The overriding narrative is that becoming a mother should be the ‘happiest time of your life’. However, for many women, this is far from the truth.
As many as 27% of new and expectant mothers struggle with perinatal mental illness. Previous experience with mental illness is not necessarily an indicator, meaning that many women are faced with feelings of severe anxiety and depression for the first time all while navigating pregnancy, birth, and early motherhood.
Without treatment, this can have a devastating impact on new mothers and their families.
Providing new and expectant mothers with mental health support is absolutely essential, but a recent report from the Maternal Mental Health Alliance (MMHA) found that new mums across the UK are left without the support they need.
The severity of symptoms varies from adjustment disorders and distress (affecting 150-300 out of every 1,000 mothers) to PTSD and postpartum psychosis. Regardless of the severity of their symptoms, all struggling mothers deserve access to support. This is a matter of urgency; tragically, ‘suicide is the leading cause of direct maternal deaths occurring within a year after the end of pregnancy in the UK.’
Underfunded or underspending?
In 2016, the UK government pledged almost £300m to provide specialist care for expectant or new mothers in England, but the recent report shows that this money is not always being put to good use. In some cases, it isn’t all being spent:
‘Figures from the MMHA show that almost three quarters of mental health trusts in England forecast an underspend for 2022. Across the UK, more than £15m allocated to improve maternal mental health in 2022 was not spent.’
Recruitment is a familiar challenge across the NHS, so it is hardly a surprise that this was cited as a contributing factor in the underspend. Teams were either not given enough certainty regarding the continuation of funding to hire more staff or the staff were simply not available.
Disparities in access to perinatal mental health services
While specialist perinatal mental health support is available in some capacity across the UK, significant disparities remain. The amount of available support - and the quality of that support - varies significantly along geographical lines:
Only 14% of health boards in Scotland were found to meet the Royal College of Psychiatrists UK-wide quality standards for perinatal mental health support. In Wales, this figure was zero.
In Northern Ireland, only 3 of 5 health and social care boards have a specialist multi-disciplinary perinatal mental health team. There is also no mother and baby unit for those who need inpatient care.
England may have the most comprehensive care, but it is not on track to meet the targets set for the year and ‘only around half of trusts are so far providing care from pre-conception to two years after birth, or offering partners support.’
Consultant perinatal psychiatrist and the president of MMHA, Dr Alain Gregoire, said:
‘Over the last 10 years, there has been a growing understanding of the importance of specialist care for maternal mental health, which has led to welcome improvements across the UK. However, it’s crucial that this momentum and commitment is maintained. National and local decision-makers must ensure that allocated resources reach clinical services to ensure that mothers, babies, and families can access the care they need.’
As well as these geographical disparities, marginalised women and birthing people from ethnically diverse groups, lower socio-economic backgrounds, and the LGBTQ+ community continue to be affected by inequalities in perinatal mental health outcomes.
Studies have found evidence that ‘non-white ethnicity puts women at greater risk of being subjected to inequitable care in regards to their perinatal mental health.’ Systematic racism and institutionalised medical bias both contribute to BAME women not feeling able to seek support - and subsequently not having their experiences taken seriously when they do.
Improving access to mental health services
Educating all birth workers (such as midwives, maternity support workers, and obstetricians) on the signs and symptoms of perinatal mental illness across birthing populations will help ensure better outcomes and catch symptoms early.
Surveys have found that women may not feel able to admit they’re struggling, with some saying that asking for help feels like a sign of failure. Encouraging women to access the support available to them and breaking down the stigma around seeking mental health support is essential.
Much like breaking down stigma around mental illness, addressing institutionalised medical bias is not something that will happen overnight. However, the enormity of the task does not make it something we should not attempt to address. Making perinatal mental health care fair and accessible to all, regardless of race, socioeconomic status or geographical location, is a matter of urgency.
With allocated funding currently left unspent, there is scope to start making these much needed changes if we can ensure the money is spent wisely.