The mental health profile has been raised in recent months, and about time. In 2010/11 over 1.25 million adults accessed NHS services for severe or enduring mental health problems (Health and Social Care Information Centre, 2014). The death of actor, Robin Williams in August this year highlighted that mental illness does not discriminate. It affects young and old, rich and poor, men and women. It has been reported that up to 20% of women experience mental health problems in the perinatal period (Bauer et al, 2014). Of these, only 40% are diagnosed and 3% experience permanent recovery.
According to a report commissioned by the Maternal Mental Health Alliance (MMHA), the long-term effects of substandard mental health care for pregnant women are costing the UK more than £8 billion a year. A fifth of this is attributed to the NHS and social services, the rest to society through factors such as loss of earnings and the economic effect of suicide (Bauer et al, 2014).
The MMHA report estimated that it would only cost £337 million a year to bring maternal mental health care up to recommended levels around the country. Dr Alain Gregoire, Consultant and Honorary Senior Lecturer in Perinatal Psychiatry and Chair of MMHA believes that ‘increasing spread of excellent mental health work by midwives needs to be supported and informed by local specialist services throughout the UK.’
In 40% of England and Scotland, 70% of Wales and 80% of Northern Ireland there are no specialist perinatal mental health service at all (Bauer et al, 2014). Fewer than 15% of the UK have comprehensive provision. Despite England and Scotland faring sightly better, of the 211 clinical commissioning groups, only 3% have formal strategies in place for perinatal mental health. This is not acceptable.
Dr Alain Gregoire presented at the International Marcé Society Scientific biennial conference in Swansea (p820) where he spoke of the disparity between mental and physical maternity services in the UK. He also discussed the opportunity that the promotion of perinatal mental health provided for equity, and investment in health and social care systems.
I believe that in order to bridge this gap in care provision, we need to start with education. In last month's issue of BJM, Patricia Jarrett (2014) explored the attitudes of student midwives of caring for women with mental health problems in the East end of London. Although this was a small study and we cannot generalise to the whole population, the results suggests there are gaps in the knowledge and practice of soon-to-be-qualified midwives towards women with additional emotional and psychological needs during the perinatal period. Worryingly, the research found that ‘students use cultural and illness stereotypes in their identification and provision of care of women with perinatal mental health problems. Students were often critical of evidence-based practice or neglected to use evidence in their care of women with mental health problems’ (Jarrett, 2014: 723–4).
For local specialist services to exist throughout the UK, it is imperative that every midwife receives adequate training to understand the complexity and sensitivity of perinatal mental health issues. This will go some way to help women receive the best possible individualised and holistic maternity care.