The Health, Social Care and Sport committee are undertaking an inquiry into perinatal mental health. The ‘perinatal period’ refers to the period of pregnancy, childbirth, and the first year after the birth. The committee is examining areas such as how the Scottish Government can improve perinatal mental health services in Scotland, both in the short-term and over the next five years, and the impact that the COVID-19 pandemic has had on perinatal mental health and services. A call for views is currently open until 24 November 2021.
To support the committee’s inquiry, this blog provides an overview of current information on perinatal mental health in Scotland, recent policy developments, and the impact of the COVID-19 pandemic.
The Royal College of Psychiatrists states that half of new mothers will experience an emotional or mental impact following the birth of a child. Changes to a mother’s usual mental wellbeing after birth is common, resulting in symptoms such as mood-swings, tearfulness and anxiety. These symptoms will usually stop around 10 days after the birth.
In some cases, perinatal mental health can be more serious. Conditions include:
- Postnatal depression, which affects between 10-15 in every 100 women having a baby.
- Postpartum psychosis, which affects about 1 in every 1000 women having a baby.
- Perinatal OCD, which affects 2 in 100 women in pregnancy and 2-3 in every 100 women in the year after giving birth.
During the perinatal period women are at a ‘substantially increased’ risk of severe mental illness and psychiatric in-patient admission. Women with a diagnosis of Bipolar Disorder Type 1 or Schizoaffective Disorder, for example, have a 1 in 5 risk of developing postpartum psychosis during their first pregnancy.
Suicide is the leading cause of direct maternal death within the year after birth, according to the Maternal Mental Health Alliance. A significant proportion of women who die by suicide in the perinatal period have early life adversity, multiple social disadvantages, and comorbid substance use. The Perinatal Mental Health Network Scotland has published a review of services for substance-using women and their infants during pregnancy and the postnatal period, which found that there was varied support across Scotland.
Without appropriate and timely support, perinatal mental health problems can negatively impact the mental and physical health of the mother, their children, partners, and significant others.
Research by the Royal College of Physiatrists suggests that children exposed to severe maternal stress during pregnancy are nearly 10 times more likely to develop a personality disorder by the age of 30.
The Perinatal Mental Health Network Scotland
Action 16 of the Mental Health Strategy 2017-2027 was met in 2017 when the Perinatal Mental Health Network Scotland (PMHN Scotland) was established as a National Managed Clinical Network (a network of specialist staff working together).
PMHN Scotland published Delivering Effective Services: Needs Assessment and Service Recommendations for Specialist and Universal Perinatal Mental Health Services in March 2019. This report assessed the state of perinatal mental health services in Scotland in 2019 and made recommendations to improve care.
These recommendations included an additional 2 to 4 Mother and Baby Unit (MBU) beds. There are currently two MBUs in Scotland (St John’s Hospital in Livingston and Leverndale in Glasgow), which have 6 beds each. MBUs are for women who require an admission in the late pregnancy or the postpartum period. Under the Mental Health (Scotland) Act (2015), mothers have the right to be admitted to a specialist MBU, jointly with their child, if they need inpatient mental health care.
The Perinatal and Infant Mental Health Board
Following the publication of Delivering Effective Services, the Scottish Government announced a £50 million investment over four years to improve access to mental health services for expectant and new mothers.
The Perinatal and Infant Mental Health Programme Board was established in March 2019 to ‘help drive implementation of the Scottish Government’s Programme for Government commitments’ on perinatal and infant mental health. The Perinatal and Infant Mental Health Programme Board will oversee and manage the £50 million investment. Additionally, the remit of the Perinatal and Infant Mental Health Programme Board includes overseeing the delivery of the recommendations in Delivering Effective Services.
A summary of the Programme Board’s actions taken to date was provided in their 2021-22 Delivery Plan (published October 2021), such as:
- All NHS Boards now have funding towards Specialist Community Perinatal Mental Health Services, with £4,075,222 invested in 2021-22. Recommendation 6 of Delivering Effective Services states that all NHS boards should have community specialist perinatal mental health provision, with the specific model dependent on factors such as the birth numbers and geographical needs of the area. Action 5 of the 2021-22 Delivery Plan commits to monitoring and evaluating the development and delivery of these services.
- Providing ongoing funding for staffing at Scotland’s two MBUs to meet the recommended levels outlined in the Delivering Effective Services report.
- The creation of a Mother and Baby Unit Family Fund to support families to visit loved ones in inpatient care. Recommendation 5 of Delivering Effective Services states that NHS boards should ensure that there are provisions for accommodating partners or other family members near MBUs, where they have to travel long distances.
- The development of The Perinatal Mental Health Peer Support Action Plan in March 2021. Peer support involves those with lived experience supporting each other to achieve better mental wellbeing. Multiple recommendations (Nos. 2, 18, 19) in Delivering Effective Services were targeted towards improving peer support
Future actions and areas of focus
The Delivery Plan outlined actions for 2021-22, including:
- Ensuring that services can offer a range of psychological interventions, appropriate to need.
- Specific action to ensure those groups identified as marginalised in the Equality Impact Assessment have equitable access to services which are responsive to their specific needs.
- Ensuring that women and their infants experience equity of access to specialist inpatient care, wherever they live in Scotland.
Maternal Mental Health Scotland released a statement on the Delivery Plan in November 2021. They acknowledged areas of improvement, such as peer support. However, Maternal Mental Health Scotland believe that a lack of local and specialist support remains. Mental health care for expectant and new mothers is ‘fragmented’, with community support only available in some areas. Furthermore, a lack of specialist skills could prevent the Delivery Plan from being implemented locally.
The Maternal Mental Health Alliance is a UK-wide charity and network which maps access to specialist perinatal mental health services across the UK.
The Perinatal and Infant Mental Health Programme Board’s Delivery Plan for 2021-22 comments that the pandemic has posed ‘additional challenges’ for perinatal mental health. The Delivery Plan also found that women from ethnic minority backgrounds and socially disadvantaged groups have been disproportionately affected.
The Scottish Government’s Covid-19: mental health – transition and recovery plan includes multiple actions for the Perinatal and Infant Mental Health Programme Board. The Delivery Plan for 2021-22 provided an update on many of these, including:
- Establishing perinatal mental health services as a priority area for the expansion of Near Me services – Near Me has been rolled-out for perinatal mental health services in the NHS and third sector, in addition to increased access to online therapies such as CBT.
- Providing dedicated support around COVID-19 to third sector funded organisations – The Perinatal and Infant Mental Health Fund was established in 2020 for third sector organisations who provide non-clinical support for women and families. £665,000 was provided to support 16 third sector organisations between October 2020 and March 2021. It is not specified if dedicated support around COVID-19 has been provided.
- Establishing a working group to gain a more detailed understand of issues raised in the Perinatal and Infant Mental Health Programme Board Equalities Impact Assessment – A working group has been established.
Cristina Marini, SPICe Trainee