Perinatal Mental Health – What Happens Next?

On Friday afternoon I was privileged to be among a gathering of 150 people invited to The House of Commons for a groundbreaking event – bringing together the knowledge, experience, research and wisdom of experts in the field of Perinatal Mental Health. I am a million miles away from being one of those experts, but listening to one powerful speaker after another talking about something that should concern every single one of us has taught me so much, and given me so much more to think about.

The event was organised and chaired by an inspirational Consultant Obstetrician, Dr Raja Gangopadhyay, who just exudes compassion, empathy and warmth towards the women in his care who are  struggling with their own mental health tortures. I have been to dozens of events and conferences, but this was different in that Raja himself is a front-line expert in this field, he lives, works and breathes this subject, and he was determined to bring as many voices together to be heard in three short hours. Each of the experts had only 15 minutes to tell us about their own work, or experiences, or research or knowledge, which gave the event an urgency, as each speaker added their own unique perspective to the overall debate.

It was akin to witnessing a story unfold, each storyteller adding their own important chapter to the entirety of the experience. We heard from Obstetricians, Psychiatrists, Researchers, Charities, Women themselves who had experienced mental health issues during pregnancy or soon after childbirth, Charities, TV presenters, Midwives, Health Visitors, a Dad and a Member of Parliament too. In addition to the 10 scheduled speakers, Raja handed the microphone to several eminent members of the audience who added their own words to the rich tapestry of this rapidly evolving knowledge-base. Without exception, everyone who spoke was passionate and engaging, and I was in turn deeply moved, shocked, angered, saddened and surprised by what I was hearing.

Here are just some of the things I learnt during the afternoon –

• Did you know that a woman is 33 times more likely to be admitted to a Psychiatric Unit after giving birth than at any other time of her life?

• Did you know that less that 50% of women who need specialised mental health services at this time of their life are identified, and even when they are, less that half of those women will receive any help at all. Worse still, of those women who receive help, less than half again actually get the right sort of help. In other words, of every 100 women desperately in need of mental health treatment, only 10 will receive appropriate help, and the other 90 will either get the wrong type of support or no support whatsoever.

• Did you know that our brains develop during pregnancy and during the first 2 years of life, and that a mother’s mental state has a profound effect on this developing brain?

• Did you also know that this means that children whose mothers had untreated mental illness around the time of their gestation or birth have significantly higher rates of emotional, behavioural, intellectual and developmental difficulties, not just throughout childhood but into adulthood as well.

• Did you know that, despite these figures, which represent a huge burden of suffering on thousands of families every day, most women are never asked about their mental health during pregnancy?

• Did you know that suicide is a greater risk to a pregnant woman than dying in childbirth?

• Did you also know how little research and funding goes into this whole area, yet the cost to society by not understanding it fully and supporting it properly is incalculably huge?

The whole issue is conveniently swept under the carpet and ignored by the media, who regard it as both “niche” and a “woman’s issue”. As Dr Alain Gregoire expressed it “If this was about men and their heart problems, the NHS would close overnight as a non-functioning organisation”.

Shame, stigma and fear were discussed as one of the main reasons that perinatal mental health is so hidden away and barely discussed. I couldn’t help but think how very convenient this must be for the policy makers and commissioners – this shame, stigma and fear is preventing women from asking for help, which means that the need isn’t recognised so the services don’t need to be provided. How easy it is to blame the mother, to encourage her to collude by her silence in ensuring that her needs are not met, and that her suffering will be passed on through her child to future generations.

However, there are many positives too. Women can and do make full recoveries from perinatal depression, and most women are able to continue to care for their babies while receiving treatment. For me, the best news of all was that enough dedicated professionals care about this issue to come together as they did on Friday to raise awareness and to endeavour to put this issue on the map, to reduce the shame and the stigma, and to do something to change the way this group of women are treated.

They cannot do it alone though.

Society has changed beyond recognition in the past couple of generations. For dozens of reasons, young women can’t always rely on being surrounded by older female relatives in those first few months of motherhood. Communities are fractured, and many people don’t even know their closest neighbours well. Loneliness and isolation are endemic and young women

often feel pressured to present an illusion of perfection to the outside world. Yet these women are living on our streets, shopping in the same shops, frequenting the same coffee shops and hair salons. They are our sisters, friends, daughters, cousins and co-workers.

This suffering is taking place under our noses. There are not enough Psychiatrists trained to help them, nor are there services adequate to cope with the demand. It is our responsibility too. We have to open our eyes and notice.  A simple hello, or a smile or a genuine “how are you doing?” might be all it takes for them to feel valued enough to take the first step towards

reaching out for help. We must all be vigilant, we must all know and be alert to the signs of perinatal depression or other mental illness.

Before the event started, I was delighted to meet up with my old friend Gill Phillips, and to hear all about her recent “Mind the Gap” project, which got local people in Coventry talking about the sort of health services they really wanted compared to the health services that were on offer, and where the gaps were. It echoed a lot of the work I do with parents of children with disabilities, and how the services that are in place to support our families often instead add to our burden of stress and difficulties rather than lighten our load.

The first speaker, Dr Giles Beresford, related a story from when he was a young inexperienced doctor who was called to help a female psychiatric patient in huge distress, who had several members of staff around her and no one had managed to persuade her to stop wailing or to stand up from the floor. Dr Beresford didn’t know what to do as a doctor, so instead he simply related to her as a human being, and asked her to tell him her story, and it all came tumbling out.

The next speaker, Dr Alain Gregoire, talked about how we need to take a radical shift in attitude.

And yes, oh how we do. Not just in perinatal mental health. Not just towards families of children with disabilities. Not just towards cancer patients or those needing elderly care. Everywhere, throughout the healthcare services, not just in the UK, but worldwide.

Our health services have lost their way. They were created by people and for people, yet somehow we’ve allowed the bureaucracy to take over, and we now prioritise pathways, protocols, policies and procedures above people time and again. The people who are the patients as well as the people who are the staff. The Key Performance Indicators measure only what can be measured, not what really matters. Kindness, compassion, humanity and listening are the essential factors for any healing relationship, yet they are an afterthought, an added extra when staff have time, because they can’t be quantified on a spreadsheet. Highly trained clinical staff are targeted more on their ability to be administrators, filling out endless forms and reports,  than their ability to extend compassion and thoughtful care. Nobody ever asks patients “Was anybody unkind to you today?” or “How well did they listen?” Until they do, nothing will change. Millions of pounds can be invested, but until that radical shift in attitude happens nothing really fundamental will change.

People need time to tell their stories and to be heard. The speakers who had experienced mental health issues all knew that, and they all spoke of it in one way or another. The young Dr Beresford knew that too. Kindness costs nothing but it’s priceless. It saves lives. It makes people feel valued and cared for. It helps people get better. Who else do we need to tell before it happens?

Very many thanks to all the speakers, and especially to Dr Raja Gangopadhyay for making it all happen. The cumulative effect of all your contributions have had a profound effect on me, and I’m sure on many others who were there. Together, how can we harness and build on all the energy and passion that was so evident on Friday afternoon? What can we do to radically shift attitudes and ensure our healthcare services meets people’s needs rather that the other way around?

You may also be interested in Difficult Conversations for Maternity Staff on this site.

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