Perinatal Mental Illness

Andrew Selous Excerpts

Thursday 19th July 2018 Westminster Hall

[Andrew Selous (South West Bedfordshire) (Con)]

It is an enormous pleasure to follow my colleague on the Health and Social Care Committee, the hon. Member for Stockton South (Dr Williams). I commend him for a tour de force of a speech, which was extremely comprehensive. I will not speak for as long as he did and I will try not to cover the points that he did, because this is a large area and there is a lot to say about it.

It might be a little surprising to some that two men are opening this debate on perinatal mental illness, but I strongly disagree with anyone who thinks that we should not be, because the strapline of the Maternal Mental Health Alliance is that this is “Everyone’s Business”. That is exactly what it is. We need men advocating and agitating, if this issue is to be taken seriously and dealt with properly.

The Health and Social Care Committee and the Education Committee, in a report earlier this year in response to the Government’s Green Paper on transforming children and young people’s mental health, included a contribution from our excellent Children’s Commissioner for England, Anne Longfield. In evidence to both Select Committees, she said:

“I would like to see a comprehensive starting point that looks at children from birth and pre-birth onwards, and recognises that problems develop along the way; and the earlier and the nearer to home they can be treated, the better it is going to be for the child.”

I think that is a really important point. While there is a lot to be commended in the Government’s Green Paper, we know that in early intervention the earliest years are key.

The Prime Minister and the Chancellor have allocated an extra £20 billion to the Department of Health and Social Care. That gives us an enormous opportunity. Quite properly, the Government are not rushing decisions on how that money will be spent. We will be thoughtful and considered, to ensure that we make wise choices. For my money, prevention and early intervention would be a good use of that money. I am sure that the Minister will push hard in the Department, to ensure that this area is prioritised.

The hon. Member for Stockton South, who spoke so well, talked a lot about the GP checks. I want to press the Minister on how this is supposed to be working at the moment, so that we can learn from it and get it right when the GP contract is renewed in September. My understanding is that Ministers have made it clear that all GP surgeries must offer a six-week post-natal check, to assess how a woman has experienced her transition to motherhood, which includes a check on her mental health. Further, I understand that GPs who opt out from doing so receive a reduction in funding. Until fairly recently, Ministers had been informed that only four practices in England had opted out. Given that information from the Department of Health and Social Care, and given that we are paying for that service and it is supposed to be happening, how is it that 22% of the women in the National Childbirth Trust survey said that they were not asked about their emotional or mental wellbeing at their appointment? Are we, as taxpayers, paying for a service that many GP practices are not providing? I ask the Minister to address the oversight and accountability of GPs in this area.

I realise that we need more GPs. The good news is that 3,157 medical students qualified as doctors and went into general practice this year. That is the highest number ever. We are increasing by a quarter the number of medical students we are training in this country and not before time, because other countries have been training more than we do. Globally, we need 2 million more doctors. I want to see a lot more British doctors—bright British children able to come into this fantastic profession. Of course, we are grateful for the doctors we have from all over the world, but we need to train more of our own and that is exactly what we will do.

The reality, which I understand, is that a lot of GPs, because of the pressures of the job, are working part-time, not full-time. I learnt recently that the average GP works four days a week, rather than five. We also know that a number of them are leaving general practice in their mid-50s, which is a crying shame. We cannot afford for them leave in their mid-50s. We cannot force people to work as GPs, but in their 50s they have so much experience and they are so needed. There is an issue of making the role of the GP less stressful and more enjoyable. In general, the Government need to think more about ensuring that public servants across the board have greater job satisfaction, so that they enjoy and look forward to going to work each day. If we have more GPs and they are less stressed, they should be able to do this work better.

I do not think I received a briefing from the Royal College of General Practitioners for this debate—perhaps I missed it. I am grateful for the briefings we had from a number of Royal Colleges and different organisations, all of which have been extremely helpful, but it would be good to have the full involvement of the Royal College of General Practitioners in addressing the incredibly important issue of perinatal mental health. Hon. Members are absolutely right to raise the training issue.

