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'Specialist midwife needed at every trust for perinatal mental illness'

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A specialist mental health midwife should be employed at every trust with a maternity unit in order to help “strengthen” services, according to a major report setting out standards for midwives working in perinatal mental health care.

The government-commissioned report noted up to 20% of women are thought to be affected by mental health problems during the perinatal period – in pregnancy, childbirth and the first postnatal year.

”Perinatal mental illness exerts a significant toll on families and the impact on the women themselves, their baby, and the wider society cannot be underestimated”

Cathy Warwick

It is known that around 12% of perinatal women have depressive symptoms and 5% have a major depressive disorder. Anxiety disorders are also common, with around 13% of women affected, said the document.

However, the new report – by the Royal College of Midwives and supported by an alliance of mental health organisations – said around half of all cases of perinatal depression and anxiety were thought to be undetected. It pointed to research that estimated the cost to the NHS each year of perinatal mental illness is £1.2bn.

Midwives are in a “strong” position to identify mental illness among women, according to the report, which set out five key recommendations to improve perinatal mental health care.

All health professionals working with women in the perinatal period should have a basic awareness, knowledge and understanding of perinatal mental health, according to one of the recommendations.

Meanwhile, every trust proviing maternity services should employ a midwife who specialises in maternal mental health at a senior level, the report said.

The document – called Caring for Women with Mental Health Problems – lays out the standards and competences required for the specialist role as well as the basic knowledge needed by all midwives.

“All midwives need to be aware that any woman in their care can be affected by mental health problems during the perinatal period. They have a role in identifying women with existing mental health conditions and those at risk of developing one in order to ensure the women receive the specialist care they need,” said the report.

“All midwives…have a role in identifying women with existing mental health conditions and those at risk of developing one ”

RCM report on perinatal mental health 

It highlighted all midwives also have a professional duty to speak out if there is a lack of local services to which women can be referred.

Annual mandatory updates on perinatal mental health within each trust or health board should be given to all midwives and ongoing training must be available, added the document.

The recommended specialist midwife role is aimed at those who have “consolidated their post-registration experience in all aspects of midwifery” and who have an understanding of perinatal mental health and its wider impact on the child and family.

The report was launched at the RCM annual conference in Shropshire this week.

RCM chief executive Cathy Warwick said perinatal mental health services in the UK were “at best patchy, and in some areas, non-existent”.

She said the standards and recommendations in the report were “not simply a wish list” and noted the cost of failing to treat women was far higher than providing better services.

Cathy Warwick

Cathy Warwick

Cathy Warwick

“Perinatal mental illness exerts a significant toll on families and the impact on the women themselves, their baby, and the wider society cannot be underestimated,” said Professor Warwick.

“They [the standards] are essential in enabling midwives to acquire the skills and expertise to identify women with mental health problems, and to provide appropriate support, care and referral so that they receive the best possible care,” she added.

Meanwhile, the RCM has also launched an online network for midwives, health visitors, and other health professionals working in perinatal mental health to improve this type of care.

The network will include resources and information on maternal mental health, as well as a forum for discussion.

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