From bumps to babies: perinatal mental health care in Wales

Last updated: 04 Sep 2018 Topics: Safeguarding and child protection

How perinatal mental health care is provided to women and their partners in Wales

During the perinatal period, from pregnancy up to a year after birth, women can be affected by a number of mental health problems. These include: depression, anxiety, obsessive compulsive disorder (OCD), post-traumatic stress disorder (PTSD), eating disorders and postpartum psychosis. These conditions are referred to as perinatal mental health conditions or illnesses.

This report provides an overview of the findings from the Perinatal Mental Health in Wales project, a collaboration between NSPCC Cymru/Wales, National Centre for Mental Health (NCMH), Mind Cymru and Mental Health Foundation, with support from the Maternal Mental Health Alliance Everyone’s Business Campaign. The project explores perinatal mental health care in Wales and how this is experienced by women and their partners affected by perinatal mental health problems.

Authors: Dr. Sarah Witcombe-Hayes with Professor Ian Jones, Paul Gauci, Jenny Burns, Simon Jones and Susan O’Leary
Published: 2018


Key findings

Barriers to identifying perinatal mental health problems

  • Women and their families feel they lack knowledge about perinatal mental health conditions which means they fail to recognise symptoms when they become unwell.
  • The stigma of perinatal mental health problems prevents some women from disclosing their difficulties to a health professional.
  • Heavy workloads, time pressures and insufficient perinatal mental health training creates challenges for health professionals to identify and respond to perinatal mental health problems.

Specialist perinatal mental health care in Wales

  • Important progress has been made in the provision of perinatal mental health care to women and their families in Wales.
  • There are now specialist community perinatal mental health services in six out of the seven health boards, and women experiencing perinatal mental health problems are already benefitting from these new specialist services.
  • Clear inconsistencies remain in the type and level of perinatal mental health service provision between health boards in Wales.

Accessing specialist perinatal mental health care

  • The area in which a woman lives still determines the specialist perinatal mental health care she can access when needed.
  • Large demands on specialist perinatal mental health services, insufficient staffing levels and space means that perinatal teams are stretched beyond capacity and unable to deliver services that are accessible to all women who need it.
  • Women experiencing the most severe perinatal mental health conditions, are not able to access mother and baby unit provision in Wales.

Third sector perinatal mental health care in Wales

  • A small number of third sector organisations are delivering perinatal mental health services in Wales, which complements specialist perinatal mental health services by extending the local support available to mums and their families.

Supporting families affected by perinatal mental health problems

  • Partners and family members need information about perinatal mental health conditions so they can identify signs and symptoms and know how best to support women affected.
  • Some partners and family members also need support to manage their own mental health problems in the perinatal period.

Recommendations include:

  • Perinatal mental health should be incorporated into pre-registration training for all mental health practitioners and all health professionals working in the perinatal period. Training should include how to recognise and appropriately respond to the full range of perinatal mental health conditions, from mild to severe, and address the association between perinatal mental health and infant mental health.
  • The Welsh Government should provide additional funding to health boards to address disparity in the level of perinatal mental health service provision and to ensure that these specialist services are able to provide all aspects of care that women need to help them recover.
  • Third sector organisations facilitating perinatal mental health peer support in Wales should work towards achieving the perinatal mental health third sector Quality Assurance Principles.
  • The effect of perinatal mental health problems on partners and family members should be recognised and taken into account by all health professionals working in the perinatal period.
  • The Welsh Government should establish a dedicated assurance group with membership from relevant stakeholders in the perinatal mental health sector to monitor the implementation of its response to the National Assembly for Wales’ Children, Young People and Education Committee recommendations.
  • As a key priority, the Welsh Government should establish the managed clinical network (MCN) so they can provide national leadership on implementing the National Assembly for Wales Children, Young People and Education Committee recommendations, and provide the necessary expertise to further develop perinatal mental health services in Wales.

Quotes

“My health visitor at the time was very supportive and so was my GP at my post-natal check-up. They made me realise I was suffering from PND [postnatal depression]”
Mum
“With the first baby everything is so new & unfamiliar that it’s difficult to know what should be ‘normal’. My baby was 7 months old when I was finally diagnosed by my GP, by which time I was severely depressed”
Mum
“The fear of my son being taken off me or that what I was experiencing wasn't normal and that I was going to be looked at as being an awful person and a bad mother”
Mum
"My partner found my anxiety and depression a real struggle. I was hard work to live with. There were times when he contemplated leaving”
Mum
“Many women are not being picked up as needing support. Some GPs & Health Visitors are not well trained enough to respond to a woman asking for help”
Third Sector Professional
“Once I got the right support it was superb, it was getting it that caused the problem”
Mum
“It’s all about mums and it can’t be. It’s got to be about the dads too, mental health impacts on the whole family, there’s a huge ripple affect”
Health Visitor Lead

Citation

Please cite as: Witcombe-Hayes, S with Jones, I., Gauci, P., Burns, J., Jones, S and O’Leary, S (2018) From bumps to babies: perinatal mental health care Wales. Cardiff: NSPCC, National Centre for Mental Health, Mind Cymru, Mental Health Foundation, Maternal Mental Health Everyone’s Business.