In this guest blog, Sally Hogg from the NSPCC writes about the important part that health professionals play in identifying mothers at risk of, or suffering from, perinatal mental illnesses, and ensuring they get the support they need:
More than 150,000 women experience a mental illness during pregnancy or after the birth of their babies in England each year. These women do not suffer alone; their illness can also impact on their families, particularly their babies. This is why, this week, the NSPCC is calling for better prevention, detection and treatment of perinatal mental illnesses.
Perinatal mental illnesses range from anxiety and depression to postnatal psychotic disorders. Many people have heard about postnatal depression – although few know how to recognise it or what to do about it – but serious perinatal mental illnesses are far less well recognised. These disorders may be rare, but are not as uncommon as the lack of knowledge about them might suggest: postpartum psychosis is twice as prevalent as Down’s syndrome – something new parents are very aware of.
Perinatal mental health problems should be seen as public health problems: the onset and escalation of perinatal mental illness can often be prevented through early identification of risk and effective action. Even if the illness itself is not preventable, it is possible to limit the negative effects of perinatal mental illness on families.
Consensus on health issues can be rare, but on this issue there is widespread agreement. Government policy, many experts, Royal Colleges and NICE guidance all describe a similar vision to that which the NSPCC sets out in our Prevention in mind report. However, despite the consensus, families are still not receiving the support they need.
What must be done: a step-change towards between prevention
First, there must be a step-change towards better prevention of perinatal mental illnesses, and early intervention when they do occur. Health professionals, including midwives, GPs and health visitors need to be confident in detecting, discussing and dealing with mental illnesses. Mental health needs to be given parity of esteem with physical health in the work of these primary care services.
NICE guidance states that all women should be asked about their mental health during pregnancy and the postnatal period. However, in a survey conducted by Bounty for the NSPCC 41% of new mothers said neither their health visitor nor their midwife asked them about depression. We believe professionals need better training and support to talk about perinatal mental health problems; the time to discuss these issues sensitively with women, and knowledge that there are specialist services in place if problems are detected.
As well as the transformation of universal services, we need to ensure the right specialist provision is in place. There should be perinatal mental health care pathways in every area, with a range of support on offer – including social support, therapy, and specialist mental health provision – so that every woman can access help appropriate to her needs. This support simply doesn’t exist in many places: fewer than 50% of mental health trusts have a perinatal mental health team with a specialist psychiatrist.
What must be done: expert early identification of perinatal mental illness
Expert early identification and management of perinatal mental illness should prevent women reaching the point where they need inpatient care. However, if women with severe perinatal mental illness do need to be admitted, it is important that they can access a specialist mother and baby unit. Without access to these, women can go without the intensive expert care that they need. They are also separated from their babies, which is traumatic and can disrupt vital early bonding.
Fast and effective action on perinatal mental illness is critical for babies’ outcomes. Babies’ early experiences set the foundations for their later development. These foundations can be shakier if their mother has experienced a mental illness that has not been managed effectively.
Evidence shows if services only focus on the mother, they might reduce her depression but not improve her baby’s outcomes. Therefore if a mother has a mental health problem, it is important that she gets help to interact in a positive and sensitive way with her baby. Specialist perinatal mental health services can support the mother-infant relationship, something that general adult mental health services may not have the time, resources or expertise to do. There are also good examples of parenting support being offered alongside mental health interventions.
Next steps: perinatal mental health roundtable
On Tuesday June 18, the Health Minister Dr Dan Poulter is holding a roundtable meeting with key commissioning and professional bodies that can make a difference to the support available for families affected by perinatal mental illnesses. This meeting provides a valuable opportunity for all to come together and discuss what action can be taken to ensure these families get the help they need, as soon as possible. More can, and must, be done. Every baby is entitled to the best start in life, and to achieve this, we must ensure their mothers have the support that they need.
Sally Hogg is the author of Prevention in Mind.