsuku okanye phantse zonke iintsuku waziva ungakwazi ukuyeka ukukhathazeka okanye ukucinga kakhulu? ☐Ewe (1) ☐Hayi (0)
Kweziveki ezimbini ezigqithileyo, ubukhe kwezinye iintsuku okanye phantse zonke iintsuku waziva umzimba uphantsi, udakhumbile (udepressed) okanye ungena themba? ☐Ewe (1) ☐Hayi (0)
Kweziveki ezimbini ezigqithileyo, ubukhe kwezinye iintsuku okanye phantse zonke iintsuku waba neengcinga kunye namacebo okuzenzakalisa okanye ukuzibulala? (Ndingakubuza imibuzo emithathu malunga nokuba uziva njani emphefumlweni? Nceda phendula ‘ewe’ okanye ‘hayi’ kumbuzo ngamnye.) ☐Ewe (1)
☐Hayi (0)
☐ 1
☐ 2 > Thumela
☐ 3 > Thumela
Wanikwa icounselling ☐Ewe (1) ☐Hayi (0)
Wavuma icounselling ☐Ewe (1) ☐Hayi (0)

Mental Distress Tool (French)

Troubles at afflictions psychologiques chez les Mamans – Outil d’Evaluation.

(Cette évaluation est indiquée uniquement dans les cas où il est possible d’aiguiller le patient vers les services de santé ou de soutien (infirmière en santé mentale, assistante sociale, ONG, docteur).

Avant de procéder à l’évaluation, présentez l’objectif de cet outil dans les termes suivants: “Nous souhaitons mieux connaître toutes les femmes qui viennent en consultation ici, notamment leur état physique et mental. Ceci nous aide à mieux adapter les soins que nous offrons. Est-ce-que vous êtes d’accord que je vous pose trois questions au sujet de votre état émotionnel ? Si oui, veuillez répondre ‘oui’ ou ‘non’ à chacune des questions.

Est-ce que, pour la plupart des quinze derniers jours, vous n’avez pas pu vous empêcher d’être préoccupée, ou de réfléchir trop? ☐Oui (1) ☐Non (0)
Pour la plupart des derniers quinze jours, est ce que vous vous êtes sentie accablée, déprimée ou désespérée? ☐Oui (1) ☐Non (0)
Pour la plupart des derniers quinze jours, avez-vous pensé et planifié de vous automutiler ou vous suicider? (L’aiguillage est urgent si le patient répond avoir pensé ET planifié une action d’automutilation ou de suicide. Si les antécédents cliniques du patient font état d’une tentative précédente, l’aiguillage est nécessaire même si le patient a pensé mais pas planifié une action d’automutilation ou de tentative de suicide) ☐Oui (1)
*Aiguillage indiqué*
☐Non (0)
☐ 1
☐ 2 > Aiguillage indiqué
☐ 3 > Aiguillage indiqué
Soins psychosociaux proposés ☐Oui (1) ☐Non (0)
Soins psychosociaux acceptés ☐Oui (1) ☐Non (0)

Edinburgh Postnatal Depression Scale (EPDS) (English)

My feelings now that I am pregnant/have had a baby

As you are pregnant/have had a baby, we would like to know how you are feeling. It may assist us in choosing the best care for your needs. The information you provide us will be kept private and confidential.

There is a choice of 4 answers for each question. Please mark the 1 that comes closest to how you have felt in the past seven days, not just how you feel today.

