We’re helping pregnant women and new mums access a radically different service to diagnose mental health issues and access better care
10-20% of women are affected by mental health problems that arise during pregnancy and up to one year after childbirth
Twenty years ago in the UK, if a woman showed signs of mental health problems after childbirth she would likely have been diagnosed with postnatal depression and referred to generic mental health services. There was a problem though: the term ‘postnatal depression’ doesn’t encompass the many issues women can experience in the post-childbirth period.
In reality, depression alone is not the only mental health problem that can affect new mothers. Anxiety disorders, post-partum psychosis, bipolar disease, fear of pregnancy – known as – tokophobia all are possible conditions. Stigma, too. And of course, problems that arise during the antenatal (pre-childbirth) period further complicate the maternal mental health scenario, with incidences of antenatal depression now potentially outnumbering incidences of postnatal depression.
Perinatal mental health (PMH) problems – mental health problems that arise during pregnancy and up to one year after childbirth – affect between 10 and 20 per cent of women. Anxiety and depression are the most common problems. The risk of women developing severe problems such as post-partum psychosis, an episode of mental illness which begins suddenly in the days or weeks after having a baby, is low but increases after childbirth. There is also a 50 per cent chance of such severe problems recurring in subsequent pregnancies.
“Pregnancy and childbirth covers a very specific period of time in woman’s life,” says Julie Jomeen, Professor of Midwifery and Dean of the University’s Faculty of Health Sciences. “Far from being referred to generic mental health services, what women actually need is very specific support from services that are dedicated to supporting them during this whole period of time.”
Commissioning change
Julie, who was inspired to pioneer improvements for better healthcare for expecting mums after spending her early career as a midwife, leads a group of researchers and specialist PMH nurses from the Hull and East Yorkshire Perinatal Mental Health Liaison Service. Its work has been hailed as transformational, specifically in driving fundamental change in PMH care provision and management in the local area.
“In 2007, the National Institute for Health and Care Excellence (NICE) released guidelines that made recommendations for the recognition, assessment, care and treatment of mental health problems during the perinatal period, ” says Catriona Jones, Senior Research Fellow in Maternal and Reproductive Health and a Lecturer in Midwifery at the University. The group’s ground-breaking research in the local area identified major deficiencies in PMH treatment, including complex referral pathways resulting in disjointed services, deficits in specialist provision and poor communication. As a result, the group went to the NHS Clinical Commissioners and set out a case for providing specialist PMH services in the local area. The services were commissioned, putting Hull and the East Riding of Yorkshire at the forefront of PMH expertise and kick-starting an on-going series of research projects on the subject. The groupalso set up a clinical healthcare network with a central hub including a psychiatrist, mental health nurses and a psychological therapist.
What’s the stigma?
“As research continues to be undertaken our understanding of the ex tent of mental illness across the perinatal period is increasing,” says Catriona. “That’s important because women’s experience of pregnancy and the post-natal period can be hugely affected by their emotional wellbeing.
Beyond this, a mother’s experience of pregnancy and childbirth can go on to impact the relationship she has with her newborn. There’s now a growing recognition through research that parents’ ability to bond with and care for their babies, and parenting style, can predict a number of physical, social, emotional and cognitive outcomes through to adulthood. The mental wellbeing of parents can ultimately have impacts across generations.”
One significant area of research for Catriona and her colleagues at present is making sense of non-attendance in women being referred for PMH appointments, and of the impact that can have on birth and mental health outcomes. “Stigma certainly plays a part, ” says Catriona. “Women clearly don’t want to be labelled.
They don’t want people thinking that they’re not coping, or they fear that if they’re seen as being mentally unwell, social service might get involved. Stigma isn’t the only issue though. The group have done a considerable amount of work around identifying women in need of support, and empowering primary care practitioners to effectively predict, detect and manage PMH problems.
“One of the key elements of addressing the growing concerns about PMH is ensuring health professionals can identify problems and support women. Crucially, that doesn’t mean gaining an extensive knowledge about every single condition. What it does mean is being able to recognise, at a basic level, when a woman’s mental and emotional wellbeing is beginning to deviate from normal, and knowing how to refer her accordingly. We know this goes some way towards making a huge difference.
Supporting families for the long term
Since the pioneering commissioning of the group’s recommended PM services in 2007, new funding has been granted to other NHS areas throughout England in order to implement services modelled on those now in place in Hull and the East Riding of Yorkshire. In addition to these services, the University has established a Master’s-level, 12-week module titled Perinatal Mental Health. It is available to all practitioners who are involved in supporting women during pregnancy and after childbirth, including midwives, health visitors, children’s centre workers, social workers and GPs. The aim of the module is to help practitioners feel more confident in supporting women with PMH problems. “We pride ourselves on the fact that we’re not just thinking theoretically about PMH,” says Julie. “We’re actually out there changing and improving practices in the services that are being delivered to women.
“While it would be unrealistic for us to say that we’re going to get rid of PMH problems, our goal is to be able to provide enough support so that women who have recognised conditions can get the help they need in a timely manner, and so that families aren’t affected in the long term.”
