More than 1 in 10 women develop a mental illness during pregnancy or within the first year after having a baby, Examples of perinatal mental illness include antenatal , depression, postnatal depression, maternal obsessive compulsive disorder, post-partum psychosis and post-traumatic stress disorder, (PTSD). These illnesses can be mild, moderate or severe, requiring different kinds of care or treatment (Maternal Mental Health Alliance 2014) if untreated perinatal, mental illnesses can have a devastating impact on the women affected and their families.
For example maternal mental health problems are associated with 33 percent to 50 percent of all children presenting to social care as children in need or children at risk of being taken into care.
National Institute for Health and Care Excellence (NICE) guidance states that women should be assessed for levels of anxiety and depression in pregnancy and after birth. Midwives and health visitors are required as part of the maternal mental health pathway to ask two key questions about depression called the Whooley questions for example:
- During the past month have you often been bothered by feeling down depressed or hopeless
- During the past month have you often been bothered by having little interest or pleasure in doing things?
Then if concerned the practitioner is required to ask a further two questions from the Edinburgh Depression score or from the GAD-7.
Whatever the level of anxiety or depression the mother should be referred to psychological therapies for cognitive behaviour therapy yet midwifery teams note anecdotally that about half of these do not attend as they need support to attend such services or different approaches that allow them to engage with the therapy services.
As part of the Royal College of Nursing Pressure Points Campaign they have
published a report on maternal mental health. 25 percent of mother surveyed reported feeling significantly depressed or down after the birth of there baby with a further 35 percent reporting feeling a little bit depressed or down. 25 percent of student midwives felt that they had not enough theoretical knowledge about maternal mental health and 27 percent felt that they would not feel confident in recognising the signs of emotional health issues in the woman they care for. The vast majority of midwives felt that the focus of postnatal care should be on emotional support compared to clinical observation and health promotion. 75 percent of mothers report been asked how they were coping during postnatal visits though some reported feeling that this was a "tick box exercise". 35 percent of midwives would like to do more to support the emotional wellbeing of new mums.
Local CAMHS Transformation Planning Guidance based on the recent Future in Mind report clearly states that local plans should place high emphasis on improving perinatal mental health.
For further information around perinatal mental health please see the dedicated area of the Child and Maternal Health Intelligence Network
The Thames Valley Children and Maternity Strategic Clinical Network and the Oxford Academic Health Science Network have collaborated to establish The Thames Valley Perinatal Mental Health Network (TVPMHN) in 2015. Membership is comprised of NHS Provider and commissioner from each locality along with patient. Family and Third Sector representation the network provides professional links and a mechanism to share local developments and challenges with regional colleagues.
In 2015/2016 TVPMHN have hosted a series of teaching events on perinatal mental health with local and international speakers.
The referral pathway for perinatal care has changed so that mid wives can now refer at booking rather than waiting for the GP or Health Visitor to refer following the birth so that early intervention can be implemented where needed. Training has been delivered to Midwife's and Health Visitors.
The Thames Valley Children and Strategic Network carried out a broad brush scoping exercise and produced a report which recommended:
- Developing training and specialisms in perinatal mental health across different services
- Commissioning specialist perinatal services in line with NICE guidance
- Establishing a regional network of professional stakeholders
- Improving data collection relating to perinatal mental health by all providers
Following on from these recommendations TVPMHN have supported a deep dive into perinatal mental health services in the region. This will report on provisions for pregnant and postnatal women in generic health services and will evidence data relating to the perianal population in the locality.