The leading cause of late maternal deaths in the UK (those between six weeks and one year post-partum) is mental health issues, including suicide. This was one of the findings of the latest MbrraceUK report—Saving Lives, Improving Mothers’ Care — released in September. On the back of this report, and the recently published 10 Year Health Plan for England, a group of industry, third sector and government experts met at the Labour Party Conference for a roundtable on maternal mental health to ask what can be done. The discussion was chaired by Prospect senior editor Alona Ferber and co-created and funded by Biogen.
“The UK stacks up well against comparable countries in regard to national policies for maternal mental health and local services, but there’s a lot that’s not working,” opened Kylie Bromley, managing director, Biogen. “Suicide is still one of the leading causes of maternal deaths and we know that has ripple effects reaching far and wide to children, partners and their communities.”
One participant started by pointing out that good strides had been made in this area with higher levels of satisfaction among mothers but the last few years had increasingly told a different story. “We’ve recently seen a regression with mother and baby units having training budgets cut and suffering from staff shortages. We’re seeing the first few infanticides in a decade by women who really should have been cared for better.”
While the UK might have good maternal mental health services on paper, one of the participants pointed out that a big issue is access to these. “Women don’t know where the front door is,” she said. “They don’t know where to find services if they do exist and actually, in some cases, support might be listed on a Trust’s website but it doesn’t exist anymore.”
It was agreed across the board that a huge part of the problem is funding and the fact that budgets for maternal mental health are not prioritised by local government and the integrated care boards (ICBs). “Budgets are under huge amounts of pressure and the risk is that this area of care falls down the priority list—there has to be a way to ensure this gets the funding it needs.”
Another challenge flagged by the group was the access to proper mental health training for midwives, health visitors and obstetricians, “in recent weeks we heard there will not be continued NHS funding for training specialist perinatal psychiatrists which is a worry for the future pipeline of staff.”
Maternal mental health should be at the forefront of, and embedded within, maternity services
None of this is helped by the fact that services that do exist are siloed—meaning someone receiving mental health services in Wales might travel to London to give birth and their maternity team will be none the wiser to their pre-existing condition. “There is no requirement to share information,” said one campaigner. “You can have the best services in the world but if there’s 30 of them and they’re not talking to each other, what is the point?”
The group discussed the disparities in care highlighted in the Mbrrace report and others, which suggest much worse outcomes for Black or Asian mothers. Looking at the specific needs of women in minority groups is essential, remarked one expert: “We must start with them and work backwards because there are a lot of women who will never come forward for mental health support because there is a cultural barrier or we’re not speaking the same language.”
The role for services led by local community groups began to surface as a solution to some of the challenges posed. In the fight against ethnic inequalities, these stand a far better chance of taking the right approach culturally and also encouraging women to open up. “We need much better support for community and voluntary services,” said one leader. “They are not only cost-effective but they can drive the best outcomes—they know these women the best and can identify risks, notice changes and start to signpost people in the right direction.”
In a similar vein, health visitors were named as key in being able to get to know women in their own homes and communities and identifying signs of concern. “When we’re talking about avoiding the death of women from six weeks after birth, this is the cohort that stands the best chance, yet the workforce has seen cuts across the country.”
With attention squarely focused on solutions, the general consensus was that maternal mental health should be at the forefront of, and embedded within, maternity services. There is no stigma or shame in seeing midwives and they could become the first line of defence—if they were properly empowered. “We know that better investment in midwives is at the core of this and would solve a lot of issues,” said one participant. Not only investment in paying midwives properly but giving them the training they need to have mental health services embedded within maternity. “What we’re seeing is a failure to recognise what a maternal mental health service is—we’ve focused on the psychiatric element and left maternity behind when it should be central.”
The rolling out and proper funding of local Women’s Health Hubs were seen as key to building on the role of midwives. A place for midwives to practice within the community, where third sector or community support groups could meet, as well as a place for women to access different healthcare needs without stigma.
On a hopeful note, many around the table agreed that now is the time to get maternal mental health on the agenda. The Government’s 10 Year NHS Plan would lead to opportunities here. “There needs to be a holistic look at maternity and I don’t think that’s at odds with the current headwinds—we have a lot of women in parliament at the moment with the will and the energy we need to lock it in.” ♦
