Maternal Mental Health

(Limited Text - Ministerial Extracts only)

Wednesday 10th March 2021 Westminster Hall

[The Minister for Patient Safety, Suicide Prevention and Mental Health (Ms Nadine Dorries)]

I thank the hon. Member for Richmond Park (Sarah Olney) for bringing forward this important debate. We have had a number of debates about maternal health over the past year, but this is particularly important, given the timing.

Pregnancy and motherhood are a period of great change for everyone. It has been particularly difficult for new mothers during the past year, while they have been in the middle of lockdown. I want to pick up a couple of points that the hon. Lady made. She cited a case study, which I cannot respond to because it is from Scotland, and, as she knows, health is a devolved matter. She asked about the number of midwives that we have, and that was mentioned by a number of Members. There has been an increase of 14.6% in full-time equivalent midwives in trusts and clinical commissioning groups over the past 10 years.

Let me answer a few quick questions that came up. My right hon. Friend the Member for Basingstoke (Mrs Miller) brought up workplaces. We need a call for evidence to gather the data that we need about what is happening to women in the workplace, both when they are pregnant and to do with their health. On Monday, I mentioned issues such as endometriosis, menopause and the musculoskeletal issues that women suffer from more than men. We need data about all that, which is why we made the call for evidence, and I do so again. It is very easy to click on the link and for women to let us know what is happening to them in terms of their health, both in the workplace and in healthcare settings. The number of respondents was in the thousands within a few hours of it going live, and we hope that it will give us the data we need to develop policies for the workplace.

My hon. Friend the Member for East Worthing and Shoreham (Tim Loughton) mentioned my right hon. Friend the Member for South Northamptonshire (Andrea Leadsom), whom I spoke to last week. We await with great excitement the early years review. It started at the first 1,001 days. This has been my right hon. Friend’s life’s work. I have known her since she first came here as an MP and before, and this is something that she is absolutely passionate about and committed to. The cross-party review will be illuminating, and we are excited to see it launched, which I think will be later this year.

Although the perinatal period can be a time of celebration and joy, for some it can be a time of considerable anxiety and worry. Indeed, like the hon. Member for Lewisham West and Penge (Ellie Reeves), when I became a mother for the first time I was actually alone, because when my baby was 14 days old my husband had to go and work abroad for six months. So I was completely alone, and I absolutely remember waking up in the middle of the night, having nobody with me and being entirely alone trying to breastfeed a baby, totally struggling and not being able to do it. So I remember how hard it is.

Actually, I think I am allowed to say that I am about to become a grandmother for the first time, and I really hope that I can be there for my daughter. I hope that we are over this pandemic and out of it by the time that my daughter gives birth, so that I can be there for her, to help her through what will be difficult times, because every new mother feels that difficulty.

I would like every new mother to know that support is there. Increasingly—indeed, at a rate of knots—we are expanding services, and there is no shame in seeking help, including through the pandemic. Specialist and in-patient perinatal mental health services have remained open during lockdown. There have been restrictions, but services have been providing digital and remote support. For those with severe needs or those who are in crisis, perinatal or otherwise, all mental health trusts have set up new 24/7 crisis helplines—I remember the call on 4 April last year when we decided that we would do this, and those helplines rolled out and were open. I have spoken to the chief executive officers of mental health trusts, and one told me yesterday that the volume of people using those 24/7 helplines has been tremendous. They have been set up and they have been used, including by new mothers.

In the 2020 spending review we also announced up to an additional £500 million for mental health services. That was on top of the £2.3 billion a year that we are investing to address waiting times for mental health services and to give more people the support that they need.

We have also taken action to ensure that mothers can continue to have broader support throughout the perinatal period, both from statutory services and from family support. Health visitors, who are ideally placed to support families, and the health visiting service continue to provide an opportunity to identify families who may need support. The health visiting service has remained in contact with families throughout the pandemic and it will continue to do so and to prioritise very young babies and vulnerable families.

Recognising the support that a father or the mother’s partner can bring, we published guidance in September to reintroduce access for partners, visitors and other supporters of pregnant women in English maternity services. We also launched a campaign to ensure that people continue to access services and get support early.

We have continued to deliver on the ambitions for maternity and mental health services that we had before the pandemic, to ensure that mothers get help earlier. From April 2020, we have invested an additional £12 million per year for every mother to be offered a six to eight-week post-natal check by her GP. I think that my hon. Friend the Member for East Worthing and Shoreham campaigned on this for some considerable time. Through the post-natal health check, every mother can now expect to have the opportunity and the time to discuss any concerns that she may have about her physical or mental health and wellbeing.

We remain committed to making perinatal mental health services a priority through the NHS long-term plan. There is now—this point is very important—a specialist community perinatal mental health service in every area of England, and we are further increasing access to perinatal services, so that at least 66,000 women will be able to access perinatal mental health services in 2023-24.

