Perinatal mental health report
Tommy's has released a report into perinatal mental health, in conjunction with Netmums, the Institute of Health Visiting and the Royal College of Midwives, and supported by the Boots Family Trust.
The pressure to succeed as a mum is a key contributor to developing either pre- or post-natal anxiety and depression, according to a study of 1500 women with perinatal mental health problems.
The study showed that symptoms were severe:
- 43% did not want to leave the house
- 22% had suicidal thoughts
- 30% reported that their symptoms lasted for more than 18 months
- Yet three in four felt unable to fully tell a health professional, and 40% didn’t receive any treatment.
Download the full report here
New measures needed for spotting mental health problems
With up to one in seven women experiencing a perinatal mental health problem, Tommy's and its partners in this report are calling for a range of measures to help women with perinatal mental health problems to get the support they need.
- Spotting the symptoms of mental health problems: Health professionals used a variety of approaches to spot symptoms.The right approach for different professionals working in different clinical settings needs to be agreed, and a minimum standard of training provided for identifying symptoms.
- Continuity of care: Commissioners should consider the way services are structured to maximise continuity of care, and ensure that midwifery and health visiting services have sufficient staff with the time and skills to provide care for those experiencing mental health problems.
- Wellbeing plan: We need to achieve a much greater awareness and openness about mental health issues during pregnancy and after birth. Routine use of a Wellbeing Plan in pregnancy would help new parents to talk openly with health professionals and recognise any symptoms and support needed early on.
The coalition who published the report has launched a Wellbeing Plan for women and health professionals so that women’s emotional health in pregnancy and after birth is given the same attention as their physical health.
Download the Wellbeing Plan here.
Reasons for depression or anxiety before or after birth
The report shows that almost half of all mothers felt that the pressure to ‘do things right’ (22%), together with a lack of practical and emotional support (21%) had triggered depression and anxiety during pregnancy or after birth. In comparison, only 12% felt that their mental health had been impacted by their hormones, and 15% felt they had a pre-disposition.
Women are not talking to health professionals about depression
Despite the severity of their symptoms, only one out of five (18%) women ever fully revealed their feelings to a health professional. One third (34%) of women did not disclose for fear that they would have their baby taken away from them. A further third (31%) were put off because of a lack of continuity of care, reporting that they saw different midwifes or health visitors at appointments. 43% were simply embarrassed to raise it.
The combination of fear and embarrassment around disclosure, the pressure to succeed and lack of time with health professionals meant that 40% of women received no medical treatment or informal support of any kind.
Carina Gordon, 25 and from Romsey, had pre-natal depression while expecting her first child. Carina said:
'About four months into the pregnancy, I just started feeling angry, but I shrugged it off thinking it was just hormones playing up. However, it only got worse - I felt like I was going mad. Most of the time I just hid it. I would cry in the car, as that was my private time. Eventually I told a midwife, who said I would be referred for treatment but no follow-up ever took place. There is so much pressure and expectation on how you should feel during pregnancy and when your baby comes, and it’s so hard to admit it if you don’t feel that way.'
Lack of continuity of care contributing to the problem
The report also surveyed 2000 health professionals, finding widespread concerns around lack of time in appointments, and lack of continuity of care, meaning that there was little opportunity to build up the relationships needed for women to open up about depression and anxiety. Less than half (46%) of community midwives saw the same woman throughout her care, and 44% said that there was not enough time to discuss mental health in appointments. Their concerns were echoed by health visitors, with only 43% seeing the same woman throughout her care.
Health professionals also felt that the tools for spotting mental health problems were not sophisticated enough. Current NICE guidelines recommend the Whooley questions, but professionals felt that the two simple questions involved – whether a woman feels sad or has lost interest in things – were not sufficient to pick up on many symptoms of mental health problems.
Sally Russell, co-founder of Netmums, said: “Depression during or post pregnancy can be dreadful for the mother – but the condition affects the whole family as well. The illness robs families of what should be one of the happiest times of their lives as they welcome a new arrival. It’s clear to see as society changes with longer working hours, fewer families living close together and the relentless media pressure for new mums to look, act and feel perfect, that there is a real danger incidences of this illness could be on the increase - but the introduction of the new Wellbeing Plan is a good step towards combating it.”
Jane Brewin, Chief Executive of Tommy’s said: “Pregnancy and motherhood are life-changing experiences and on top of the physical changes and new responsibilities, many women are scared of doing the ‘wrong’ thing or fear they will ‘fail’ as a mum. Everyone expects pregnancy to be a happy time, which makes it even harder for women to open up when they’re feeling under pressure, anxious or depressed. Mental health problems in pregnancy can have consequences for both mother and baby, and we need to create both a society and a health care system where women can be open about their feelings, and get the support and treatment they need.”
Cathy Warwick, Chief executive of the Royal College of Midwives said: “The results of this survey give an indication of why we need urgent collective action from practitioners and commissioners to address this long standing issue. The government have publicly pledged to do more to help women with mental health difficulties in pregnancy and after birth. The survey also highlights the need to improve professionals’ knowledge and willingness to help and support women to access appropriate help. We recognise that this if often very difficult as midwives face pressure on their time due to the demands on the maternity services caused by a rising birth rate, more complex births and a shortage of midwives.”
Dr Cheryll Adams, Director of the Institute of Health Visiting said: “At any point in time during the first postnatal year 1:8 mothers will be suffering with depression. Mothers and fathers need anticipatory information from health professionals, such as the Wellbeing Plan offers. Also health professionals who are properly trained and resourced with services organised to allow mothers to build a trusting relationship with one midwife/health visitor who they are confident in calling if they feel they are not coping. Whilst the first year of our child’s life is one of the most special times in our lives, without the right support it can also be one of the most bewildering and challenging.”
Chris Currer of the Boots Family Trust, who funded the work, said: “We all assume that pregnancy and the arrival of a new baby is a time of hope and promise. But the truth is that many new mothers experience some level of emotional distress and all deserve systematic and compassionate support. We hope that this research will be a step towards creating a comprehensive network of professional tools, public policy, and general awareness that will help give mums much needed support.”
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Estimates show that 10-15% of women will experience a perinatal mental health problem. Royal College of Psychiatrists 2012.