Maternal Mental Health

Laurence Robertson Excerpts

Wednesday 10th March 2021 Westminster Hall

[Mr Laurence Robertson (in the Chair)]

I remind hon. Members that there have been some changes to normal practice in order to support the new hybrid arrangements. Timings of debates have been amended to allow technical arrangements to be made for the next debate. There will also be suspensions between each debate. Members participating physically and virtually must arrive for the start of Westminster Hall debates and are expected to remain for the entire debate. If Members attending virtually have any technical problems, they should email the Westminster Hall Clerks’ email address. Members attending physically are asked to clean their spaces before they use them and before they leave the room.

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[Tim Loughton (East Worthing and Shoreham) (Con)]

It is good to see you in the Chair, Mr Robertson, in this new Chamber, which is a first for us all. I congratulate the hon. Member for Richmond Park (Sarah Olney) on securing the debate. It is good that we have had a number of debates in recent months about maternal challenges during the pandemic, the impact on families and the impact on the mental health of parents and children. There is little that is more important, frankly. It is something that we will have to spend a lot of time concentrating on as we build out of the pandemic in the coming months.

Let me declare my interests. I am chair of the all-party parliamentary group for conception to age two: first 1001 days. Given the hon. Lady’s comments, I think we have a new recruit. If she is not already one of our members, I would be delighted to welcome her along. It is a very active group. I also chair the all-party group for children, and until recently I was the chairman of trustees of the Parent-Infant Foundation charity, which concentrates on the initial 1,001 days and the attachment between parent carers and their children.

I was impressed by the response from the digital teams in the House. It was a very good exercise. As the hon. Lady said, 11,265 responses is not to be sniffed at. Alas, the responses were all too familiar. We have heard similar anecdotes from our constituents about what has been going on during lockdown. There were responses about parents, and particularly mums, feeling lonely. They feel isolated in hospital, particularly if they have to stay in for any length of time because of complications. They have problems even getting their partners—the fathers—to be able to visit them. They feel isolated from family support networks that we normally take from granted. They feel isolated from new mum and baby groups. One of the respondents to the survey called them a safety valve where completely new mums, in particular, learn from other mums—either new mums or experienced mums—and the babies interact too. It was interesting that, for colleagues who gave birth during the lockdown, it was several months before their babies were actually able to meet another baby, and there was a bit of a shock factor there. We perhaps underestimate the impact of that social contact from the very earliest stages after a child is born.

In particular, as the hon. Lady mentioned, there is the isolation from health professionals on a face-to-face basis. I know that there have been a lot of substitute virtual visits, but they are not a substitute and they must not become the norm. We need to build back our health visitor numbers, as we did so well in the coalition Government between 2010 and 2015, when we produced 4,200 additional health visitors, who were absolutely invaluable. They are the friendly face that new parents will welcome across a threshold, where they may be more suspicious of a social worker or other care workers. They are also an early warning system for problems that may be going on with a new parent and ultimately any safeguarding issues.

A report that the First 1001 Days Movement produced last year, called “Working for babies”, said that services supporting nought to twos were highly depleted during the first spring lockdown last year. The majority of services for nought to twos did not bounce back quickly as lockdown measures were eased. We need to make sure that mistake is not made again this time.

This lockdown has been especially stressful for first-time mums, single mums, and families having to balance working remotely, new forms of working and working covid-safely, and juggling home schooling if they have other children too—thank goodness all my children are above school age and we have not had that additional challenge. Even before the covid pandemic, at least one in six mums suffered from some form of perinatal mental illness—commonly anxiety disorders and depression. We know that the pandemic and lockdown have impacted on the mental health of just about everybody, but particularly on that cohort of mums.

A survey by the excellent baby charity Bliss found that, among its members who had received neonatal care during the pandemic, 90% of parents said they felt more isolated as a result of having a baby in neonatal care during the pandemic; 70% said their mental health was negatively affected as a result of the experience; 56% said the mental health of their partner and wider family had been affected; and 47% said they were not offered support for their mental health while their baby was in neonatal care. We know that, in extremis, suicide is the biggest cause of maternal death. We must do so much more to ensure that women do not get in that position and that support is there and accessible.

The shortage of health visitors is a false economy. I have always said that; we had a debate specifically on that last year. I pay tribute in particular to Cheryll Adams, who set up and has led the Institute of Health Visiting. She is retiring at the end of the month. The service she has given to that area has been extraordinary and has informed many debates in this place. I put on the record our thanks and gratitude to her.

There is also the whole issue of increased domestic abuse during pregnancy. The figure that I always find hard to take on board is that a third of domestic abuse happens during pregnancy as well, and we know that domestic abuse has gone up during the pandemic, so all the additional pressures on women who are about to give birth or who have just given birth are extraordinary.

The cost of perinatal mental illness, as calculated by the Maternal Mental Health Alliance some years ago—it still holds true, and today it is probably an underestimate—was £8.1 billion each and every year. On top of that, the cost of child neglect is £15 billion, so we as taxpayers are paying £23 billion-plus into the health service to get it wrong. To prevent us getting it wrong, if we spent a fraction of that on the support services—the health visitors and those networks—being there in the first place, that would be money well spent and well saved.