I went to see one of these perinatal services at the beginning of my time in post, 18 months ago; they had just begun to roll out. I have been to see one of these perinatal mental health teams working, and it was just tremendous. The nurses had only been in place and operating for a matter of weeks, but they had already had something like 120 referrals and mums they had seen. That demonstrated the need for such a service and almost endorsed the reasons why they were there, as well as highlighting the services that they were providing to those young mums.

Importantly, we are extending the length of time for which specialist perinatal mental health community services will be available, so those services, which currently run from preconception to 12 months after birth, will be available from preconception to 24 months after birth. We are also developing and implementing maternal mental health services or maternity outreach clinics, which bring together maternity and reproductive health and psychological therapy for women experiencing mental health difficulties directly arising from or related to the maternity experience.

As the hon. Member for Richmond Park can see, we have put a huge amount of work into maternal mental health. She is quite right. I cannot remember who highlighted the fact—it may have been the hon. Member for Tooting (Dr Allin-Khan)—that suicide is still the biggest cause of death in the period from, I think, eight weeks post delivery to 12 months. It is still the biggest cause of maternal death. That is why this issue is so important to us. To reduce the figures and ensure that suicide is not the biggest cause of maternal death, we have to put the services in earlier. We need to ensure that both at an antenatal stage and at the time of the check with a qualified GP at six to eight weeks, those perinatal mental health services, which are now available in every area of the country, are in place. We have done that through the funding that there has been from the £2.3 billion that has been allocated to the long-term plan.

Many mothers who experience mental health problems in the perinatal period are treated in the community, but a very small number will need hospital admission for their mental health, as the hon. Member for Richmond Park will know. It is right that, where possible, we keep mother and child together. That is why—this is also an announcement; a fact that I am proud of—NHS England has expanded the capacity of mother and baby units in England, with additional four to eight-bed units now providing specialist care and support to mothers who are experiencing severe mental health problems during and after pregnancy. I checked just before I came into the room for this debate, and we are now up to 152 beds across England, which represents a tremendous increase in the number of those units. It is so important in those first days to keep mother and baby together as much as possible.

The units support women with serious mental health issues by keeping them together with their babies and with specialist staff who nurture and support the mother-infant relationship on the ward at the same time as the mother is treated for her mental illness. That is a huge step forward from how things used to be not so long ago. Mothers who are at that severe stage of mental illness post delivery can have that treatment in those beds; they can be treated by those specialists. Mother and baby are together, and there are psychiatric services at the same time. That is a huge leap forward.

We recognise that maternal ill health can also have an effect on the child’s father or the partner of the mother. We are therefore also offering partners of women accessing specialist perinatal mental health services and maternal mental health services evidence-based assessments for their mental health and signposting to support as required. In the future, partners of expectant and new mothers who are seriously unwell will be offered a range of help, such as peer support, behavioural couples therapy sessions and other family and parenting interventions.

We are also taking forward work to ensure that all babies and young children in England receive the best start in life. I will come on to the early years review. My right hon. Friends the Secretary of State for Health and Social Care and the Prime Minister jointly commissioned in the summer of 2020 the early years healthy development review. It is important, so I will say this again. The review looks across the first 1,001 critical days. The SNP spokesperson, the hon. Member for East Kilbride, Strathaven and Lesmahagow (Dr Cameron), also spoke about the importance of the first 1,001 days, from conception to the age of two. This is about ensuring that babies and young children in England can be given the best start in life. Phase 1 of the review is in its final stages, and the vision for brilliance, setting out policy actions for the Government, will be published shortly.

I hope that my response goes some way to assuring all hon. Members that this Government remain committed to supporting mothers throughout the perinatal stages and up to 24 months after giving birth and ensuring that we can reach out to mothers who may need help coming forward about their mental health.

I would like to end by talking about women’s health more broadly. Pregnancy, childbirth and motherhood are just some of the stages of life that many women can experience. Throughout the course of our lives, the physical milestones, the changes to our bodies and our experience of the world have an impact on our health. I reiterate that we are having our International Women’s Day debate tomorrow, and I hope that the call for evidence will be mentioned, so that we can better understand women’s experiences of the health and care system but also, as I said at the beginning, their experiences of health, including motherhood and maternity, in the workplace. Without that evidence from women, we do not have the data and the information that is necessary in order to adapt and develop policies moving forward.

I will finish by urging all women to share their experiences through the call for evidence. It will form the basis of a new women’s health strategy—the first of its kind. This is the first time any Government have called on women for evidence, so that we can set an ambitious and positive new agenda to improve health and wellbeing and to ensure that health services are meeting the needs of women everywhere, especially in perinatal mental health.