New mums failed by services

Posted Sunday 14 May 2006

Mind reveals antidepressant concerns, 'postcode lottery', shocking ward facilities in new report

I didn't tell anyone I was feeling low. I didn't want to admit I wasn't the 'supermum' I hoped I'd be and I felt ashamed I couldn't cope. But if someone had given me the chance, I'd have poured my heart out. I wish I'd had that opportunity. (Kelly, 32)

Today mental health charity Mind launches its 60th anniversary Mind week with a worrying new report, Out of the blue? Motherhood and depression (1). At least one in six women experience mental distress during pregnancy or after birth and 25 per cent of all maternal deaths are due to psychiatric causes. Yet Mind's survey reveals an alarming shortfall in services, failures in diagnosis and lack of treatment options for these women.

Mind's research asked women with experience of post- or antenatal mental distress about the care they had received. We found that:

• 63 per cent of those women admitted to hospital were on general psychiatric wards, contrary to national guidelines.
• over 2/3 of women had to wait a month or more for treatment, while 1 in 10 had to wait over a year.
• 75 per cent of women were prescribed medication and less than 20 per cent were offered Cognitive Behavioural Therapy when they sought help.
• 90 per cent of women attributed their problems in getting care to a lack of understanding by health professionals (as we hear about cuts in midwifery training budgets) and poor advice and information.

Lack of diagnosis

Many health professionals caring for mothers (GPs, health visitors, midwives) have had insufficient training to distinguish between normal emotional changes and mental health problems. Picking up potential risk factors for the development of mental ill-health, such as a history of mental health problems, should be routine in early pregnancy and there is confusion over roles and responsibilities in managing this aspect of perinatal care. Over half of women who have taken their own lives after childbirth had a previous psychiatric history (2) - a clear risk factor, yet not identified or acted upon by involved health professionals.

Lack of treatment choice

Mind report's found yet another area where drugs are often the only treatment available, with some women waiting up to one to two years for cognitive behavioural therapy, despite six NICE guidelines recommending it as a key treatment for mental health problems. This is particularly crucial for mothers, firstly so they can recover to look after and bond with their babies, and also because there are some problems connected to antidepressant use during pregnancy, and possibly during breastfeeding. Recent research looking at over 5,000 women in Canada suggested that antidepressant use during pregnancy doubles the risk of a stillborn baby, doubles the chance of a low birthweight baby, has greater risk of lung defects, and 20 per cent of those on SSRIs gave birth prematurely compared to 12 per cent of those who did not.

Shortfall in specialist services

The severe shortcomings in provision for perinatal care are at the root of many of the problems reported by the surveyed women. b (MBU) or access to one and fewer than half have any kind of specialist perinatal mental health service (3). The type of care women received depended on a 'postcode lottery'. Vast areas of Wales, North-East, and South-West have no specialist services or MBUs. There are only 16 MBUs in England, one in Wales (two in Scotland, none in Northern Ireland), and the term is loosely used, with no standards as yet set - the Unit can be just two rooms without security opening out onto a general psychiatric ward. Women have reported feeling unsafe, with a lack of separate bathing or feeding facilities, unhygienic conditions, and a lack of any specially trained staff. Number of beds range from just two to ten - so often women cannot get a bed on an MBU, even when there is one in their area.

Mind's recommendations include:

• all maternity services should have a lead clinician with an interest in perinatal mental health
• all women requiring admission to a psychiatric unit after birth should be admitted to a specialist MBU with their babies where appropriate
• better training is needed to enhance skills/knowledge of health professionals, developed with women with experience of perinatal mental ill-health
• standard maternity services should be required to address emotional wellbeing and provide continuity between ante- and postnatal support

Today Mind's Chief Executive, Paul Farmer, said: "Emotional and mental distress can be devastating for mothers and their families. Yet again, we come across drugs being used as the only treatment - and for this group, that has particular impact. It's shocking how many women are being diagnosed incorrectly or not at all, put on waiting lists for treatment or told that services are not available in their area. Far too many women are placed on general psychiatric hospitals without their baby because of a critical shortage of specialist mother and baby units.

"The gaps in knowledge, provision and care for these vulnerable women must be addressed now."

Survey process:

Mind commissioned the survey from Dr Margaret Oates and Dr Ian Rothera of the Perinatal Mental Health Managed Care Network Project, Trent Strategic Health Authority, with the assistance of PNI-UK, a charity for women experiencing perinatal ill-health. 148 women took part, mainly via PNI-UK's website; further in-depth interviews were conducted with some women.

Notes

(1) Out of the blue? Motherhood and depression is available from the Mind online shop.

(2) Confidential Enquiries into Maternal Deaths (2001, 2004) Why mothers die - deaths from psychiatric causes. London, RCOG press.

(3) Oluwatayo, O. and Friedman, T. (2005) 'A survey of specialist perinatal mental health services in England'. Psychiatric Bulletin, 29, 177-9.

Further facts about perinatal mental health:

• Both mild and severe perinatal mental health problems, if not dealt with, can affect the relationship between mother and infant. Children of women with untreated postnatal depression show signs of reduced social, emotional and cognitive development (Murray and Cooper, 2003).
• 15 per cent of all maternal deaths are due to suicide (Confidential Enquiry into Maternal and Child Health 2004).
• 25 per cent of all maternal deaths are due to psychiatric causes (Confidential Enquiry into Maternal and Child Health 2004) which include deaths from suicide but also from substance misuse, physical illness and accidents which, in the opinion of the Confidential Enquiry assessors, would not have occurred in the absence of a psychiatric disorder.
• 30 per cent of women experiencing postnatal depression are still ill at one year following childbirth.

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