Earlier this week, I chaired the all-party parliamentary group for supporting couple relationships and reducing inter-parental conflict. We were looking at the issue of loneliness. New parents are one of the groups in society who often feel quite alone, if they do not have all the support networks that we would ideally like them to have. Someone at that meeting said that raising mental health touched on GPs’ anxiety that they would open a Pandora’s box of issues that would take them some time to deal with. GPs generally work to 10-minute appointments. We need to ensure that they have the time, in a relaxed environment, to go into these issues properly. It cannot be done in a rush or on a tick-box basis.

I want to pay attention to the important role that fathers and the partners of women with newborn children have in this area, because it needs to be properly recognised. Unsurprisingly, mothers report that fathers are their main source of emotional support. Yet fathers can sometimes feel left out and not as fully involved as they could and should be in dealing with perinatal mental illness, while the mother of the child wants the father to be involved. We have not always done as well in that area as we should.

I understand that there is evidence that a father’s involvement in pregnancy increases the likelihood that a woman will receive pre-natal care in her first trimester by 40%. The Royal College of Midwives also reports evidence that teaching massage and relaxation techniques to fathers to assist during labour is an effective way of increasing couple satisfaction and decreasing post-natal depressive symptoms, as well as providing psycho-social support for women. We also know that the mother’s relationship with her partner is a key determinant of antenatal maternal stress. This suggests the importance of assessing and addressing a range of attitudes and behaviours on the part of expectant fathers—not just domestic abuse but their own mental health, substance abuse, hostility, infidelity, rejection of the pregnancy and so on. Those issues must be dealt with, because they will have a huge impact on the wellbeing of the mother.

As I have said, poor paternal mental health has an impact on maternal mental health. Research suggests that a father’s mood and anxiety disorder can exacerbate the effects of a mother’s poor mental health and escalate the risk of a child developing emotional and behavioural problems, while fathers with better mental health can provide a buffer against the negative impacts. Fathers and partners are very important, and I am grateful to the Centre for Social Justice for pulling together some of that research.

Again, I am grateful to the Centre for Social Justice for drawing my attention to Greenwich Mind, which is a practical example of a service that provides answers to some of the issues that I have described. It works in partnership with Tavistock Relationships and other local providers to run post-natal support groups and parenting workshops in local children’s centres for parents with or at risk of depression. Those activities specifically focus on the co-parenting relationship, not least in terms of how it is affected by adjusting to parenthood. Evaluations show that relationship quality and mental health improved as a result. That is an example of a good service that we need to see more of.

We must remember the wise words of the hon. Member for Stockton South about the impact that maternal mental health has on children’s development. The health and mental wellbeing of our children is key. I also serve as a vice chair of the all-party parliamentary group on adverse childhood experiences. We are a bit behind the curve in this area in England. The research in America is overwhelming. As an English Member of Parliament, it concerns me that the understanding of it is better in Scotland than in England; the same could be said for Wales and Northern Ireland. I look forward to the time when England is at the same level of understanding.

I will not repeat what the hon. Gentleman said about the earliest years of a child’s development, but those issues really matter. The wellbeing of the mother—indeed, of both parents—in those early months is critical for how our children develop and for giving them the best chance to flourish.

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[Rosie Duffield (Canterbury) (Lab)]

It is a pleasure to serve under your chairship, Mr Davies, and I congratulate my hon. Friend the Member for Stockton South (Dr Williams) and the hon. Member for South West Bedfordshire (Andrew Selous) on securing this debate.

We should judge the success of our society by how we treat our new mothers—it really is that simple. I am here today to speak up for better-quality, more consistent and well-funded services for perinatal women.

I am not a new mother. In fact, my youngest teenage son is sitting just over there in the Public Gallery and Members may be able to tell from his towering 6-foot frame just how long it has been since I was recovering from giving birth to him, the second of my two gigantic children. Even so, I remember those special early days for all the many wonderful, and some horrible, reasons that all mothers will know.

We do not discuss post-natal truths enough in the UK. Women will sometimes share with their friends the gory details of their experience of giving birth, but we rarely ever see in the print media, on TV, or in films what happens after a baby is born. If the fairy tale does not end when Cinderella weds her prince, as most fairy tales do, it most certainly has ended by the time Cinderella has entered her third trimester and is waddling around the palace. Nobody wants to hear about Cinderella’s third-degree tear, the fact that her boobs leak, the possibility that she may experience incontinence, or the fact that, even though she has a wonderful, healthy baby in her arms, she just cannot stop crying. But fairy tales are out of date and so is the fact that we do not talk about perinatal experiences—both external and internal experiences—with the honesty we need.

