Guest post: Mental health care for new mothers - 'my bad experience was one of many'
This week, figures from The National Childbirth Trust revealed that only 3% of Clinical Commissioning Groups (CCGs) have a perinatal mental health strategy. Here, MN blogger Beth Bone - who experienced severe postnatal depression - argues that these figures expose the huge gaps in provision for new mothers, and explains why this desperately needs to change.
The Musings of a London loving Mum
Posted on: Tue 08-Jul-14 17:37:52
(27 comments )
In February 2011, the month after my son was born, I became ill with severe postnatal depression. I remained ill for the majority of his first year. The NHS care I received kept me safe - I was a risk to myself, and therefore was admitted to a Mother and Baby Unit. But it didn't do much else to help me: it was only after I gained admission to a private hospital that I really started to get better. I was lucky to have the means.
Although now recovered, the severity of my illness, the mental scars it left, and my grief over the time missed with my son can still catch me unawares.
As a survivor of postnatal illness, I know that perinatal mental health provision is patchy at best. But even so, I was completely horrified by the figures recently released by the National Childbirth Trust (NCT) based on data they gathered through FOI requests.
When they contacted Clinical Commission Groups (CCGs) across England, they found that only 3% said they have a perinatal mental health strategy. Worse still, of the remaining 97% with no strategy, 60% have no plans to put one in place.
It's hard not to be shocked - especially when we consider that suicide is one of the leading causes of death for women during pregnancy and one year after birth.
As a society, we mythologise reproduction and everything that comes with it. It is glowing, magical – all soft-lighting and pastels - and therefore impervious to anything untoward. It helps no one in the long run, because it implies that variation from the “norm” is unacceptable.
I came so close to ending my life during the months I suffered - I wanted the mental anguish to stop and I genuinely thought I may never recover. I was not alone in feeling like this, and now my heart aches for those who have died - and the families left behind.
Perinatal mental illnesses can be mild, moderate or severe. The mental illness can have existed before pregnancy, or it can develop for the first time or be greatly exacerbated in the perinatal period - and each illness requires different kinds of care and treatment.
Yet often we see ‘postnatal depression’ used inappropriately to cover all perinatal mental illnesses. Antenatal depression, maternal obsessive compulsive disorder, postpartum psychosis, post-traumatic stress disorder – general knowledge about such conditions is poor. Is it any wonder, when we consider the huge gaps in provision for mothers?
There is a fundamental lack of understanding about the impact that infertility, conception, pregnancy, birth, becoming a parent and bereavement (both ante- and postnatal) can have on mental health. As a society, we mythologise reproduction and everything that comes with it. It is glowing and magical – all soft-lighting and pastels - and therefore impervious to anything untoward. It helps no one in the long run, because it implies that variation from the “norm” is unacceptable.
Even as I write this I can feel the effects of the stigma – how much do I disclose? What will the response be? I'm not proud to have been suicidal, but I refuse to feel guilty about my illness. I find that when people are judgemental, it tends to say more about them than me - and I want to talk about what happened to me to prevent further deaths.
It’s not that the medical profession don’t acknowledge the seriousness of this issue. Clinical guidance issued by the National Institute of Health and Care Excellence (NICE) in 2007 on antenatal and postnatal mental health states that: “Mental disorders during pregnancy and the postnatal period can have serious consequences for the health and wellbeing of a mother and her baby, as well as for her partner and other family members.”
And yet, in response to the NCT's request for information, some CCGs directed them to local NHS trusts or NHS England. This suggests a lack of clarity about who is responsible for commissioning and providing services. Amazing charities are attempting to fill the voids, but we shouldn't need to rely on the third sector to do this - there are massive gaps in services, and the NHS needs to step up.
For me, it’s personal - I am incredibly thankful to have survived, and I still wonder how I managed it sometimes. But it should also be personal for anyone who may give birth, or who has a partner, sister, daughter or friend who may. This is why the Maternal Mental Health Alliance has launched its #everyonesbusiness campaign. It highlights that pregnant women and new mothers in almost half of the UK do not have access to specialist mental health services, potentially leaving them and their babies at risk. They have even put together maps to show the gaps in provision.
This is an issue that needs urgent attention - something very fundamental is broken, and it involves all of us.
By Beth Bone
Hi Beth - brilliant post!! So pleased that you recovered eventually, though sad it took so long. You highlight very well the real need for all that the maternal MH alliance is calling for. As I keep telling people, it ain't rocket science! We know how to save lives, we just need the politicians to implement things...
Great post. And the part about a generic "postnatal depression" covering a number of mental health illnesses really struck home with me. I was traumatised and depressed after my dd's birth, but didn't think I had pnd (no probs bonding) so didn't know what to do.... I also believe strongly that mothers with some key indicators (eg prev depression, years of infertility, loss of mother, traumatic birth) should be highlighted as at risk is advance and some attempt made by GP/midwife to engage proactively.
I didn't realise that suicide is one of the leading causes of death in pregnancy and perinatal period - that alone should demand attention.
I was diagnosed with OCD when my son was 8 months old and this is the first time I've heard the term "maternal OCD"!