Of course, the key is good attachment between babies and their parents or primary carers from those very earliest stages and during conception, hence the founding of the First 1001 Days Movement. My right hon. Friend the Member for South Northamptonshire (Andrea Leadsom) launched the 1,001 critical days manifesto back in, I think, 2012, which was signed up to by colleagues across parties, the royal colleges, clinicians, academics and children’s charities alike. It is still relevant today.

To quote research by the First 1001 Days Movement and the Parent-Infant Foundation—I pay tribute in particular to Sally Hogg, who does so much of the good work there—it is estimated that 10% to 25% of young children experience significantly distorted relationships with their main carer or carers, and from that a range of poor social, emotional and educational outcomes in childhood and across the life course can be predicted. Maternal mental illness in pregnancy and the early years of a child’s life can have adverse effects on the child’s brain development and long-term outcomes. Maternal mental illness can affect children both directly and indirectly. For example, exposure to stress hormones in the womb is thought to affect the child’s developing stress response systems, and mental illness after birth can affect a mother’s ability to care for her baby, her parenting style and her developing relationship with her baby. Even relatively mild mental illness, if untreated, can inhibit a mother’s ability to provide her baby with the sensitive, responsive care that they need.

This, again, is a statistic that I always use. If a 15 or 16-year-old teenager is suffering from some form of depression or low-lying mental illness, there is a 99% likelihood that that child’s mother suffered some form of perinatal mental illness—the connection is that close. So why are we not doing more to support the mother before and soon after she gives birth? The implications of not doing so will be with her child and her for many years to come, and often into adulthood for the child.

It is also important to note that although perinatal mental illness increases the risk of disruptions in early relationships, they are not inevitable. Some mothers can continue to give their babies the sensitive, responsive care they need, particularly with the right support—and good, effective support can be had, if it is available. That is the problem: it is not always there, or not always there at the right time or in the right place.



Other risk factors put early relationships and infant mental health at risk, including families where fathers or other care-givers have serious mental health problems themselves. Again, we underestimate the impact of becoming a father, particularly for the first time, on the mental health of dad. In most cases this is a joint partnership, but fathers often get overlooked. They often get excluded from the whole neonatal process within hospitals, as well. They need looking after too, because if they can be looked after, they can look after their partner and there is a mutual benefit from all of that. We need to do more for fathers.

The NHS long-term plan includes a commitment to expand access to evidence-based parent-infant interventions within specialist perinatal mental health services, which is indeed welcome. It will ensure that attention is given to the parent-infant relationship alongside the mother’s own mental health when mothers have moderate or severe mental health problems. We must not just look at the child or the mum in isolation; we are looking at the bonded family.

However, access to mental health services for babies should be dependent on the risks to their mental health and not contingent on other factors, such as their mother’s mental health needs. So, the NHS long-term plan for England also committed to improving access to specialist services for all children from 0 to 25, but delivering that commitment requires specialist provision for all babies who need it, as they are children, too. Such provision would need to be delivered by parent-infant specialists. However, the NHS long-term plan says nothing explicitly about specialist mental health services for the youngest children in their own right.

The solution is that we need specialised parent-infant relationship teams providing therapeutic support where a baby’s development is most at risk due to severe, complex and/or enduring difficulties in their relationships. Such teams focus on the relationship between a baby and his or her parents or care-givers as the main way to improve infant mental health. However, there are fewer than 40 specialised parent-infant relationship teams in the whole of the UK, and most babies live in an area where these services just do not exist; vast areas of the country have no provision.

One of the aims of the Parent-Infant Foundation charity, which was set up by the right hon. Member for South Northamptonshire, is setting up parent-infant projects around the country, where practitioners are available, to work on the attachment of parents and their children. We just need it to be mainstream across the whole of the national health service.

As the Royal College of Psychiatrists has said, the need for more perinatal psychiatrists to work in these services is crucial. These specialist services need a highly trained specialist workforce, but the workforce census in 2019 showed that 13% of consultant and perinatal psychiatrist positions remained unfilled. Without more psychiatrists, ambitious plans to transform and expand services will be put at risk.

We are soon to have the Leadsom review, if I may call it that; it does not really ring true as “the South Northamptonshire review”. The right hon. Member for South Northamptonshire is producing the review; hopefully it will be published later this month. I have been privileged to play a part in it, and chaired a parliamentary advisory group.

Absolutely key to that review are a joined-up support service between the NHS, local government and other key professionals, to give that wraparound service to parents in those crucial early months and years; a digital record, so that all those professions are working from the same information, rather than every visit to mum being a new visit; and a national template of the quality that we need to reach, but with local implementation, so that a service in Richmond, although it may look a bit different from a service in my part of the world on the Sussex coast, is none the less required to produce quality outcomes and clear the same threshold.

We look forward to that report in the coming weeks and months, and I very much hope that the Government will take it on board and produce the goods, because little, if anything, is more important than the welfare, good health and good mental health of our children. And a child is given the very best opportunity—the best start in life—if their parents are in a safe and stable place as well.

[Mr Laurence Robertson (in the Chair)]

In order to call everyone, I wonder if I might ask all Back Benchers to stick to around five minutes in their contributions, please.