Things are changing, however. After all, we are here today saying that what is on offer to post-partum women in the UK just is not good enough. It is outrageous that women in one quarter of the UK are still without access to specialist perinatal mental health services. How can the mental healthcare of new mothers still be a postcode lottery? It is not as if mental health changes are uncommon after a woman has given birth. In fact, 81% of women say they have experienced at least one perinatal mental health condition either during or after their pregnancy.

I know from talking to friends, family and, indeed, constituents how imperative perinatal mental health support is. We must remember that three quarters of women who say they have experienced a perinatal mental health condition had no previous history of mental health problems. For those who have experienced mental health problems before giving birth, changes to the brain’s chemistry post-birth, combined with post-partum isolation, can trigger the return of symptoms that they had previously experienced, often in their teenage years.

Speedy referrals and access to early treatment is vital for those who experience mental health issues during or after pregnancy. What is so worrying is that it takes more than four weeks for 38% of women in the UK who are referred to be seen. In fact, there are cases of women suffering post-partum who have the courage to seek help from their doctors and health visiting teams but who still have to wait beyond a year for help after referral. That is a whole year that these women are waiting for help in what is often one of the most turbulent, joyous, change-filled and complicated times in any mother’s life. Any service that keeps people waiting for more weeks that I can count on the fingers of one hand is completely unfit for purpose.

We must close the funding gaps that cause huge waits—it is reassuring to hear that the Government intend to do that—and end omissions in service provision. We must also ensure that maternity services do not remain overstretched and understaffed. We must bring back full bursaries for midwives and related healthcare qualifications, which will allow staffing gaps to be filled with the much-needed new caring talent that will have the capacity to offer continuity of care to high-risk women in pre and post-natal moments of vulnerability. The erosion of higher education bursaries, especially for nurses, midwives and other healthcare students, was yet another example of this Government knowing the cost of everything but the value of nothing.

There is another reason why we must act and act soon. A study by the department of anthropology at the University of Kent, which is in my constituency, shows that post-partum depression discourages mothers from having more than two children. The decision to have children, or the decision to have more children, is a woman’s choice alone. However, that choice must be made without the pressures and limitations that come with poor funding of post-natal care. A choice made through fear is no free choice at all.

I completely echo colleagues’ calls for there to be much greater depth in the maternal six-week check. The baby’s check by the doctor and the mother’s check by her doctor must be separate. A woman’s six-week check cannot be limited, as I so often hear it is, to a few rushed questions. I have been told of women being asked only about the contraception they plan to use, with no questions at all about their physical or mental wellbeing. I have heard from friends that their doctors simply asked them, “Are you feeling okay?” That is not a proper question. As any mother will say, the moment their new new-born is in their arms, the definition of what was previously considered “okay” is thrown of out the window. Time must be put aside for proper, in-depth questions and for real insight.

After all, as we have already heard, according to the Royal College of Midwives 42% of women with post-natal depression never even mention it to a healthcare professional, and three quarters of those women stay quiet because they feel guilty about having such thoughts. Moreover, many women are led to believe that serious mental health issues are merely a bout of the baby blues. We urgently need proper training and proper conversations to create an environment where mothers feel safe, well-informed and able to talk about any difficult experiences.

I acknowledge that even the most thorough six-week check for women would not always pick up on everything. Post-natal depression can sometimes manifest slowly. One study suggested that the majority of women experiencing symptoms did not report them until six months post-partum or later. To tackle that, I urge that the maternal mental health check by health visitors at three to four months is reinstated. Even taking more time at that early point when a woman is sat with her GP at the six-week check will save lives. A couple of weeks ago, I attended the NCT’s #HiddenHalf event, where several brave women attested to just that.

[Andrew Selous]

Has the hon. Lady had a chance to look at the clinical evidence base for the effectiveness of the three to four-month check? Is she aware of a good base of evidence from clinicians that it is a sensible use of money at that point?