Great post. Particularly the point about pnd/ptsd/ocd and other conditions being lumped together.
I was admitted to a mother and baby unit when my dd was 7 weeks. It saves my life. The care I received there and for the next 18 months from the perinatal team was amazing. But it is so patchy. There were only 5 beds. The next nearest units had 10 and 5 and that was it for whole North of England. There were women in there with me who had spent time separated from their baby in psychiatric wards and one whose husband had to do a 4 hour round trip to visit her.
I saw a leaflet about perinatal and postnatal provision in our local GPs waiting room. I was very glad that the surgery saw fit to treat the subject seriously.
One thing that struck me was the lack of urgency. Post natal is a time-specific condition but I seemed to be lumped in with generic NHS waiting times. The twins were born in March. I was pretty bad within a month. I was referred and got a perinatal appointment for the end of July!!!
I had post natal OCD when my son was born. It was truly awful. I am indebted to the local mental health crisis team who visited me 3 times a day to check on me, but I still would have fallen apart entirely if my mum hadn't been able to stay with me 24/7 for a month. I really should have been admitted to hospital, in retrospect, but this was never even presented as an option.
Great post. I had very severe depression and anxiety when I was pregnant. I suffered with hyperemesis for the first 18 weeks and was admitted to hospital to be put on a drip 3 times in that period. It got to the stage where I just couldn't cope anymore and literally paced the house (not sleeping or eating) for days. I couldn't ever see myself getting better and just wanted the mental agony to stop.
I must say I received excellent care from the Medway NHS Trust. During one of many visits to A&E, a doctor could see I was in great distress and got two members of the psychiatric team to speak to me. They were so understanding and kind and referred me onto the Mental Health care team, who visited me at home every day, and gave me a 24 hour phone number to call. I was then discharged to a mental health nurse I visited once a week. They also referred me to the specialist mental health midwife at the hospital who was fantastic. She even visited me on the ward when I had my daughter.
I can honestly say without their support (along with the support of my family, friends and colleagues and the anti-depressants) I wouldn't be here today. I would certainly have ended up with post-natal depression at least. As it is, I feel stronger today than ever before (my daughter is now 8 months old).
The services in my area were fantastic, and this clearly needs to be replicated across the country. Perinatal mental health isn't talked about and isn't accepted as a risk to mothers. With the amount of hormones flooding through your body, not to mention the substantial changes a baby brings to your life, it is a real risk and should be given priority nationally.
This is a great piece, I relate to a lot of it. The very worst thing I did and, stupidly, continue to do is confide in make friends. It's a depressing fact in itself Tht they just don't get it. The guilt you speak of, the mourning over lost precious time with your baby..... Somehow that converts into a certainty that your children are better off without you as already you've done them so much harm. Also, the all consuming nature of motherhood is something men cannot understand. I'm lucky to have access to mums in a similar position to me. That has helped more than anything.
Great post, Beth.
I already struggle with depression and anxiety, so it's unclear as to whether or not I have PND or if having a child exacerbated my condition. Maybe it's a little of both?
I'm not in the UK, but as an outsider I can say that your treatment through the NHS, though however limited, seems miles ahead of the almost nonexistent care I sought for myself here in Canada. For the first three months after DD was born, I was told that it was just nerves, DD had colic, I had the baby blues, etc. But no one ever had enough time or resources to figure out what was really bothering me. I had a complete breakdown when DD was 7 months, and everyone was still shocked. I should have sorted myself out by then, I was told, and was asked why I didn't say anything before.
I'm in counseling now, through a private practice as the free health services were oversubscribed. It helps, but is extremely costly so I have to assess my need for it vs.the cost every month. I feel one step forward, two steps back most days.
I am so glad to read that you and others have received the help you needed. Despite its flaws, you are indeed fortunate for your NHS.
Beth, I'm so sorry you've had such a hard time. I just wanted to add a tiny comment. I'm a clinical psychologist, and where we work, pregnant women and mothers of children under one year go straight to the top of the (otherwise very long) waiting list, because it's recognised just how urgent these problems can be. I'm sorry to read that your experience was not good.
Maternal MH needs a much higher priority than it currently has, and an understanding that the treatment needs to be tailored to this specific group.
I have pnd and it was only when I became suicidal that any help other than antidepressants became available. This was a local MH crisis team staffed by MH nurses who visited me at home, however they knew little about pnd and although some were great many others weren't helpful. Advice such as to give my baby a dummy to stop her crying or to take her for (another) walk didn't address the problems I was having but made me feel even more of a failure as a mother.
I also found that the referral process to the psychological help I needed wasn't specific to maternal health and I had to fill in a questionnaire asking me, among other things, how often in the last two weeks had I felt suicidal? The answers to which I had to reveal in a phone assessment before they would even put me on the waiting list. Not something that is easy to do when you are in a black hole.
obviously all MH services need more funding, but maternal MH seems to be largely ignored, misunderstood or the treatment is inappropriate. I am so glad you got the help you needed, but good Care needs to be in place across the nhs which it sadly isn't.
