Mental health issues in the perinatal period have long been misunderstood – and their remedies underfunded – but a funding boost offers hope of a turnaround, says Lesley Regan
As many as 10-20 per cent of women develop a mental illness during pregnancy or in the first year after delivering their baby, and women with a history of mental health problems are at significant risk of relapse during pregnancy, particularly if they stop taking their medication.
Findings from the Mothers and Babies: Reducing Risk through Audits and Confidential Enquiries (MBRRACE) -UK report, Saving Lives, Improving Mothers’ Care, identified that around one quarter of all maternal deaths between six weeks and a year after childbirth are related to mental health problems and one in seven of the women who died in this period committed suicide.
The authors suggest that in approximately 40 per cent of cases, improvements in care may have made a difference to outcome. This may include adherence to guidelines and efficient referral to specialists in medical and mental health.
Although we must not forget the impact on the child, it is important to remember that women’s mental health problems need to be identified and treated urgently to provide the best possible outcomes for her baby
Despite these alarming figures, in almost half of the UK pregnant women and new mothers have no access to specialist maternal mental health services. Furthermore, since only 3 per cent of clinical commissioning groups have a maternal mental health service strategy, an enormous number of women and their babies are at risk.
At the start of the year the government announced almost a billion pounds of investment for mental health services, including £290m for specialist support for mothers during and after pregnancy, offering us a golden opportunity to improve the care we provide.
Feedback from our recent Royal College of Obstetricians and Gynaecologists event Joining up Maternal Mental Healthcare highlighted the power and importance of lived experience and women’s personal stories. It helped to remind us that women need to be at the centre of our focus when it comes to maternal mental health.
Although we must not forget the impact on the child, it is important to remember that women’s mental health problems need to be identified and treated urgently to provide the best possible outcomes for her baby.
Some of the key themes identified at our event, that we hope to address with the help of other stakeholders and affected women, include:
An end to stigma
One in four people will experience a mental health problem at some point in their lifetime, yet nearly nine out of 10 with mental health problems say that stigma and discrimination have a negative effect on their lives.
We have come a long way with successful campaigns such as Time to Change and the work of mental health charities, but we must continue to address the stigma associated with mental health. We heard from many women that they fear being seen as a “bad mother” and having their child taken away from them. Women are frequently made to feel guilty that they’re not the “perfect mother”.
We must treat the women as individuals, not as an illness or a symptom
No one is perfect and as a society we need to be reinforcing this message constantly. Given that mental health may run in families, women should be encouraged to talk across the generations but stigma currently prevents this. No woman deserves to suffer in silence.
In healthcare, we also need to give parity of esteem to mental and physical health. The chief medical officer of England’s annual report (December 2015) is dedicated solely to women’s health. Dame Sally Davies emphasises that neither mental nor physical health can or should be ignored, nor considered in isolation.
Further, that embarrassment about taboo subjects and stigma should never be a barrier to better health. We must treat the women as individuals, not as an illness or a symptom, and encourage healthcare professionals to adopt a holistic life-course approach.
The structure of maternal mental health services
Currently the fragmentation of healthcare provision, both within primary care and across disciplines, means that women face a number of challenges accessing the care they need. Very frequently the lack of services means primary practitioners have no means to refer.
Greater integration between primary and secondary care is urgently required to ensure that women with significant medical and psychiatric conditions are assessed before becoming pregnant. They need to be referred for specialist care in a timely manner to ensure that the woman receives the right support throughout pregnancy and beyond.
If the healthcare provider lacks the skills to deal with that problem, it is unlikely that the woman will approach another healthcare provider for help
Changes within commissioning will help ensure the money allocated to priority areas such as maternal mental health is spent optimally. We must also utilise the enormous potential of new digital technology to better link up care.
Research has shown that continuity of care in maternity services improves outcomes for both mother and baby. This is particularly important in the provision of maternal mental healthcare, where women have highlighted the value of developing long-term relationships with their doctors and midwives.
Communication, education and training
Healthcare professionals are often the first point of contact that a woman suffering with mental health problems reaches out to.
If the healthcare provider lacks the skills to deal with that problem, it is unlikely that the woman will approach another healthcare provider for help. It is therefore vital that all healthcare professionals involved in the care of women during pregnancy and the first year after birth have relevant education and training in perinatal mental health.
Greater integration between primary and secondary care is urgently required to ensure that women with significant medical and psychiatric conditions are assessed before becoming pregnant
Our role should increasingly be about empowering women to make decisions about their care and in supporting women to help themselves.
Our focus should now be on identifying practical steps to address the problem we face in the UK. Maternal mental health has been made a key priority by government and funding has been allocated.
This is an opportunity of a lifetime and we must seize it with both hands.
Professor Lesley Regan is president elect of the Royal College of Obstetricians and Gynaecologists
We must seize this once in a lifetime chance
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We must seize this once in a lifetime chance