  1. I have been able to see the funny side of things:
    ☐ As much as I always could
    ☐ Not quite so much now
    ☐ Definitely not so much now
    ☐ Not at all
  2. I have looked forward with enjoyment to things:
    ☐ As much as I ever did
    ☐ A little less than I used to
    ☐ Much less than I used to
    ☐ Hardly at all
  3. I have blamed myself when things went wrong, and it wasn’t my fault:
    ☐ Yes, most of the time
    ☐ Yes, some of the time
    ☐ Not very much
    ☐ No, never
  4. I have been worried and I don’t know why:
    ☐ No, not at all
    ☐ Hardly ever
    ☐ Yes, sometimes
    ☐ Yes, very much
  5. I have felt scared or panicky and I don’t know why:
    ☐ Yes, quite a lot
    ☐ Yes, sometimes
    ☐ No, not much
    ☐ No, not at all
  6. I have had difficulty in coping with things:
    ☐ Yes, most of the time I haven’t been coping at all
    ☐ Yes, sometimes I haven’t been coping as well as usual
    ☐ No, most of the time I have been coping quite well
    ☐ No, I have been coping as well as ever
  7. I have been so unhappy I have had difficulty sleeping:
    ☐ Yes, most of the time
    ☐ Yes, sometimes
    ☐ Not very much
    ☐ No, not at all
  8. I have felt sad and miserable:
    ☐ Yes, most of the time
    ☐ Yes, quite a lot
    ☐ Not very much
    ☐ No, not at all
  9. I have been so unhappy that I have been crying:
    ☐ Yes, most of the time
    ☐ Yes, quite a lot
    ☐ Only sometimes
    ☐ No, never
  10. I have thought of harming myself or ending my life:
    ☐ Yes, quite a lot
    ☐ Sometimes
    ☐ Hardly ever
    ☐ Never

Thank you

Edinburgh Postnatal Depression Scale (EPDS) (Afrikaans)

My gevoelens nou dat ek swanger is/my baba gekry het

Nou dat jy swanger is/die baba het, wil ons graag weet hoe jy voel. Dit mag ons help om die beste sorg vir jou behoeftes te beplan. Die inligting wat jy aan ons verskaf sal privaat en vertroulik hanteer word.

Daar is ’n keuse van vier antwoorde vir elke vraag. Omsirkel asseblief die antwoord wat die beste beskryf hoe jy gedurende die afgelope sewe dae gevoel het, nie net hoe jy nou vandag voel nie.

Gedurende die afgelope sewe dae:  

  1. Kon ek die snaakse kant van dinge sien:
    ☐ So maklik soos ek altyd kon
    ☐ Nie heeltemal so maklik nie
    ☐ Definitief nie so maklik nie
    ☐ Glad nie
  2. Kon ek met genot na dinge uitsien:
    ☐ So baie soos ek altyd het
    ☐ ’n Bietjie minder as wat ek altyd het
    ☐ Baie minder as wat ek gewoonlik het
    ☐ Amper glad nie
  3. Het ek myself blameer wanneer dinge verkeerd gaan, al was dit nie my skuld nie:
    ☐ Ja, meeste van die tyd
    ☐ Ja, soms
    ☐ Nee, nie dikwels nie
    ☐ Nee, nooit nie
  4. Was ek bekommerd en ek weet nie hoekom nie:
    ☐ Nee, glad nie
    ☐ Omtrent nooit
    ☐ Ja, soms
    ☐ Ja, dikwels
  5. Het ek bang en paniekerig gevoel en ek weet nie hoekom nie:
    ☐ Ja, nogal baie
    ☐ Ja, soms
    ☐ Nee, nie so baie nie
    ☐ Nee, glad nie
  6. Het ek gesukkel om dinge te hanteer:
    ☐ Ja, meeste van die tyd sukkel ek om dinge te hanteer
    ☐ Ja, soms hanteer ek dinge nie so maklik soos gewoonlik nie
    ☐ Nee, meesal hanteer ek dinge redelik goed
    ☐ Nee, ek hanteer dinge so goed as wat ek altyd kon
  7. Was ek so ongelukkig dat ek sleg geslaap het:
    ☐ Ja, meeste van die tyd
    ☐ Ja, soms
    ☐ Nie dikwels nie
    ☐ Nee, glad nie
  8. Het ek hartseer en ongelukkig gevoel:
    ☐ Ja, meeste van die tyd
    ☐ Ja, nogal dikwels
    ☐ Nie dikwels nie
    ☐ Nee, nooit nie
  9. Was ek so hartseer dat ek gehuil het:
    ☐ Ja, meeste van die tyd
    ☐ Ja, dikwels
    ☐ Net soms
    ☐ Nee, nooit
  10. Die idee om myself leed aan te doen het al by my opgekom:
    ☐ Ja, nogal dikwels
    ☐ Soms
    ☐ Amper nooit
    ☐ Nooit

Baie dankie

Edinburgh Postnatal Depression Scale (EPDS) (isiXhosa)

Indlela endiziva ngayo ngexa ndikhulelweyo naxa disasandula ukufumana umntwana

Njengokuba ukhulelewe okanye usandula ukufumana usana sifuna ukwazi ukuba uziva njani. Oko kungasinceda ukukhetha eyona ndlela esingathi sincedisane nemfuno zakho. Yonke inkcazelo oyakuthi usinike yona izakugcinwa iyimfihlo.

