Specialist midwives should be in post at every trust to provide vital perinatal mental health support, organisations representing health professionals have said in response to a hard-hitting new report.
It called for “appropriate and sustainable care” to be an “expectation and a right” for all women who experienced maternal mental health problems.
“Every trust with maternity services should have a specialist midwife in post”
Women who felt unwell during the perinatal period “must be confident” that if they told a midwife or health visitor they would receive help, said the report published by the Royal College of Midwives.
“With the right access to treatment, recovery from maternal mental illness is possible and this is a key message of hope for all mothers,” it stated.
The report was inspired by a petition created by Lucie Holland whose sister, Emma Cadywould, died during 2011 in tragic circumstances as a result of perinatal mental illness.
Ms Cadywould was under the care of the local mental health “crisis team”, but it was a general service and no one in it was experienced enough in perinatal mental healthcare to understand or recognise how unwell she was, said her sister.
Ms Holland set up the petition in 2015 calling for better awareness of perinatal mental illness and a urgent review of care for those affected by it. It received over 55,000 signatures of support and also many comments on people’s own experiences.
The RCM has now collated and analysed all the 6,989 comments in the report titled Every mother must get the help they need, which was launched at a round-table event in London on 19 July.
Over 17% of respondents said in their comments that they thought the availability of specialist maternal mental health services across England was “patchy”.
In addition, 12% of comments made reference to a lack of awareness and common misconceptions concerning maternal mental health problems.
“Specialist midwives and specialist health visitors should be in post at every local level”
The report stated that its findings added to previous evidence that maternal mental health was under resourced in terms of awareness and funding of services across the UK.
The report also highlighted some of the comments received from health professionals. For example, Julie from Bolton said: “I am a midwife and feel helpless when trying to access services for my clients.”
Meanwhile, Stephanie from Portsmouth, said: “I am a mental health nurse working in maternal mental health and can see the hugely positive impact that our service has on the mothers we meet. I am proud of my service and hope that all women experiencing these difficulties can access the help they need.”
The report concluded that there were examples of good practice and committed health professionals who wanted to see appropriate and sustainable care be provided for all women.
But added that access to good practice should not be a lottery, saying: “It should be an expectation and a right for all women who experience maternal mental health problems.
“A mother who feels unwell during the perinatal period must be confident that if she tells a health professional – e.g. her midwife, health visitor or family doctor – about her illness she will receive the help she needs,” it said.
Janet Fyle, the RCM’s professional policy advisor, said: “The comments left on Lucie’s change.org petition speak of the devastation suffered by some women and their families.
“This is an opportunity to hear the voices of thousands of women and their families and generate new ideas going forward,” she said. “It is crucial that we collectively take on board these comments.
“Every trust with maternity services should have a specialist midwife in post to enable women who are unwell to get the very best care and support they need,” said Ms Fyle.
“The comments should also be the driving force behind how we organise and provide perinatal mental health services for all women across the UK irrespective of where they live,” she stated.
The RCM also asked Ms Holland what would be the three things that she would most like to see as a result of her petition.
She said for the “continuing stigma and taboo” surrounding maternal mental health to be broken down in society and for there to be “clear, honest, mandatory” information and advice given to a key member of the family, before any woman left their place of giving birth.
“The provision of perinatal mental health services is under looked”
The third was to continue to commemorate her sister’s life and enable her “spirit and fierce determination” to drive and support change in perinatal mental health.
Ms Holland added: “The provision of perinatal mental health services is under looked, yet significantly important in preventing the loss of any more mothers in the UK. Thank you for every one of the 6,898 comments left; with these we will build positive change out of a tragedy.”
Dr Cheryll Adams, executive director of the Institute of Health Visiting, said Ms Holland’s campaign should serve as a “moral imperative” for commissioners at every level, so that “such a tragedy should never happen again”.
“We need to broaden perceptions of mental health, so that all women and their families, and all health and social care professionals consider mental health equal to physical health,” she said.
Dr Adams stated: “It is vital that all practitioners working alongside women and their families in the perinatal period are competent, confident and committed to ensuring that the right care, at the right time, is available in the right place for all women and their families.
“Specialist midwives and specialist health visitors should be in post at every local level, as part of a comprehensive specialist perinatal mental health service offer,” she said.
The RCM noted that several potential improvements have been announced in the period between the petition taking place and the report being published.
Health visitors lacking time for mental health support
Maternal mental health had become a stated government priority, with a maternal mental health community services development fund launched in summer 2016.
Under the initiative, 20 areas of England have received funding to improve local specialist services. Another tranche of funding will be released in late summer 2017.
In addition, NHS England has guaranteed funding for four new mother and baby units, and the Maternity Transformation Programme and Mental Health Transformation Board both been given explicit briefs to improve maternal mental health pathways and services.
The Welsh government also pledged £1.5m in 2016 for improving maternal mental health, and each health board in Wales has established a maternal mental health community specialist service.
Meanwhile, the Scottish government’s 2017 mental health strategy included a pledge to fund a “managed clinical network” to improve recognition and care of maternal mental health problems.
However, the report cautioned that it “remains to be seen” how many of these “much needed” specialist maternal mental health community services would actually be funded, and that funding for maternal mental health services should be consistent across the UK.