(Title Image: pni-uk.org)
Children & Young People Committee
Perinatal Mental Health (pdf)
Published: 17th October 2017
Chair’s Statement, Lynne Neagle AM (Lab, Torfaen):
“We have heard from women, their families and from health professionals who have told us that mental health support for women giving birth in Wales needs to improve. It is estimated that perinatal mental ill health affects up to one in five women at some stage during their pregnancy or in the first year after childbirth with conditions ranging across a spectrum of severity.
We are pleased our work to shine a light on this subject has already borne fruit, with the Welsh Government committing to develop specialist inpatient mental health support for new mothers within Wales.”
1. Urgent work be undertaken to determine demand for perinatal mental health services
Perinatal means the period from the start of pregnancy to one year after the birth of a child. While perinatal mental health usually means the mother, it can also include partners and families.
Providing high-quality community mental health services doesn’t mean specialist inpatient units should be ignored. Between 50-70 new mothers are likely to require specialist mental health care, but because only 5 women had been admitted in Wales for that reason, it was believed demand for the services was being massively underestimated due to a lack of reliable data.
As a result, many women with perinatal mental health problems were simply admitted to general mental health boards without their baby. Which leads neatly into the next key recommendation.
2. A mother and baby mental health unit should be established in south Wales (and, in future, a cross-border centre in north-east Wales)
There’s currently no specialist mother and baby mental health unit in Wales and there hasn’t been since 2013 when a unit in Cardiff closed due to lack of funding and under-use of the facilities (see above). This has been roundly criticised by the British Psychological Society.
Many women admitted onto general mental health boards declined requests to be moved to specialist mother and baby units in England because they would be too far from home. It also has a financial impact and places stress on their families.
To justify an 8-bed specialist mother and baby unit you need 15-20,000 births a year based on Royal College of Psychiatrists guidelines. South Wales would meet this requirement easily, but north Wales falls short by around 7,500 births a year, so consideration should be given to establishing a cross-border service in north-east Wales.
3. Waiting times for therapy should be improved
All local health boards in Wales are developing core community-based perinatal mental health services backed by £1.5million a year from the Welsh Government. However, it was described as a lottery with variations between different areas and there’s still a lack of capacity to provide for patients’ needs.
A full range of different therapies needed to be available – including cognitive behaviour therapy and talking therapies – but health boards are struggling to meet waiting time targets for assessment and treatment; patients in the north west of Wales could wait up to 33 months to start specialist therapy.
4. The public should be more aware of perinatal mental health issues
The Welsh Government’s Together for Mental Health strategy wants to see more prospective mothers offered good information and support about their mental health needs during a pregnancy. However, mental health issues aren’t always covered in antenatal classes as each class may have a different format from place to place. When surveyed, 26% of Welsh mothers said they were never asked about their mental health during pregnancy, compared to the UK average of 15%.
So one proposal from healthcare professionals would be to move towards more structured antenatal classes that shift away from the physical aspects of childbirth and pregnancy to include emotional well-being. The aim would be to prevent mental health problems.
5. Breastfeeding should be normalised
There’s a clear link between a lack of breastfeeding (or a drop off in breastfeeding after birth) and mothers developing mental health problems. Wales has a poor breastfeeding rate and there was a consensus amongst witnesses that it has to be turned around. Post-natal depression can also be triggered by mothers being unable to breastfeed (for whatever reason) and “feeling like a failure”.
One big problem is deciding what prescription drugs can be used whilst breastfeeding, particularly when it comes to anti-depressants. Some mothers who’ve developed mental health problems are told to stop breastfeeding in order to take medication, so it’s important to weigh the risks of the medication against the risks of not breastfeeding.