Perinatal Mental Illness

Alison Thewliss Excerpts

Thursday 19th July 2018 Westminster Hall

[Alison Thewliss (Glasgow Central) (SNP)]

It is a pleasure to serve under your chairmanship, Mr Davies. First, I thank the National Childbirth Trust for its work and campaigning on this issue and the hon. Members for Stockton South (Dr Williams) and for South West Bedfordshire (Andrew Selous) for bringing this issue to the House. I thank all the Members who have spoken so passionately. There were common themes on access to support, expectations on mothers and being able to talk about post-natal depression.

Perinatal mental illness is crucial for families, and I welcome the calls for a more comprehensive six-week check and the implementation of the other recommendations made by the NCT. Other Members have talked about their experience, so I will mention my own, which was largely fine, other than the stress of being a new parent and being responsible for a new baby. Those things are overwhelming. New parents are given a tiny baby and they leave the hospital with it, and then they have to look after it for the rest of their life. That is quite a big deal, and we downplay it a little bit in society.

My pregnancies were trouble-free and my babies were both well, but in reflecting on this issue, I remembered vividly having panic dreams in which the baby had gone out of the cot. I would wake up in a huge panic, and everything was fine, but it reminded me that we are surrounded by all these hormones and feelings, and it is difficult and stressful, and we do not support mothers enough through that.

I was very glad of the support from the team at Bridgeton Health Centre and Townhead Medical Practice—I want to put it on the record that they were absolutely fantastic. However, when it came to the six-week check, I questioned the efficacy of getting people to fill out a tick-box form about their mental health. It seems to me pretty obvious that if someone did not want to disclose a mental health issue, they could easily fill in that form so that it passed, and nobody would ask any further questions. People have to actively seek help, at a time in their life when they do not know what is normal and hormones are flying all over the place. I hope that that can be improved, and that the check can be more detailed. At the moment, it is too easy to miss the key signs, as hon. Members have mentioned. It was good to hear the hon. Member for Stockton South talking about the feedback that he had from a patient. I hope that more doctors are like him, asking those questions in a way that will draw proper answers, and that time can be given to such things.

Conversations about mental health in society have changed a lot. However, as the hon. Member for Canterbury (Rosie Duffield) mentioned, how we talk about these things has not changed quite enough. I was struck by Serena Williams’ comments about her experience of post-natal depression. This is a woman who is known for her strength and resilience, and for being an athlete, champion and star. She struggled just like anybody else would, and found it incredibly difficult, but has been able to work through it. As we saw with her recent performances, she has come back very strongly, but we are all very vulnerable in those circumstances, and we cannot be complacent about how difficult it can be.

Research from the National Childbirth Trust found that only 50% of women get the help that they need at that key intervention point, and that stigma and embarrassment continue to be rife. The NCT report also highlights the genuine fear that women have—46% in the survey—of the consequences of a healthcare professional thinking that they are incapable of looking after their baby. Certainly in Glasgow, where there are many cases of social work intervention in families, women are scared that if they confess to any weaknesses, they will lose the care of their child. That might not be the case, but the fear is enough to stop women coming forward.

Socioeconomic factors are in play, and perinatal mental health problems are a major risk factor in poor outcomes for children and mothers. Mothers in areas of higher deprivation are far more likely to experience repeated mental health problems and predicted future problems. There is thought to be a direct causality between poor mental health and children’s development. A longitudinal survey in Scotland showed that children whose mothers were emotionally well had better social, behavioural and emotional development than those whose mothers had brief mental health problems. Those children had better development than those whose mothers had repeated mental health problems. That can affect children’s transition to school and their subsequent development and attainment. I recommend looking at the work of Scotland’s former chief medical officer, Sir Harry Burns, who has spoken passionately about the impact of children’s mental health and of parental mental health, and the consequences that it can have.