Kunentlobo ezine zempendulo kumbuzo ngamnye, Nceda yenza isangqa kwenye ethe yasondela kwindlela ubuziva ngayo kwintsuku ezisixhenxe ezidlulileyo, hayi ngendlela oziva ngayo ngoku.

Kwintsuku ezisixhenxe ezidlulileyo:  

  1. Ndibenakho ukubona icala lezinto ezingalunganga:
    ☐ Kangangoko bendisenza
    ☐ Hayi kangako
    ☐ Ngokuqinesekileyo akukho kangako ngoku
    ☐ Akukho kwaphela
  2. Izinto ndizijonga ndinolonwabo:
    ☐ Njengoko bendihlala ndisenza
    ☐ Kancinane kunokuba ndisenza
    ☐ Kancinci kakhulu kunokuba bendisenza
    ☐ Hayi konke konke
  3. Bendibeka ityala kum xa izinto zingandihambeli kakhule, ibe ingeyompazamo yam:
    ☐ Ewe amaxesha amaninzi
    ☐ Ewe ngelinye ixesha
    ☐ Hayi kangako
    ☐ Hayi kwaphela
  4. Bendikhathazekile kwaye ndingamazi unobangela:
    ☐ Hayi konke konke
    ☐ Kunqabile ukuba kwenzeka
    ☐ Ewe ngamanye amaxesha
    ☐ Ewe kakhulu
  5. Bendiziva ndisoyika okanye ndinexhala kwaye ndingamazi unobangela:
    ☐ Ewe kakhulu
    ☐ Ewe ngamanye amaxesha
    ☐ Hayi kangako
    ☐ Hayi konke konke
  6. Ndifumene ubunzima kakhulu ukumelana nezinto:
    ☐ Ewe ixesha elininzi bendikwazi ukumelana nezinto
    ☐ Ewe ngelinye ixesha bendingakwazi ukumelana nezinto ngendlela ebendimelana nazo ngayo
    ☐ Hayi ixesha elininzi bendiphumelela kakhulu
    ☐ Hayi bendingafumani bunzima kwaphela
  7. Bendingonwabanga kakhulu kwaye bendifumana ubunzima xa kufuneka ndilele:
    ☐ Ewe ixesha elininzi
    ☐ Ewe ngalinye ixesha
    ☐ Hayi kangako
    ☐ Hayi konke konke
  8. Bendizive ndibuhlungu kwaye ndixhalisekile:
    ☐ Ewe amaxesha amaninzi
    ☐ Ewe ngolonahlobo
    ☐ Hayi kangako
    ☐ Hayi konke konke
  9. Bendingonwabanga kakhulu ndisoloko ndilila:
    ☐ Ewe ixesha elininzi
    ☐ Ewe ngolonahlobo
    ☐ Ngamanye amaxesha
    ☐ Hayi azange
  10. Ingcinga yokuzenzakalisa ike yandifikela:
    ☐ Ewe ngolonahlobo
    ☐ Ngamanye amaxesha
    ☐ Ayizange kwaphela
    ☐ Ayizange

Enkosi kakhulu

Edinburgh Postnatal Depression Scale (EPDS) (French)

Mes sentiments, maintenant que je suis enceinte/que j’ai un bébé

Comme vous êtes enceinte/vous avez un bébé, nous aimerions savoir comment vous vous sentez. Cela nous aidera à choisir les meilleurs soins dont vous avez besoin. Les renseignements que vous nous fournirez demeureront privés et confidentiels.

Il y a un choix de quatre réponses pour chaque question. Encerclez celle qui se rapproche le plus de la manière dont vous vous êtes sentie les sept derniers jours, et pas seulement la manière dont vous vous sentez aujourd’hui.

