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Perinatal mental health is still everyone's business

02 March 2017
Volume 25 · Issue 3

Pregnancy and birth in the UK are safer than ever. But while the maternal mortality rate has declined steadily since 2003, there has been no significant reduction in maternal suicide. It is now the leading cause of direct maternal deaths up to 1 year after birth (Knight et al, 2016).

This context makes all the more concerning the revelation that less than 10% of women with mental health problems during or after pregnancy are referred to specialist care (Royal College of Obstetricians and Gynaecologists, 2017). A survey of more than 2300 women revealed that 81% had experienced a mental health problem during or following pregnancy; referrals were made for only 7% of these women, more than a third of whom then waited over 4 weeks to be seen. In some cases, women had to wait up to a year for treatment.

This is nothing new. Three years ago, the Maternal Mental Health Alliance (2014: 1) launched the Everyone's Business campaign, calling for women ‘to receive the treatment they need, where and when they need it, as outlined in numerous national guidelines’. Yet it appears that perinatal mental health services across the UK are still not up to scratch. Our health service is letting women down.

The problem is complex, but can be considered under two broad themes: firstly, the perception and stigma surrounding mental illness; and secondly, the critical lack of funding and resources in the NHS. Clearly these issues exist at a systemic level, so what can individual midwives do to tackle them?

Working to reduce the stigma around mental health is vital. We have come a long way in this area, but we still have far to go. Midwives should encourage women to talk about mental health from as early as the booking appointment. It is essential to foster an environment in which women feel comfortable discussing these issues. But there also needs to be a sea-change in how our society perceives mental illness, and we can all play a part in that. If you use social media, join the conversation. Share information and encourage others to be open and understanding about mental health. Speak up when you hear people make misleading or judgemental comments about mental illness. Every small step in the right direction will help us get there.

Meanwhile, throughout the NHS, costs have been cut and services slashed. Now, more than ever, is the time to innovate. Consider teaming up with a local charity to reach out to women through volunteer support. Again, small steps can be crucial; always act with compassion and be sure to keep every individual woman at the centre of care. There is hope for the future; NHS England has committed to invest in perinatal mental health services and 20 areas have successfully bid for the first stage of funding. Big problems need big solutions, but each of us can contribute in some way—and we owe it to women, families and our society to do so.