In Scotland, we have moved towards a nationally co-ordinated systemic approach. The Scottish Government’s new mental health strategy for 2017 to 2027 focuses specifically on allowing children to start their lives with good mental health. The Scottish Government have funded a national managed clinical network on perinatal mental health to the tune of £173,000 per year. It is the first MCN covering mental health in Scotland. The network will provide a focus, enabling us to improve standards for all children and new mothers across Scotland. The MCN is multidisciplinary, involving specialists in perinatal mental health, nursing, maternity and infant mental health. The establishment of the first network for mental health is part of the Scottish National party Government’s determination to give mental health parity with physical health. I understand that such clinical networks work in other parts of the health service and have a proven track record of driving up standards of care across the board.

I have seen figures that suggest that one in eight babies in Scotland are born to a parent who has experienced mental health issues, so it is significant and widespread. We know that perinatal mental health problems do not only affect mothers; they have a wider impact on the family. The MCN is taking forward a work plan addressing that, which includes assessing current provision across all levels of service delivery in Scotland. In the longer term, that will ensure that all women, and their infants and families, have equity of access to the perinatal mental health services that they need right across Scotland, where we have huge rural areas, many islands and various geographical challenges to overcome.

In its review of the current provision, the network will pay particular attention to the pathways into care for women who may live some distance from an existing mother and baby unit, and will make recommendations on improving access where difficulties emerge. The hon. Member for Strangford (Jim Shannon) spoke passionately about the issues that that causes in Northern Ireland and in Ireland more widely, where women cannot access mother and baby units and the support that they need. It must be even more stressful if a woman has to travel over the sea to get to a unit that provides the support they dearly need. In doing so, they will lose contact with family networks that could also support them.

Another core remit of the MCN is to determine what training midwives, health visitors, primary care and mental health professionals—

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On resuming—

[Alison Thewliss]

I see we have had a change of Chair, Mr Rosindell. It is good to see you.

As I was saying before we were interrupted by the vote, the managed clinical network aims to ensure equitable co-ordinated access to mental health provision for pregnant and post-natal women. It seeks to understand current provision and promote improvements in local services, including access and options for families, professional expertise and effective service delivery. Beyond that, it will seek to contribute to improved early years health and development for infants, as part of a broader Scottish Government intention for improved early intervention. The MCN will make fuller recommendations before the end of this year on what services should be available in all board areas to meet the needs of women and their families.

The most exciting part about that for me was the women and families maternal mental health charter, “My Right to Good Care from NHS Scotland for my Baby, my Family and Me”, which was launched on 4 June. The charter has nine points, which I want to put on the record. They are, first, the right to be at the centre of my care, so that I have the information I need to make the best decisions for me, my pregnancy and my infant’s future health; secondly, the right to be seen by staff who have the appropriate level of knowledge and skills to assess and care for me; thirdly, the right to preconception and pregnancy advice and care if I have a pre-existing mental health condition; fourthly, the right to access expert advice and care about my maternal mental health when I require it, wherever I live in Scotland; fifthly, the right to have priority access to talking therapies during my pregnancy and post-natal period; sixthly, the right to be admitted jointly with my infant if I need in-patient mental health care; seventhly, the right to discuss my maternal mental health without fear of stigma or being judged; eighthly, the right for my family to have the information they need to help me and to get help for themselves; and ninthly, the right for my baby to have parents who are supported with their mental health. All these are very good points, which are the bedrock of what we should see in a mental health service for women and infants.

I cannot end my speech without mentioning my role as chair of the all-party parliamentary group on infant feeding and inequalities. The discussion in this country about breast feeding versus bottle feeding has become increasingly divisive. I do not want to venture into it, but a cause of many issues is the pressure on women to have the perfect, glowing, spotless, white-bloused-in-a-perfect-home version of breastfeeding, but that is unrealistic. It is more like chaos surrounding a knackered mother with all the surfaces covered in vomit and soggy muslin cloth—or maybe that was just me.

The hon. Member for Stockton South mentioned the perfect baby ads that we see and the idealised images of motherhood. We put pressure on mothers all the time without necessarily supporting them with being a mother and with the learned skill of breastfeeding. By not providing that support, we set women up to fail. Many carry that very personal pain around for a long time. It should not be that way.

