• By Laura Whybra
  • Posted on Tuesday 26th November, 2013

Mental health and motherhood: the silent 70,000

strong> At least one in 10 new mothers experiences mental illness during pregnancy or the first year of her baby’s life. In England alone, more than 70,000 women suffer perinatal mental illness every year. But most of those who are ill don’t get the care they need, a new report by the NSPCC argues. The gap between health services and mothers’ need is massive, the children’s charity contends. Because midwives are in short supply, 40% of women see a different midwife at every appointment, making it impossible for expectant mothers and their midwives to build up a rapport. Specialist training in perinatal mental health is rare for both midwives and mental health practitioners.And mothers’ mental illnesses can damage both their own well-being and the well-being of their children and the family as a whole. Children with mothers who were anxious or depressed during the perinatal period are more likely to struggle in school and have special needs or mental health problems. Although many parents with mental illness still manage to provide children with the care and affection they need, child abuse or neglect is more likely when parents have mental illness. In extreme cases, severe mental illness, such as untreated postnatal psychosis, can cause mothers to kill themselves or their babies. How could it be better? The NSPCC identifies a postcode lottery for maternal mental health services. Those who live in particular areas have access to the services they need. Many don’t. The lack of services is a “national scandal,” the NSPCC says. Two types of action are needed. First, identify the areas where mothers do not have access to necessary services, and “plug the gaps.” Second, improve existing services to prevent and treat perinatal mental illness. The “big four” perinatal mental illnesses Four mental illnesses are of greatest concern for pregnant women and new mothers.First, depression is the most common perinatal mental illness, affecting 10-14% of women either during pregnancy or after the birth of a baby. Postnatal depression is well-known as a problem, but symptoms of depression and anxiety are actually more common in late pregnancy or after birth, the report points out. Many new mothers who experience postnatal depression had the first symptoms during pregnancy. A system that is better able to identify and treat depression at an earlier stage could reduce the risk of an illness escalating while parents are coping with the stress of caring for a new baby.Second, OCD is estimated to affect around 3% of new mothers. However, screening is rarely done, so many cases may not be detected.Third, postpartum psychosis is a severe disorder that is more likely to occur in the first few weeks after the baby’s birth, with a range of symptoms including paranoia, delusions, mania and depression. Fourth, post-traumatic stress disorder is more common in pregnant women than in women in general. Women who previously experienced traumatic events, such as abuse in childhood, are at greater risk of PTSD during pregnancy. Childbirth, particularly stressful experiences during or after birth, can also trigger symptoms. The changes needed Although poverty and deprivation increase the risks, mental illness affects women from all backgrounds. As a result, universal services should be structured to detect and respond to perinatal mental illness in all women, the NSPCC argues.Services are already provided universally to all new mothers by GPs, midwives and health visitors. These providers are therefore in an ideal position to detect perinatal mental illness, or signs of risk, early. But a crucial condition for success, says the children’s charity, is to provide every new mother with a consistent midwife throughout her pregnancy and immediately after their baby’s birth. That midwife also needs to have the training and time to provide supportive and sensitive care to each mother in her caseload. At present, there is a shortage of 5,000 midwives in England, but this may be changing. The Government has pledged to increase the number of midwives and health visitors, as well as expanding the Family Nurse Partnership, to reduce the current staff shortages and improve this provision.In addition to increases in staffing and time, midwives and health visitors need to be well trained in techniques to encourage mothers to share their mental health concerns. Mothers often hide their symptoms for fear that others will think they are unfit to care for their babies. And once the problem is shared, practitioners need to have information about the care pathways and referral systems in their local area at their fingertips. The Government is currently considering recommendations from the Royal College of General Practitioners to extend GP training from three to four years and include specialist-led mental health training as part of the core curriculum. The NSPCC report also recommends regular refresher training in perinatal mental health, and the provision of time and encouragement by service providers to increase attendance at training sessions. Investment for the future Investment in these important services, from consistent, universal care through to inpatient units, would improve outcomes for children of mothers with perinatal mental illness, such as reducing the need for out-of-home placement. Substantial investments are required, but these would pay off in the long term by reducing the need for lifelong interventions for families. Report: Hogg, Sally. “Prevention in Mind: All Babies Count: Spotlight on Perinatal Mental Health.” NSPCC report. http://www.nspcc.org.uk/Inform/resourcesforprofessionals/underones/spotlight-mental-health_wdf96656.pdf

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