Maternal mental health: What support is available?

Following research from LSE and the Maternal Mental Health Alliance, we chatted with pregnancy and postpartum psychotherapist, Sophie Harris, to learn more about the support available for new and expectant mums

Research conducted last year by the London School of Economics and Political Science, commissioned by the Maternal Mental Health Alliance, revealed the devastating impact that perinatal mental health problems have on women and their families when not effectively treated. What’s more, the former 2014 report calculated that perinatal mental illness costs the UK £8.1 billion annually.

Since 2014, the UK has invested in specialist services provided by the NHS to transform the lives of expectant women with complex mental health problems and their babies. As welcome as these findings may be, more action is now required to see that women and their families receive the quality of care that they need

Whilst improvements have been made, access to perinatal mental health services is still a challenge. The report highlights the long waiting lists for mental health services, including those provided through the NHS Talking Therapies programme (previously known as ‘Improving Access to Psychological Therapies’ or IAPT). Not only this, but many of the services are unable to meet pregnancy and parenting-specific needs. This means some women don’t accept referrals, miss appointments or are dissatisfied with their treatment.

With more maternal mental health problems being identified as a result of the pandemic, now has never been a more important time to ensure services can respond to increasing demands and are fit for purpose.

The outcomes from the LSE report propose a better integration of perinatal health services, such as maternity and health visiting, with primary mental health services. The collaborative efforts will help address maternal wellbeing and support the early developmental needs of children. This, coupled with identifying women in need and facilitating access to treatment, will have a clinically cost-effective role in society.

We chatted to pregnancy and postpartum cognitive behavioural therapist, Sophie Harris to find out more.

Do you find the findings from the 2014 report surprising?

“Absolutely not,” Sophie says. “Not only are the impacts of maternal mental health difficulties felt by the mother, but also of their child, and potentially even their children. At the moment, there are a lot of unsupported mothers who are struggling. Unfortunately, our children feel our stress. Untreated mental health conditions will have a huge social, emotional and financial impact both on the needs of the mother and child and wider society.”

Do you welcome this research?

“Yes. I believe that any research that highlights the need for maternal mental health support is positive. However, it requires significant action for the impact of these findings to be shown in the outcomes of care for our mothers who are struggling.

“There appears to be a large-scale underestimation of the mental health needs of new mums. For example, the NHS website states that one in 10 women will experience postnatal depression in the first year after a child is born. I would argue that this is hugely underestimated, particularly due to the long-term lack of support and lack of “the village” that new mums so desperately need.

“The restrictions caused by the pandemic have only further exacerbated these problems. I believe that the underestimation of maternal mental health needs can often mean that mothers who are experiencing psychological problems feel like a ‘failure’ or ‘guilty for not enjoying motherhood’ when, in fact, experiencing these difficulties is a completely natural response to going through the huge adjustment in life.”

How important is early identification of maternal mental health problems?

The report highlights that we have not yet addressed treatment options for the more common mental health problems. It is these more common problems which, if left untreated, can escalate. Therefore, it is important that health professionals, such as midwives and health visitors can identify issues early on. The findings show that the difficulty here lies in the lack of resources and understaffed services, meaning that early intervention is not always possible.

Sophie says that “the identification of mental health difficulties should be as important as identifying physical needs of new and expecting mothers during this time.

“The separation of the mother’s mental and physical health needs is unhelpful, as both are closely linked. Stress, anxiety and low mood contribute towards physical health conditions throughout pregnancy and postpartum. Similarly, physical health conditions can contribute to poor mental health. General medicine often tries to separate physical and mental health, although it would be difficult to successfully treat one of these areas without considering the other.

“I believe that midwives, health visitors etc. could be well placed to provide low-intensity mental health support for new mums. However, this would benefit from a wider understanding of physical and mental health, which would require additional training throughout the different professions, including doctors and those in other medical roles.”

Sophie goes on to say that “another significant challenge is the time limitations and high caseloads placed on birthing professionals. It would be difficult to provide meaningful care, for a mother to feel supported and validated, in the current climate of the over-stretched healthcare service. I think that if we were to normalise having emotional difficulties through pregnancy and postpartum, new parents would feel less stigmatised or guilty for struggling.

“The large majority of new mums I know, both professionally and personally, have experienced some level of emotional distress after having a baby. Yet, this distress remains generally unrecognised. I believe that universal campaigns could help new mums to recognise that they are not alone, and that difficult times are completely expected after having a baby.”

Do you agree with the recommendations in the report?

“Yes, within the context of a wider understanding of the strong links between physical and mental health. I agree that increased interventions for new mums who are experiencing mental health difficulties would be beneficial. However, I would argue that these interventions would need to be specific to the needs of new mums.

“For example, I have spoken to women who experienced traumatic births with devastating impacts, and they have been offered group support for ‘managing anxiety’. This kind of intervention would be completely irrelevant for a mother who has experienced birth trauma. Incidents such as this increase a mother’s feelings of helplessness, and not being understood when they have been prescribed an unhelpful treatment. For maternal mental health interventions to be prescribed effectively, there would need to be thorough training to increase understanding of professionals and the wider system.”

“Additionally, more general support could be of benefit. So rather than a treatment for a specific mental health condition, like postnatal depression, mothers could benefit from learning emotional skills that are required as a mum that we may not need to have learnt before. For example, managing feelings of over-stimulation and overwhelm. We do not need to be experiencing a diagnosed mental health difficulty to greatly benefit from this form of awareness and intervention.

“Also, the findings of this report, and specifically the treatment of mental health conditions, would need to be in the context of wider societal change. Many new mums are feeling lonely, disconnected and under-supported. It would be difficult to treat a mental health condition which results from this without addressing these wider issues. For example, low maternity pay and high childcare costs all greatly contribute to the mental health needs of mothers, particularly in the current economic climate.”

Where else can people find support?

“There are various support networks in place for those still awaiting treatment. Private counselling or therapy is available through services such as the Counselling Directory. Use keywords such as ‘pregnancy/postpartum/perinatal’ to search”

Other resources include:

The PANDAS Foudnation.The Birth Trauma Association.Apps such as the Peanut app for social connection.

You can find Sophie on Counselling Directory and via her website, Looking After Mum. Sophie also offers free mental health support for new mums over on YouTube and her Instagram @lookingaftermum.

Read the full report from LSE and MMHA here.