Depression and anxiety among pregnant women and new mums is going under-treated due to lack of disclosure and poor continuity of care, according to new research.
Demonstrating the scale of unmet need, the research found that only 18% of patients fully disclosed their mental health concerns to their midwife or health visitor. As a result, 40% of women with a perinatal mental health problem received no formal treatment or support at all.
The report Perinatal mental health: experiences of women and health professionals, produced by a coalition of pregnancy research charity Tommy’s, Netmums, the Royal College of Midwives (RCM) and the Institute of Health Visiting, canvassed the views of 2,000 health professionals and 1,500 women. It found that the major barriers to discussion around mental health included:
• 31% of women did not disclose because they saw a different professional at every appointment
• 1 in 5 women did not disclose because they thought health professionals were too busy
• 44% of community midwives and 18% of health visitors reported there was not enough time to discuss mental health at appointments
• 22% of health professionals felt that women wouldn’t want to discuss their mental wellbeing and 59% reported that women themselves don’t talk about it enough in comparison to their physical health.
Also, while 97% health professionals felt comfortable in raising the topic, both patients and professionals felt that a lack of continuity of care, and lack of time in appointments, made it difficult to establish a trusting relationship within which women felt able to disclose mental distress.
Health visitors and midwives also felt that the tools for spotting mental health problems weren’t always sophisticated enough. Current National Institute for Health and Care Excellence 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 ill health. Furthermore, just 22% felt that they had good perinatal mental health services available in their area.
Call for more resources
Midwives and health visitors also wanted more resources to facilitate discussion and treatment. More than half (55%) wanted better information on available support services and resources to support discussion, while 45% wanted access to a colleague who was a specialist in perinatal mental health.
Responding to the concerns and needs of health professionals, the report authors are launching a new Wellbeing Plan to help open discussions between patients and professionals and plan support so that women’s perinatal mental health can be given the same attention as their physical health.
The coalition is also calling for a range of measures to help women with perinatal mental health problems to get the support they need:
• Spotting symptoms: Health professionals use 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 ill health
• 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.
Tommy’s, Netmums and the Institute of Health visitors will each be creating further resources to help support both women and professionals in talking more openly about mental health.
Change is needed
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, added: “Mental health problems in pregnancy can have long-lasting consequences for both mother and baby including low birth weight and increased risk of psychological problems for the child. We need to create a healthcare system that allows equal care and attention to be paid to a woman’s mental health as to the physical aspects of pregnancy, so women can get the support and treatment they need.”
Meanwhile, Cathy Warwick, chief executive of the Royal College of Midwives, called for 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 are under pressure due to the demands on the maternity services caused by a rising birth rate, more complex births and a shortage of midwives.”