Les sept derniers jours:  

  1. J’ai été capable de voir le côté amusant des choses:
    ☐ Autant que je l’ai toujours pu
    ☐ Pas autant maintenant
    ☐ Certainement pas autant
    ☐ Pas du tout
  2. J’ai attendu les événements avec impatience et plaisir:
    ☐ Autant que je l’ai toujours fait
    ☐ Un peu moins qu’auparavant
    ☐ Bien moins que d’habitude
    ☐ Presque pas
  3. Je me suis blâmée quand les choses n’allaient pas bien et que ce n’était pas ma faute:
    ☐ Oui, la plupart du temps
    ☐ Oui, quelquefois
    ☐ Pas beaucoup
    ☐ Non jamais
  4. J’étais inquiète, et je ne savais pas pourquoi:
    ☐ Non, pas du tout
    ☐ Presque jamais
    ☐ Oui, quelquefois
    ☐ Oui, beaucoup
  5. Je me suis sentie effrayée et pleine de panique et je ne savais pas pourquoi:
    ☐ Oui, beaucoup
    ☐ Oui, quelquefois
    ☐ Non, pas beaucoup
    ☐ Non pas du tout
  6. J’ai eu des difficultés à faire face aux événements:
    ☐ Oui, la plupart du temps, je n’ai pas pu me débrouiller
    ☐ Oui, quelquefois, je n’ai pas pu me débrouiller comme d’habitude
    ☐ Non, la plupart du temps, je me suis assez bien débrouillée
    ☐ Non, je me suis pas débrouillée aussi bien qu’avant
  7. J’ai été si malheureuse, que j’ai eu des difficultés à dormir:
    ☐ Oui, la plupart du temps
    ☐ Oui, quelquefois
    ☐ Pas beaucoup
    ☐ Non, pas du tout
  8. Je me suis sentie triste et misérable:
    ☐ Oui, la plupart du temps
    ☐ Oui, beaucoup
    ☐ Non, pas beaucoup
    ☐ Non, pas du tout
  9. J’ai été si malheureuse que j’ai pleuré:
    ☐ Oui, la plupart du temps
    ☐ Oui, beaucoup
    ☐ Quelquefois seulement
    ☐ Non, jamais
  10. La pensée de me faire du mal m’est venue:
    ☐ Oui, souvent
    ☐ Quelquefois
    ☐ Presque jamais
    ☐ Jamais


Risk Factor Assessment (RFA) (English)

My situation now that I am pregnant/have had my baby:

We are interested to find out how your situation is in your pregnancy/now that you have had your baby. This questionnaire may help us suggest extra care for you if necessary. Your answers will be kept confidential. Please answer either yes or no to the following questions. Tick the box.

    Yes No
1 I feel pleased about being pregnant/now that I have had my baby.
2 I have had some very difficult things happen to me in the last year (e.g. losing someone close to me, losing my job, moving home, etc.)
3 My husband/boyfriend and I are still together.
4 I feel my husband/boyfriend cares about me (say no if you are not with him anymore).
5 My husband/boyfriend or someone else in the household is sometimes violent towards me.
6 My family and friends care about how I feel.
7 I have experienced some kind of abuse in the past (e.g. physical, emotional, sexual, rape).
8 My family and friends help me in practical ways.
9 On the whole, I have a good relationship with my own mother (say no if your mother has passed away).
10 I have experienced one of the following in the past: miscarriage, abortion, stillbirth, or the death of a child any time after birth.
11 I have had serious depression, panic attacks or problems with anxiety before.

Thank you

Risk Factor Assessment (RFA) (Afrikaans)

My situasie nou dat ek swanger is/my baba gekry het

Ons stel daarin belang om uit te vind wat jou situasie is in jou swangerskap/nou dat jy jou baba gekry het. Hierdie vrae kan ons help om moontlik extra hulp vir jou aan te bied indien nodig. Jou antwoorde sal vetroulik hanteer word.

Antwoord asseblief Ja of Nee op die volgende vrae. Maak ’n kruisie.

