Perinatal mental health has been lingering near the top of the midwifery agenda for a while—at least in terms of rhetoric—but now some of the talk is being translated into action. The Perinatal Mental Health Community Services Development Fund is one of the first tangible changes to the way we approach mental health in pregnancy and the postnatal period. Applications opened in August for the first stage of funding, which aims to support service development across England by expanding existing specialist community teams or creating new teams to meet local needs. The funding is part of a commitment by NHS England to spend £365 million on providing specialist perinatal mental health services by 2021.
The Royal College of Midwives (RCM) has welcomed the new funding, with director for midwifery Louise Silverton commenting that ‘the current level of service and care… is unacceptable.’ The RCM wants every Trust with maternity services to have a specialist maternal mental health midwife, who can work with community specialist teams to provide high-quality care. This is, of course, an excellent aim, but we should remember that it is not only ‘specialist’ midwives who are required to understand issues around perinatal mental health. We know that 10–15% of pregnant and postnatal women experience depressive symptoms (RCM, 2015: 4), so it is almost inevitable that every midwife will provide care for women with mental health issues at some point. Specialist services to which women can be signposted are just one crucial element; all midwives have a responsibility to provide the best possible care in line with women's needs. Part of this involves understanding the risk factors so that any problems can be identified early. For example, it is known that women with a history of mental illness have a higher risk of perinatal depression (Boots Family Trust Alliance, 2013). Other factors associated with poor perinatal mental health include low socioeconomic status, unintended pregnancy and gender-based violence (Prince et al, 2007). Depressive symptoms can range from mild to severe, in the form of puerperal psychosis. It is important to remember that partners may also experience perinatal mental health problems; paternal postnatal depression is not widely recognised but its prevalence may be as high as 10% (Philpott, 2016).
Of course, perinatal mental health involves far more than depression. Some women may experience post-traumatic stress disorder following childbirth; in particular, women with a history of sexual abuse or assault may find childbirth triggering and traumatic. Wider recognition of the manifestations of perinatal mental health problems is the first step to ensuring that appropriate care is provided.
The new funding offers a much-needed investment in services and cements the status of perinatal mental health as a key national issue. It is essential that midwives, health visitors, GPs and other health professionals work together to ensure the best possible outcomes are achieved. While specialist services are a fundamental aspect of this, it must not be forgotten that—as the Maternal Mental Health Alliance (2014) has emphasised—perinatal mental health is everyone's business.