I suffered a pretty traumatic birth with DS, made a million times worse by the callous attitude of a significant portion of the staff who attended me while I laboured and the very poor community support when we got home.
I'm not sure when I developed PND but at around 6 months it all got too much for me and I made a plan to commit suicide, feeling, like Loulou said, that I was such a fuck up that everyone would be better off if I was dead.
Luckily I still had some awareness left and recognised that this was not healthy and sought help from my GP, who was absolutely amazing and referred me for counselling immediately, along with some drugs.
The counselling took more than 5 months from referral to appointment. During that time I was contacted by a counsellor who offered me a course of therapy but then refused to see me if I brought my baby with me, even after I explained that one of the reasons I felt so unwell was that I had absolutely no alternative child care open to me and couldn't afford to either pay for care or have my husband take time off work. By the time I did get an appointment I had a toddling child who was disruptive in the appointments and so I really wasn't able to get the full benefit.
I had horrendous anxiety and did that pacing the house unable to sleep thing after having ds. I became paranoid about friends, neighbours and family members, thinking they were going to reports to SS and take my baby away and thought strange cars in the street were watching me. I would panic for days about ds' doctors appointment, obsess over any marks he had, plan his outfits, what I would say etc. At one point he had scratched his face and I cried about it on and off for three days as I had a HV visit coming up and was convinced she would think I had harmed him. My husband worked long hours but even he must have been able to see that I was quite ill at one point.
I eventually plucked up the courage to go to the gp and was told I was probably a bit overwhelmed, to try some relaxation, maybe yoga and take time out for myself.
Due to the nature of the anxiety, I was always well put together, well groomed, ds clean and dressed nicely etc and holding down a decent job and must have always looked from the outside like I was coping, even when I was falling apart inside but that was part of it. I was desperate to be seen to be coping out of this irrational fear that someone would think I was an unfit mother and take ds. I couldn't express the seriousness of what I was feeling and I didn't try again to get help.
Luckily it seemed to get better by itself eventually and I have another dc now. I remember finding out I was pregnant and crying at the thought that the feelings would come back but they didn't seem to, although I do still have a wobble now and then when things get too much.
Perhaps it was the nature of my anxiety which made me unable to reach help effectively or perhaps because I wasn't in pieces in reception with unbrushed hair I didn't give the impression that I needed help but I really, desperately did at one point and there was no one.
Sorry, my grammar is all over the place! That was quite difficult to type actually. It all feels so long ago now.
Interesting and well written post on a very important topic, but for me it misses something. What exactly was it that the private hospital did and the NHS didn't do which helped you recover? Please can you be specific so that women without your 'means' will know what to ask for from the NHS to help their recovery?
Oh my goodness Beth. We were in the private hospital together for the same reason. I'm so glad to hear that things are going well for you, have thought of you often.
Wow, just wow.
whoisafraidofnaomiwolf differences for me personally between private and NHS admissions.
- NHS is all about making sure you get to a point where you are no longer a danger to yourself/anyone else. That's all they have the budget for I think. As a result you are woken up, get your meds, then that's all the staff interaction you really get other than to be fed until evening meds. Yes, you get looked in on every 10 or 15 minutes if you are on observations, or there might be a card making activity or something to keep people occupied for half an hour, but generally the inmates just sit in front of the telly or shuffle round in their slippers looking bored.
Private - we had 10 till 4, 5 days a week group therapy of all kinds. You had to have a really good excuse not to go. 2 meetings a week with your consultant psychiatrist, regular chats with the psych nurses on the ward. Just a completely different mentality towards things, almost working towards enabling you to manage handling the problem behind the suicidal feelings rather than just patching you up and shipping you back to carry on dealing with it. But then it cost a fortune (thank god for private healthcare insurance through work) so you'd expect the quality of care to be there.
Have a look at some of the main Midwifery textbooks used in training and prepare to be appalled at the meagre information on mental health, mental illness and post natal mental health problems. One textbook used by students at all major Schools of MW and nursing has half a page on the whole subject.
The student MWs I worked with when they did their MH placements were almost always disengaged, seeing the placement as something to 'get through'. Rarely did I meet one who wanted to educate themselves in ante/intra/post natal mental health issues and sadly this attitude can carry right through to maternity commissioning.
BTW- our local mental health services may be under a lot of financial and organisational strain but they offer occupational therapy 9-5 each day, access to psychological therapies, group therapies and a full programme of activities and one to one time.
No not perfect but service users are offered plenty of things to engage in during the day.
Our local hospital, when I was last an inpatient anyway, only offers the therapy services to you once you have been discharged. Which is great (that the service exists) but ideally some kind of group could be run on the ward for those who are going through the worst of times.
TheWildRumpyPumpus - I totally agree with your analysis of the NHS approach being to patch you up rather than deal with the underlying problem.
As well as being under the care of the mental health team and taking anti-depressants, I was also having counselling. BUT I had to do this privately and pay for it myself. The waiting lists are horrendous on the NHS and it's not really tailored to the patient's needs. I think it's really important to find a therapist you connect with but you're not really given that choice on the NHS.
I think again it's a case of short-sightedness on the government's part who would rather stick a plaster on it than solve the problem.
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