    Ja Nee
1 Ek voel gelukkig nou dat ek swanger is/my baba het.
2 Baie moeilike dinge het in die afgelope jaar met my gebeur (bv. iemand na aan my is dood, ek het my werk verloor, ek het getrek).
3 My man/vriend en ek is nog bymekaar.
4 Ek voel dat my man/vriend gee om vir my (merk Nee as julle nie meer bymekaar is nie).
5 My man/vriend of iemand anders in die huis tree soms agressief teenoor my op.
6 My familie en vriende gee om hoe ek voel.
7 Ek was al in die verlede mishandel (bv. fisies, emosioneel, sexueel, verkrag).
8 My familie en vriende help my op praktiese maniere.
9 Oor die algemeen het ek ’n goeie verhouding met my eie ma (merk Nee as jou ma reeds oorlede is).
10 Ek het een van die volgende in die verlede ervaar: miskraam, aborsie, stilgeboorte, dood van my kind enige tyd na geboorte.
11 Ek het vantevore aan ernstige depressie gelei, paniek aanvalle of probleme met angs gehad.


Risk Factor Assessment (RFA) (isiXhosa)

Imeko endikuyo njengokuba ndikhulelwe/naxa ndifumene umntwana

Sinomdla wokwazi injani imeko okuyo njengokuba ukhulelewe okanye ufumene umntwana. Lemibuzo ingasinceda ukuthi sikwazi ukukubonelela ngoncedo xa kuyimfuneko. Impendulo yakho iyakugcinwa iyimfihlo. Nceda phendula apha Ewe okanye Hayi kulemibuzo ilandelayo. Hlaba kwibhokisi.

    Ewe Hayi
1 Ndiziva ndixolile njengokuba ndinzima/njengokuba ndifumene umntwana.
2 Ndibenezinto ezibuhlugu kakhulu ezindehleleyo kulonyaka uphelileyo (umzekelo ndaye ndaphulukana nomsebenzi, ndaphulukana nomntu owayesondele kakhulu kum, ndafuna indawo yokuhlala ngokutsha).
3 Umyeni/isoka lam sisekunye kunye (uthi hayi ukuba anisahlali kunye).
4 Ndicinga ukuba umyeni/isoka lam lindikhathalele kakhulu.
5 Umyeni/isoka lam okanye omnye umntu endlini ngamanye amaxesha babanobundlongondlongo kum.
6 Izazalwane kunye nezihlobo zam ziyikhathalele indlela endiziva ngayo.
7 Ndifumene ingxaki yokuphatheka kakubi kwixesha elidlulileyo (umzekelo ngokwasemzimbeni, ngokwasemphefumulweni, ngokwesondo nangokudlwengulwa).
8 Izizalwane nezihlobo zam bezindinceda kwizinto ezenziwayo.
9 Ngokupheleleyo ubuhlolo phakathi kwam nomama buhle kakhulu.
10 Ndifumene ezingxaki kwixesha elidlulileyo: ukuphuma isisu, ukuqhomfa, ukuzala umntwana sele etshabile, okanye ukuswelekelwa ngumntwana sendimfumene.
11 Ndike ndaba nokudakumba okuxhalabisayo komphefumlo, ndaziva ngathi. Ndivaleka umphefumlo, intliziyo ibetha ngamandla, ndinokudinwa okugqithileyo kwixesha elidlulileyo.


Risk Factor Assessment (RFA) (French)

Ma situation, maintenant que je suis enceinte/que j’ai un bébé

Nous aimerions connaître votre situation durant votre grossesse. Ce questionnaire nous aidera à suggérer des soins supplémentaires pour vous, si c’est nécessaire. Vos réponses seront confidentielles.

    Oui Non
1 Je suis heureuse d’être enceinte.
2 J’ai connu des difficultés au cours de l’année dernière (par exemple: perte de quelqu’un de cher, perte de mon emploi, déménagement, etc).
3 Mon mari/compagnon et moi sommes toujours ensemble.
4 Je sens que mon mari/compagnon m’aime toujours (dites Non, si vous n’êtes plus avec lui).
5 Mon mari/compagnon, ou quelqu’un d’autre à la maison est quelquefois violent avec moi.
6 Ma famille et mes amis se soucient de la manière dont je Me sens.
7 J’ai souffert quelque forme de mauvais traitement dans le passé (ex. physique, émotionnel, sexuel, viol).
8 Ma famille et mes amis m’aident dans les choses pratiques.
9 Dans l’ensemble, je jouis d’une bonne relation avec ma propre mère (écrivez « non », si votre mère est morte).
10 J’ai subi l’un des chocs suivants dans le passé: fausse-couche, avortement, enfant mort-né ou la mort d’un enfant quelque temps après la naissance).
11 J’ai souffert de dépression sérieuse, panique ou des problèmes d’anxiété au passé.


