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Large shortfall in mental health care for new mothers, UK survey reveals

Only a handful of referrals made, and long waits for treatment common

Caroline White

Wednesday, 22 February 2017

There’s a large shortfall in mental health care for new mothers, reveal the results of a UK survey, published today by the Royal College of Obstetricians and Gynaecologists (RCOG) and the Maternal Mental Health Alliance (MMHA).

Only a handful of specialist referrals are made for those with mental health issues during and after pregnancy, and waits of more than four weeks are common, once a referral has been made.

More than 2,300 women who had given birth over the past five years in the UK were quizzed about their experiences of perinatal mental health problems, engagement with healthcare professionals, and the quality of care they received.

Most (81%) of the respondents had had at least one episode of mental ill health during or after their pregnancy. Over two thirds said they had experienced low mood; half said they had felt anxious; and just over a third said they had been depressed.

Only 7% of those with a mental health issue were referred to specialist care and for almost four out of 10 of those who were, it took more than four weeks to be seen, with some waiting up to a year for treatment.

Care provision across the country varied significantly with a 20% difference in referral rates in some areas, and the type of care received also varied: in one area only 8% of women were referred to specialist maternal mental healthcare services, compared with 50% in another.

Women frequently said that they had been given inconsistent and/or conflicting advice around whether to continue, stop, or change their medication. Care was often rushed and women who voiced concerns were shut down or had to repeatedly ask for help.

Lack of continuity of care was often cited as a reason why women felt uncomfortable raising mental health problems with healthcare professionals. Women described a lack of awareness of the range of mental health issues, and the impact of physical conditions in pregnancy on mental health was often overlooked.

The lack of bereavement care after a miscarriage or stillbirth and support for breastfeeding were also issues for the respondents.

Some 12% of women’s partners who had experienced a mental health problem during or after the pregnancy were similarly provided with little support.

Professor Lesley Regan, RCOG President said the results conveyed “a stark picture of how the NHS is letting some of the most vulnerable women in our society down.”

She continued: “Currently the fragmentation of health care provision means that women face a number of challenges accessing the care they need. Access to specialist community perinatal mental health services is crucial and greater integration between primary and secondary care will ensure that women are referred in a timely manner and receive the right support throughout their pregnancy and beyond.”

Healthcare professionals are often the first point of contact for a woman with mental health problems, and all staff involved in the care of women during pregnancy and the first year after birth must be trained in how to deal with perinatal mental health, she insisted.

Dr Alain Gregoire, who chairs the Maternal Mental Health Alliance, commented: “Despite some additional funding, GPs, midwives, health visitors, therapists and specialists providing perinatal mental healthcare are under extreme pressure, and in half of the UK, pregnant women and new mothers have no access to the care they need. Yet leaving this inadequate care for perinatal mental health problems adds costs to society of £8.1 billion each year, of which over £1 billion is borne by the NHS.”

He added: “In this survey, women have spoken out. Despite the pain, trauma and stigma these women have faced as a result of mental health problems, they have conveyed a clear and unequivocal message that services in the UK must improve. Women should not have to experience such low rates of referral, long waits, a lack of continuity of care, misunderstanding and stigma. Services must also address the needs of affected partners and children, whose mental health is so often neglected.”

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