Maternal mental health is everyone's business...but we need leadership from Stormont
In recent weeks there has been an increased focus on maternal mental health from the BBC’s In The Mind Series to commitments from the government in Westminster to improve services in England.
With the Northern Ireland Assembly’s All Party Group on Mental Health set to discuss the issue, let's look at the changes that need to take place to ensure that mothers in Northern Ireland are able to access adequate mental health support.
Maternal mental health problems can be distressing and devastating for the mother, her family and friends. A conversation with one mum in Omagh whose mental health problems had started with the birth of her first child has stayed with me. She was so afraid that her baby would be taken off her by social services if she said that she was struggling that: "I just went into the backroom and their daddy did everything and that is where I stayed for the next twenty years."
Northern Ireland brings a whole new meaning to the term ‘postcode lottery’ when it comes to maternal mental health. While care is patchy across the UK, in Northern Ireland there is only one specialist service (run by Dr Janine Lynch within the Belfast Health and Social Care Trust). There is no mother and baby unit meaning that mothers and babies are always separated in Northern Ireland if the mother needs hospital-based mental health care.
The Maternal Mental Alliance’s Everyone’s Business campaign graphically illustrates the lack of support for mothers and their families with their UK map, using information gathered by the Royal College of Psychiatrists. Today, 80% of women in Northern Ireland still have no access to specialist public service support. The scale of the issue was outlined in a Northern Ireland Maternal Mental Health briefing sent to all party leaders in August 2014.
Of the 25,273 births in Northern Ireland in 2011, 2,527 women developed antenatal depression, 3,790 women developed postnatal depression, 50 mothers developed puerperal psychosis and 50 were admitted as a result of relapsing.
The good news
As we countdown to celebrating Mothers’ Day this Sunday, the good news is that we know what good maternal mental health services look like. The National Institute for Clinical Excellence (NICE) has produced guidance and a standard for the perinatal period (pregnancy and the first year after the birth).
In 2012 the Public Health Agency published the Integrated Mental Health Perinatal Care Pathway. The Pathway is a testament to the efforts of the extraordinary, dedicated health and social care professionals who have championed the mental health of mums and babies for many years. But its impact is limited by the ongoing lack of investment.
There is help for women and families affected by mental health problems: you are not alone. Everyone’s Business has resources including helplines, support groups and information. Aware NI has a factsheet on postnatal depression and runs a number of wellbeing programmes, including Mood Matters Parent and Baby to which you can self refer or have a healthcare professional complete the form.
Dads need help, too
Dads can be deeply affected when their partner experiences mental health problems during pregnancy or after the birth. An experience that was anticipated with great joy can turn to one of huge distress - as well as a logistical nightmare as family and friends try to support the mother while arranging the necessary 24/7 care for the baby.
There is growing evidence of dads developing mental health problems – particularly depression. Dads may struggle to continue working – often having to take leave or stop working altogether to look after their family. PANDAS (Pre And post Natal Depression And Support) has resources for dads.
Specifically, to support mothers and their families we need political leadership to achieve:
- public maternal mental health services in Northern Ireland to be delivered to the UK standard set by the NICE
- exploration of opportunities to deliver multi-disciplinary services on an all-Ireland and cross-border basis to realise economies of scale efficiencies, particularly a mother and baby unit
- peer support and self management programmes for mums, dads and their families
- research to understand the particular experiences of maternal mental health problems in Northern Ireland.
Investment saves money
Investment in maternal mental health services saves money. According to an economic report from the London School of Economics and Centre for Mental Health investing £400 per normal birth to bring services up to NICE standards would realize at least £10,000 in savings over the lifetime of the mother and child. Savings would be enjoyed by public services (such as health, education and criminal justice) and society (through higher rates of economic activity and reduced care needs).
We are involved in a number of initiatives in Northern Ireland. In Britian, with the support of Big Lottery, we run peer-support and self-management programmes for families: our maternal mental health project Mums and Babies in Mind, Creating Connections, and Young Mums Together. We are also a member of the Maternal Mental Health Alliance, which is based in our London office.