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Maternal Mental Health – Women’S Voices

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Maternal Mental Health – Women’S Voices Maternal Mental Health – Women’s Voices February 2017 Maternal Mental Health – Women’s Voices February 2017 Royal College of Obstetricians and Gynaecologists 27 Sussex Place, Regent’s Park, London NW1 4RG © Royal College of Obstetricians and Gynaecologists 2017 Registered charity no. 213280 www.rcog.org.uk Report written by Karina Russell with input from members of the Maternal Mental Health Alliance, Annette Ashley, Gerald Chan, Samantha Gibson and Rebecca Jones Copy-edited and typeset by Andrew Welsh (www.andrew-welsh.com) Contents Foreword iv Visual summary vi Executive summary ix Recommendations xi 1 Introduction 1 2 Women’s experiences of perinatal mental health problems 2 3 Women’s experiences engaging with healthcare professionals 5 4 Referrals and services for perinatal mental health 9 5 Partners’ experiences of mental health problems 14 6 Regional variations in perinatal mental health services 16 Experiences engaging with healthcare professionals 16 Referrals to services 16 7 Women’s Voices 19 Knowledge and understanding 19 Experiences of and access to support 21 Experiences of healthcare professionals 23 Specific perinatal mental health conditions 26 Breastfeeding and mental health 30 Appendix A Provision of specialist community perinatal mental health teams in the UK 32 Appendix B Survey questions 33 Appendix C Respondents’ demographics 41 iv Foreword As many as one in five women develop a mental health problem during pregnancy or in the first year after the birth of their baby. The pain this causes women and their families, the negative impact on their health and wellbeing, and the economic costs to individuals, the NHS and the nation are considerable. The Saving Lives, Improving Mothers’ Care* report by MBRRACE-UK in 2015, covering the period 2011–13, identified that around one-quarter of all maternal deaths between 6 weeks and 1 year after childbirth were related to mental health problems and one in seven of those women died from suicide. In approximately 40% of cases, improvements in care may have made a difference to the outcome. National policy and National Institute for Health and Care Excellence (NICE) guidance have identified the evidence-based interventions and services needed, but across almost half of the UK pregnant women and new mothers have no access to such care. As a result, an enormous number of women and their babies are at risk. We are encouraged that maternal mental health has been made a priority by Government. The National Maternity Review, with its aspirations to offer more personalised and safer care, was explicit in its call for more investment in postnatal and perinatal mental health care. NHS England, working with the Maternity Transformation Programme and Mental Health Transformation Board, will implement this vision and are currently working with stakeholders to produce care pathways and protocols for specialist community perinatal mental health services. In August 2016, it was announced that a Perinatal Community Services Development Fund was being launched and this was followed in September with another announcement that NHS England was to fund four new inpatient mother and baby units for women with the most complex and severe needs in areas where there was no access. In 2016, the RCOG marked International Women’s Day by holding a one-day conference that examined the barriers to the provision of high-quality care in maternal mental health. With the support of the Royal College of Psychiatrists and input from a range of clinicians, including our midwifery and GP colleagues, we discussed why women do not seem to be receiving the care they need on the NHS. We also heard heart-wrenching stories from women who had mental health problems during and after pregnancy – a stark reminder to all of us that no woman should slip through the net and their mental health needs must be at the centre of our focus across the whole of their maternity and postnatal care. Feedback from the event revealed that women’s voices often went unheard or unnoticed. We believed that it was time to give women the opportunity to speak out by conducting a survey exploring women’s experiences of perinatal mental health problems, their experiences with healthcare professionals and access to specialist services. Despite the pain, trauma and stigma that women describe as a result of mental health problems, over 2300 women responded in order to convey a clear and unequivocal messages to us all. The results present a stark picture of an NHS in which women with poor maternal mental health during pregnancy and after birth experience low rates of onward referral and long waits, with many * MBRRACE-UK. Saving Lives, Improving Mothers’ Care: Surveillance of Maternal Deaths in the UK 2011–13 and Lessons Learned to Inform Maternity Care from the UK and Ireland Confidential Enquiries into Maternal Deaths and Morbidity 2009–13. Oxford: National Perinatal Epidemiology Unit, University of Oxford; 2015 [www.npeu.ox.ac.uk/ mbrrace-uk/reports]. seeking private treatment as a result. This is not delivery of evidence-based care on the basis of v need, free at the point of access, and is neglecting some of the most vulnerable people in our society. The NHS in England has a lot of work to do to ensure that women can access specialist community Voices Maternal Mental Health – Women’s perinatal mental health services, as well as to meet waiting times requirement for perinatal mental health. Regional variation is evident across many of the results of the survey, demonstrating the geographical inequity of care in what should be a national health service. Equally striking is the variation in professional advice, behaviour and care experienced by these women. In an area of healthcare already beset by misunderstanding, ignorance, stigma and other barriers to access, it is tragic that professionals and services are so often making matters worse. Throughout the UK, other serious gaps in services remain: maternity services need the capacity to offer continuity of care to this group of women, universal health visiting services must have the capacity to work with these most needy and high-risk parents and their babies, and child mental health services must invest in parent–infant attachment services. We also have work to do in addressing the needs of partners, 12% of whom were described by respondents as having mental health problems themselves, often neglected by healthcare professionals and services. However, there are glimmers of hope. Among women who gave birth 4–5 years ago, 24% reported that they had not been asked by any healthcare professional about their mental health, but this was down to just 8% among those women who gave birth in the past year. Many of the responses also described excellent care provided at every level, as well as the benefits of specialised help from perinatal mental health services and mother and baby inpatient units. In England, we can expect that many more women will be able to access well-informed care at every level and specialist care when needed following recent Government funding. In Wales too, new funding is now being used to improve specialist care. Highlighting the power and importance of lived experience, we have heard from women themselves. To the already well-documented health and economic necessity, these results now add the moral imperative to take action. This is truly everyone’s business – healthcare professionals, managers, providers, commissioners, policy makers and politicians. Individually and collectively, we must all respond to this sobering report now and put an end to these unacceptable levels of avoidable suffering. Professor Lesley Regan President, Royal College of Obstetricians and Gynaecologists Dr Alain Gregoire Chair, Maternal Mental Health Alliance MaternalVisual summary mental health Putting into context It's been estimated that maternal mental health problems cost the UK £8.1 bn* each year Up to 1 in 5 women develop mental health problems during pregnancy or in the first year after childbirth † Around one quarter of all maternal deaths between six weeks and a year after childbirth are related Nine out of ten people with mental health to mental health problems problems experience stigma ‡ Psychosis In almost half of the UK, pregnant Low mood women and new mothers have no access to specialist Maternal mental health community maternal conditions can range from mental health services low mood to psychosis * London School of Economics and Centre for Mental Health. The costs of perinatal mental health problems. October 2014 [https://www.centreformentalhealth.org.uk/maternal-mental-health] † MBRRACE-UK. Saving Lives, Improving Mother’s Care. December 2015 [https://www.npeu.ox.ac.uk/mbrrace-uk/reports] ‡ Maternal Mental Health Alliance. UK Specialist community perinatal mental health teams (current provision) [http://everyonesbusiness.org.uk/?page_id=349] © Royal College of Obstetricians and Gynaecologists Maternal mental health Key findings from the RCOG's survey of 2300 women 81% Referred 7% 81% of women in the RCOG's survey had experienced a maternal Only 7% of women who mental health problem experienced maternal mental Women reported health symptoms were referred no consensus to specialist care among healthcare professionals about medication for existing r 4 w mental health conditions Ove eek % w during or after pregnancy 8 ai 3 t OCTOBER 2016 38% of women waited over 4 weeks to be referred, with some Referred women waiting a year SEPTEMBER 2016 There is an unacceptable SERVICE FREE SERVICE wide variation There is poor awareness of care across the UK among women and healthcare professionals of the range of mental health conditions and services available partners experience mental health Difficulties in breastfeeding 1 in 8 problems and most received no support can have an impact on some women's mental health © Royal College of Obstetricians and Gynaecologists Executive summary ix During pregnancy and after the birth of a child, women are at a higher risk of experiencing mental health problems.
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