2. Making referrals

2-1 How to write a referral letter

A letter of referral may be used when referring to an organisation outside your facility. Use the template to draft a letter of referral.

Letter of referral

Address of your health unit District
Telephone number

Contact at referral organisation
Name of referral organisation
Address of referral organisation

Date [insert date here]

Dear [include name of contact person here]

Re: [include name of patient here]

Thank you for considering [include name of patient here]. She is [include age of patient here] years old.

I am concerned about this patient because [include details of your concerns].

I hope that you will be able to assist her with her difficulties.

Please contact me for further information and to let me know that this referral has been successful. My telephone number is [include your contact number here].

Yours sincerely

Your name

Job Title

2-2 Mental Health Referral Evaluation

This evaluation form helps to see if your referral has been useful.

After referring your client, complete a ‘follow-up’ evaluation using the referral evaluation form.

Referral Evaluation Form

Date referral made

Who made the referral?

Where referred to?

Date of appointment?

Did you go? Yes/No

If No, what stopped you?

If Yes, did you get help for your problem? Yes/No

What help was given?

What do you think about the help that was offered?

Would you recommend that place to a friend? Yes/No


3. Useful contact numbers for care providers in South Africa

ICAS (an employee wellness support organisation)

In many provinces, care providers and their dependents have access to the ICAS employee wellness service.

SADAG (South African Depression & Anxiety Group)

SADAG offers referrals to psychologists, psychiatrists or support groups by trained counsellors.

FAMSA (Families South Africa)

FAMSA offers counselling for couples and families, with branches throughout South Africa. National office telephone number: 011 975 7106/7


Lifeline offers support for personal crisis, trauma, abuse or rape. Toll-free number: 0861 322 322

4. Resources for pregnant women and new mothers

The following resources can be photocopied and given to pregnant or new mothers.

A few suggestions:

About 1 out of every 3 pregnant women suffers from depression or anxiety during or after pregnancy. It is not your fault. You are not a bad mother. You can and should get help.

Useful phone numbers

FAMSA (Families South Africa) 011 975 7106/7

Lifeline 0861 322 322

SA Depression and Anxiety Group 011 262 6396

AIDS Helpline 0800 012 322

Other (add your own notes below)

Organisation Number

5. Information about termination of pregnancy

Certain public health facilities should be able to perform terminations of pregnancy free of charge. These services are less available in rural areas.

The Marie Stopes Clinics also do terminations. They are an international organisation offering services in sexual and reproductive health. They have 14 centres around South Africa and practise under World Health Organisation clinical guidelines. Terminations are subsidised and are much cheaper than having it done in a private clinic. The cost of the abortion depends on how far the pregnancy has progressed and also on where the clinic is situated. Further details can be found on: www.mariestopes.org.za or their toll-free number 0800 11 77 85.

6. Information on adoption services

The National Department of Social Development is responsible for child protection services in South Africa. Social workers are trained to assist with adoptions. There are many adoption agencies in the country.

6-1 What is the process for adoption?

If the biological parents of the child are alive, they must both consent to the adoption. Consent is not necessary if the parent or guardian:

Both the mother and the father must sign the consent form to allow the adoption by a specific person or couple. If the biological parents are not married, the mother and father must also both give consent for the adoption of the child. Biological parents can withdraw their consent within 60 days of signing their consent.

A child may be placed temporarily with caregivers who are not the child’s family. This is called foster care. In most cases the foster child lives with their foster carers full time but the length of their stay will depend on individual needs and circumstances.

When the child is adopted, all parental responsibilities and rights between the child and its biological parents end. An adoption is finalised once the adoption order is finalised.

6-2 What needs to happen for the child to be placed with an adoptive family?

For an adoption to take place, an adoption agency needs to:

6-3 What organisations help with adoptions?

