Women’s voices Report on maternal mental health

The Royal College of Obstetricians and Gynaecologists (RCOG), supported by the Maternal Mental Health Alliance (MMHA), have launched a new survey Women’s Voices – Maternal Mental Health which highlights the urgent need to improve maternal mental healthcare.

The survey of over 2,300 women who had given birth in the last five years in the UK, explores their experiences of perinatal mental health problems, engagement with healthcare professionals and the quality of care they received.  It reveals the impact of low rates of specialist referral, long waits, as well as lack of consensus over medication and little support for their partners.

81% of women who responded had experienced at least one episode of a mental health problem during or after their pregnancy. Low mood was experienced by over two thirds of these women, anxiety by around half and depression by just over a third.

Only 7% of the women who reported experiencing a maternal mental health condition were referred to specialist care and for 38% of the women who were referred, it took over 4 weeks to be seen, with some waiting up to a year for treatment. Care across the country varied significantly with a 20% difference in referral rates in some areas, and the type of care received also varied – in one area only 8% of women were referred to specialist maternal mental healthcare services, compared with 50% in another.

Women frequently reported that they received inconsistent and conflicting advice around whether to continue, stop or change their medication. Care was often rushed and women who voiced concerns were shut down or had to repeatedly ask for help. Lack of continuity of care was often cited as a reason why women felt uncomfortable raising mental health problems with healthcare professionals. Women described a lack of awareness about the range of mental health problems, and the impact of physical conditions in pregnancy on their mental health was often overlooked. Bereavement care following miscarriage or stillbirth and support for breastfeeding were also reported as lacking.

The survey also revealed that 12% of women’s partners experienced a mental health problem during or after the pregnancy and were provided with little support.

Professor Lesley Regan, President of the Royal College of Obstetricians and Gynaecologists (RCOG), said:

“These survey results reveal the true impact of the care that women with maternal mental health problems currently receive in the UK and present a stark picture of how the NHS is letting some of the most vulnerable women in our society down. Only by listening to these women can we learn through their experiences and take urgent action to improve our services.

“Currently the fragmentation of health care provision means that women face a number of challenges accessing the care they need. Access to specialist community perinatal mental health services is crucial and greater integration between primary and secondary care will ensure that women are referred in a timely manner and receive the right support throughout their pregnancy and beyond.

“Healthcare professionals are often the first point of contact that a woman suffering with mental health problems reaches out to and we must ensure that all staff involved in the care of women during pregnancy and the first year after birth have relevant education and training in perinatal mental health. Our role should increasingly be about empowering women to make decisions about their care and in supporting women to help themselves.

“Giving parity of esteem to mental and physical health is crucial and we have some way to go in addressing the stigma associated with mental health. No one is to blame for developing a mental illness and as a society we need to be reinforcing this message constantly.

“There is a wealth of data, evidence and guidance on good practice. Maternal mental health has been made a key priority by Government and funding has been allocated in England and Wales for more highly specialised services. Listening to the voices of women gives us the opportunity of a lifetime to ensure that they and their families get the care they need and deserve.”

Dr Alain Gregoire, Chair of the Maternal Mental Health Alliance, said:

“We know that suicide is a leading cause of maternal death, and that this represents the tip of an iceberg of suffering that has been ignored for too long. Despite some additional funding, GPs, midwives, health visitors, therapists and specialists providing perinatal mental healthcare are under extreme pressure, and in half of the UK, pregnant women and new mothers have no access to the care they need. Yet leaving this inadequate care for perinatal mental health problems adds costs to society of £8.1billion each year, of which over £1billion is borne by the NHS.

“In this survey, women have spoken out. Despite the pain, trauma and stigma these women have faced as a result of mental health problems, they have conveyed a clear and unequivocal message that services in the UK must improve. Women should not have to experience such low rates of referral, long waits, a lack of continuity of care, misunderstanding and stigma. Services must also address the needs of affected partners and children, whose mental health is so often neglected.

“These women have reminded us that the healthcare responsibility and the economic necessity to take action, are joined by a moral imperative to put an end to these unacceptable levels of avoidable suffering.”

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