[Luciana Berger (Liverpool, Wavertree) (Lab/Co-op)]

The hon. Lady is making a very compelling case. I am sorry that I was unable to attend the start of this debate, but I commend Members on both sides of the House for bringing us together to discuss these very important matters. Does she, like me, worry that the reduction in antenatal services and services for new mums and dads, particularly in our children’s centres, increases the challenges that new parents and expectant parents face?

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[Alison Thewliss]

Absolutely. I visited a children’s centre in Blackpool and spoke to people involved with the Breastfeeding Network, and they said they had seen the peer support service cut suddenly. That service was crucial, because it was doing the job that the community services and health visitors did not have time to do. It was providing early intervention and support with mental health issues and all the other things that mothers need. I understand that the hon. Lady is very committed to this issue. Early intervention services are absolutely crucial. Children’s centres—somewhere that women can go—are so important, because going to them is an easy first step for women to take. They are not scary; they are accessible and are right on the doorstep—or they certainly should be.

The Breastfeeding Network cites evidence that breastfeeding can have a preventive effect when it comes to mental illness. It said:

“A large scale research study published in 2014 showed that mothers who planned to breastfeed and who actually went on to breastfeed were around 50% less likely to become depressed than mothers who had not planned to, and who did not, breastfeed. Mothers who planned to breastfeed but who did not go on to breastfeed were over twice as likely to become depressed as mothers who had not planned, and who did not breastfeed.”

Providing support for women’s breastfeeding goals is absolutely crucial. If women want to do it but are set up to fail, that can have a serious negative impact. The positive impact of the oxytocin, the bonding and the skin-to-skin contact can be crucial in helping women and children through what can be a very difficult period.

Women on antidepressants are given the often erroneous advice that they should stop breastfeeding. Some 15% of enquiries to the Breastfeeding Network drugs in breastmilk helpline, run by the amazing Wendy Jones, are about that very issue. Evidence demonstrates that giving up breastfeeding is not necessary in many cases, and that if a mum stops breastfeeding before she is ready, that can have a further negative effect on her mental health. I encourage the Minister to look at the drugs in breastmilk helpline and perhaps find some funding for that voluntary service, because GPs and pharmacists often rely on it to give advice to women.

The key to all of this is support for women in how they decide to feed their baby and in the choices they make in life. There is a real postcode lottery. I encourage the Minister to examine this further and to speak to the UNICEF UK Baby Friendly Initiative, which has been cataloguing come of the cuts.

In Glasgow, support also comes from the community, in the shape of groups such as Glasgow South PANDAS, run by Lauren Tonner. The group meets regularly and allows parents to talk about their concerns. As we have heard, it can be difficult to open up, but NCT research shows that opening up and seeking help generally leads to much better outcomes. I encourage those experiencing challenges to find a way to take the first step towards accessing support. It is important to state and restate that women in that situation are not alone. There is always support there for them, and there must be ways of ensuring that women understand that. Handing them a leaflet is not good enough; there must be support and talking therapy.

My wider concern is that we are not supporting women enough anymore. When they go into hospital to give birth, they have to leave very quickly. Community services are often not there, and families are more fragmented and further apart nowadays. That is an issue particularly for women with insecure immigration status, those who have not been in the UK very long, and those who are living in communities where community resilience has broken down and people do not know their neighbours well enough to ask for support. A friend of mine told me recently that she had wonderful neighbours who were there for her when she had her baby, which made a big difference to her when she was struggling. We need to do all we can to help women who are struggling to put food on the table, or are struggling with other aspects of life, such as maternity discrimination and all the other societal pressures on them. All those things contribute to post-natal depression and women’s poor mental health.

I hope UK Ministers and my colleagues in Edinburgh can share best practice and seek to remove barriers to support for women experiencing perinatal mental health issues. We owe it to every family to ensure that having a baby is a time when women can feel safe, supported and cared for.