[Rosie Duffield]

I thank the hon. Gentleman for that intervention. I have not looked at the issue in that kind of depth. I have been working on it with local women and local groups who suggest that it would be good to reinstate it. I will look into it further.

The women at the #HiddenHalf campaign event said that their lives had been saved by a fortuitous visit to the right GP at the right time, but they know they were the lucky ones. The mother’s six-week check must also allow time for a full physical health check to prevent long-term and often totally avoidable health complications resulting from difficult deliveries. Furthermore, it is my belief that a course of pelvic floor physio should be provided for every single woman who has experienced a vaginal birth, as happens in France. I am working with a group of women on health policy for post-partum women. This debate focuses on the perinatal health symptoms of the hidden half, but many of the mental health conditions that health visitors report are triggered by the physical trauma of a difficult birth and women having to reconcile themselves to a completely new sort of body.

Those of us here today will not stop campaigning and raising the issue until the situation changes for new mothers and new families who need our help. We should get the full truth of post-natal motherhood out there and become a country that can rightly say, “There’s lots of help here for you. We will assist you and your families for as long as it takes. We are here to champion and celebrate you in being the happy, healthy, supported mother that you ought to be able to be.”

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[Jackie Doyle-Price]

The hon. Gentleman earlier used the phrase “spend to save”, so the answer is yes, because obviously if we make interventions earlier and they help people to help themselves, there is a long-term saving to the NHS. That is the exact spirit in which we are entering the 10-year plan for the NHS. I look forward to hearing suggestions from the APPG—get in touch with us soon.

I thank everyone who has contributed to the debate and hope that we can go forward with the shared objective of doing the best we can for new mothers. By that I mean not only improving services, but giving support in general to women who are going through the experience of motherhood. As many Members have said, we are offered a fairy tale fantasy about how everything is perfect and wonderful, when actually there is a lot of associated vomit, pain and misery—joyful as the experience is overall. We need to tackle the taboo, because the fact that we think that everything is a perfect fairy tale means that the pressure on those women who are struggling makes them feel like failures. They are not: it is all entirely normal.

I am always struck by the fact that one in three women suffers from incontinence. People do not know about it, because everyone suffers in silence and just gets on with it. I often ask, “How would it be if one in three men suffered from incontinence?” We would hear about that a lot more. We need to be generally more open and give women the message: “Do you know what? It is normal to feel you are struggling, and feel miserable, because you have gone through a life-changing experience and a physical trauma. It is inevitable that it will affect your mental health.” Giving them the message that it is normal is half the battle, because they will realise that they are not a failure but just need to manage and work through the situation. We need the right services in place to help them.

[Andrew Selous]

Is the Minister aware of the Best Beginnings “Baby Buddy” app, which has videos of parents sharing their experiences to help reduce the isolation some parents feel? It encourages women to take the time to look after themselves and their relationships, if they are with a partner. Does she agree that that is practical? It is free and lottery funded. It is not making a profit, as far as I am aware. I think it is run by a charity. Things like that can be helpful to mothers who might otherwise be quite isolated.

[Jackie Doyle-Price]

That sounds like a good resource, not least because it means women can get access to help in a more anonymous, less threatening way. We need sufficient tools to be available for women—and families, for that matter.

We have heard constantly throughout the debate that women are not always asked about their mental health in GP health checks. For that matter, they are not always asked about their physical health either; it is all about the baby. One of the challenges we have in improving the way in which we deliver health comes from the fact that an NHS practitioner faced with a patient will focus on the immediate problem and not the patient’s holistic needs. There is a need to consider mother and baby together. A baby cannot be looked at in isolation. The role of the mother, and the relationship with the mother, is part of the child’s welfare. We need to spread better practice in that regard.

[Andrew Selous]

I agree very much about looking at the mother as well as the baby, but does the Minister agree that, where there is a relationship with a partner, dad must not be left out, and that working on the couple’s relationship is a key matter, given that mums probably look to their children’s parent more than anyone else for emotional and practical support?

[Jackie Doyle-Price]

I thank my hon. Friend for being my conscience—we absolutely must not forget dad or partner, or for that matter the wider family. Members have expressed concern about the declining number of health visitors, and the beauty of having a health visitor is exactly the fact that they develop a relationship with the family and can talk to dad as well. Quite often, dad feels excluded from the process.