Organisations that assist with adoption services:

Afrikaanse Christelike Vroue Vereniging (ACVV)


Child Welfare South Africa (CWSA)

Other resources

Other websites that provide information about adoptions include:

7. Maintenance Orders

This information applies to South Africa. It is worth finding out about relevant laws and processes in your country.

7-1 What is the process for getting a Maintenance Order?

The mother (for the sake of simplicity, we refer to a mother applying for a Maintenance Order in this section, however, fathers and other primary caregivers can also apply) needs to go to the Maintenance Office at the Maintenance Court in her area to apply for the court order. The mother will need to fill in a form.

7-2 What if the person ordered to pay maintenance does not pay?

For more information contact the Maintenance Officer at your local Magistrates’ Court.

8. Child Support Grants

This information applies to South Africa. It is worth finding out about relevant laws and processes in your country.

The Child Support Grant is a monthly payment to help parents or primary caregivers in financial need to support the children in their care. The amount changes every year. From 1 April 2017 the Child Support Grant is R380 per month.

8-1 Who qualifies for a Child Support grant?

Parents or primary caregivers can apply for this monthly payment on behalf of the children in their care.

When primary caregivers apply for a grant for a child, they must declare under oath that they are the primary caregiver, and provide some documentary proof of this. They cannot receive this grant for more than 6 children, unless the children are legally adopted.

Children who are heading households, and who are between the ages of 16 and 18, can apply for the Child Support Grant with the help of a supervising adult, like a social worker.

Parents or primary caregivers who earn below a certain amount can also access this grant.

8-2 What is the process for getting a Child Support grant?

Parents or primary caregivers can apply for a grant at their nearest South African Social Security Agency (SASSA) office. There is no cost to apply.

The parent or primary caregiver will need:

If the primary caregiver is not the child’s parent or guardian:

At the SASSA office, the parent or primary caregiver will be asked to complete and sign a form known as a ‘sworn affidavit’, confirming who the person and the children are. The parent or primary caregiver will also be asked to bring an affidavit from a reputable person (like a councillor, traditional healer, social worker, priest or school principal) who can verify that they know the person. SASSA may also ask for other documents, like a clinic card or the child’s school report.

At the SASSA office, the parent or primary caregiver will be assisted to complete the forms. The person will be interviewed and fingerprints will be taken.

If the parent or primary caregiver cannot go to the office, a friend or family member can take the documents, with a letter from the person and a doctor saying that the person cannot go to the SASSA office. A SASSA official will then arrange to visit the person at home.

When the parent or primary caregiver makes the application, the person must say how he/she would like the money to be paid. The person can:

In some SASSA offices, applicants are told immediately whether or not they qualify for a grant.

SASSA cannot take longer than 3 months from the date of the application to start paying the grant. The payments will be backdated to the date the parent or primary caregiver applied for the grant, if it takes this long.

The parent or primary caregiver can phone the free SASSA helpline: 0800 601 011 to find out what has happened to the application and when the person can expect payment.

The parent or primary caregiver does not need to renew the grant.

Every year, SASSA will send the person a registered letter asking to provide up-to-date information about the person’s financial situation. If the person’s financial situation gets better before SASSA sends this letter, it is the person’s responsibility to let SASSA know. It is the person’s responsibility to let SASSA know of any other changes in his/her situation.

Child Support Grants will be stopped:

For more information contact a local SASSA office or look at: www.services.gov.za/services/content/Home/ServicesForPeople/Socialbenefits/childsupportgrant/en_ZA

9. Protection Orders

This information applies to South Africa. It is worth finding out about relevant laws and processes in your country. This information below is taken from Miller R. (2003). It’s an Order! A simple guide to your rights. Cape Town: Mosaic Training, Service and Healing Centre for Women (www.mosaic.org.za).

9-1 What is a Protection Order?

A Protection Order is a document which legally forbids an abuser from committing any acts of domestic violence against the applicant (e.g. woman). The types of abuse covered by Protection Orders are:

Anyone who has been or is being abused can apply for a Protection Order. In this section, we will refer to a woman applying for a Protection Order. Also:

Depending on the severity of the abuse, once the application forms and affidavit have been completed, an Interim Protection Order might be granted for a short period until the date the abuser must appear in front of the magistrate for the hearing of the case. Once the Protection Order is finalised, the Protection Order is permanent. A Protection Order can be withdrawn.

