Wednesday 2 May is World Maternal Mental Health Day. The key messages are that women, as well as their family and friends, need to know the signs of maternal mental ill-health and that new mothers are not alone. They can also get help and support for perinatal mental health problems.
Perinatal mental health problems
Perinatal mental health problems are mental health problems which occur during pregnancy and up to one year after a child’s birth. This includes new problems. But, it also includes the recurrence of existing problems. The period around birth is a time of increased risk for women who have a history of mental health problems.
In Scotland, perinatal mental health problems are common. Mental illness during pregnancy, or in the first year after birth, is thought to affect between 10% and 20% of women. In Scotland 54,488 births were registered in 2016. The period following childbirth is also the period of greatest risk for developing severe mental illness in a woman’s life.
The problems which mothers face vary in nature and severity. They include problems coping with their new situation (adjustment disorders) and distress, to severe depressive illness and psychosis.
The report Confidential Enquiry into Maternal Deaths and Morbidity, published in December 2017, noted that suicide is the leading cause of direct deaths occurring during pregnancy or up to a year after the end of pregnancy. One in seven women who die in the period between six weeks and one year after pregnancy die by committing suicide.
The long term costs of perinatal mental illness are significant. A study published in 2014 by the London School of Economics and the Centre for Mental Health provided estimated costings. The most common forms of perinatal mental illness (depression, anxiety and psychosis) are thought to cost the NHS in the UK £1.2 billion per year. The report put the total economic cost to the UK at over £8 billion per year.
Detection and access to services
Some organisations point out that, although the prevalence of perinatal mental health problems is high; rates of detection and appropriate intervention are low. Post-natal depression and depression during pregnancy is thought to go undetected in as many as one in two women.
Training and service provision for perinatal mental health has improved over the last decade. However, some organisations take the view that there is still not adequate support available in many parts of Scotland.
Community perinatal mental health services
The Maternal Mental Health Alliance has published a map of Scotland showing the provision of specialist community perinatal mental health teams. This reveals seven NHS Boards have no provision and only one Board, NHS Greater Glasgow and Clyde, has a specialised perinatal community team that meets the Perinatal Quality Network Standards Type 1. According to the Royal College of Psychiatrists, failure to meet these standards results in a significant threat to patient safety, rights or dignity and/or would breach the law.
Specialist Community Perinatal Mental Health Teams (Scotland)
A 2016 report by the Mental Welfare Commission for Scotland noted that stigma remained a significant barrier to women seeking help for postnatal mental illness. They found that “women across Scotland continue to face significant inequity in access to specialist perinatal community mental health care”.
Specialist mother and baby inpatient units
There are two specialist mother and baby inpatient units (MBUs) in Scotland which provide hospital care for mothers with perinatal mental illness. This allows them to continue caring for their child up to the age of one. These are located at St John’s Hospital (Livingston) and Leverndale (Glasgow) and both units provide 6 beds.
The Commission’s report found:
- Many mothers (36%) did not receive care with their baby in one of the specialist
- Women who received treatment in non-specialist general adult acute wards (without their babies), did not receive the same standard of care as those in the MBUs.
- Women in the non-specialist wards were less positive about their experiences of care and were often separated from their babies for prolonged periods.
The Commission suggested that the option of MBU admission is not always offered or actively promoted to women who are normally the main carer for their baby and require inpatient care and that this is contrary to national guidelines and the Mental Health (Scotland) 2003 Act.
They noted that some women chose admission to a local general adult ward and not their regional MBU because of the distance from home and family. This was particularly the case when women had older children to consider. Nursing staff and consultant psychiatrists, particularly in northern Scotland and remote or rural areas, also shared this concern.
The Commission made 13 recommendations in its report. One of these was the establishment of a national managed clinical network (MCN) for perinatal mental health as recommended in the national clinical guidelines, SIGN 127.
In its Mental Health Strategy 2017-2027, the Scottish Government outlined its commitment to establish a MCN. The network is currently undertaking a review of current inpatient MBU provision, including access to care for women irrespective of where they live in Scotland. The network also plans to put in place systems to monitor on-going access to beds. If it is judged that the number of beds is not sufficient to meet need, the network will make recommendations on how such need can be met.
This issue has been discussed in the Scottish Parliament and has been the subject of a number of motions and parliamentary questions. See, for example, First Minister’s Question Time 18 April 2018 and motion S5M-10464 in the name of Clare Haughey on the Everyone’s Business Campaign.
Lizzy Burgess, Senior Researcher, Health and Social Care.