9-2 What is the process for getting a Protection Order?

All courts process Protection Orders slightly differently, but the procedure that most courts follow is described below.

Applying for the Protection Order

A woman can apply for a Protection Order at any Magistrates’ Court nearest to where she lives or works, nearest to where her abuser lives or works, or nearest to where the abuse took place.

  1. The woman will have to fill in an application form for a Protection Order and write out a statement (affidavit) about the abuse.
  2. She will be asked to make a sworn statement to the clerk or policeman that what she has written is true, and sign the application form. Her file will be passed on to the magistrate.
  3. The magistrate will read through the application form and decide if the woman qualifies for an Interim (temporary) Protection Order or not.
  4. If it is granted, the clerk will tell the woman what her court return date is, and will give her an application number.
  5. The magistrate will issue a Notice to Appear in Court to the abuser, which will inform him that an application for a Protection Order has been made, and that he must appear on the return date to give his side of the story.
  6. The police or sheriff will go to the abuser’s address and serve the copy of the Interim Protection Order on the woman’s abuser.
  7. The police or the sheriff will fill in the Return of Service form, and return it to the court when the Protection Order has been served.
  8. Then, the woman will be entitled to receive an Interim Warrant of Arrest, which she must get from the court. Some courts may only give a Final Warrant of Arrest when a woman appears in court for the Protection Order to be made final.
  9. If the clerk does not give the woman an Interim or Final Warrant of Arrest, she must demand one or report it to the chief magistrate.
  10. The woman’s court return date should not be less than 10 days after the Interim Protection Order has been served on the abuser. However, there is no time limit as to how far in advance the date should be made for the final court hearing.

Finalising the Protection Order

  1. The Interim Protection Order lasts until the woman and her abuser have to go back to court on the woman’s return date to find out if she can get a Final Protection Order.
  2. During her hearing in court, the magistrate, and lawyers (if she or the abuser have one) will ask questions to her and her abuser.
  3. The magistrate will decide if the woman can have a Final Protection Order on the basis of her affidavit and on the basis of what she and the abuser said in court.
  4. With the Final Protection Order, the woman will also get a Final Warrant of Arrest.
  5. If the woman’s Protection Order is lost or destroyed, it can always be replaced if she goes back to court and asks for another copy.

9-3 What happens if the abuser goes against the Protection Order?

10. South African national helplines

South African national helpline contact numbers

Organisation Number
Advice Desk for Abused Women 031 262 9673/9679 or 031 204 4922
AIDS Helpline 0800 012 322
Alcoholics Anonymous 0861 435 722
Care Assist (health & psychiatric concerns helpline) 011 359 5000
Child Line 0800 055 555
Child Welfare 0800 435 754 or 011 492 2888
Compassionate Friends 011 440 6322 or 072 798 1202
Domestic Violence Assistance Programme 031 261 4398
Emergency contraception helpline 0800 246 432
Families South Africa (FAMSA) 011 975 7106/7
Gay & Lesbian Association 011 717 4239
Lifeline 0861 322 322
Love Life Sexual Health Line 0800 121 900
Marie Stopes (pregnancy, emergency contraception, abortion) 0800 11 77 85
Mental Health Info Centre 021 938 9229/9029
Mental Health Society 011 781 1852
Narcotics Anonymous 083 900 6962
People Opposing Women Abuse (POWA) 011 642 4345 or 083 765 1235
Post Natal Depression Support Association (PNDSA) SMS ‘help’ and name to 082 882 0072
Rape and Trauma Line 021 447 9762
SA Depression and Anxiety Group 011 262 6396
Safeline 0800 035 553
Schizophrenia Foundation of SA 011 484 9330
Stop Gender Violence Helpline 0800 150 150
Western Cape Mental Health Service Directory 021 483 4003/4270/5660/4572
National Mental Health Information Line 0800 567 567

11. South African organisations for training in counselling

11-1 Lay counselling training

Families South Africa (FAMSA)


11-2 Professional counselling training

Families South Africa (FAMSA)

South African College of Applied Psychology (SACAP)

University South Africa (UNISA)

12. Additional information on infant mental health

For further information about some of the key concepts in the chapter on Infant Mental Health:

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