Perinatal Mental Illness (NHS Family Services)

John Bercow Excerpts

Wednesday 14th October 2015 Commons Chamber

[Rehman Chishti (Gillingham and Rainham) (Con)]

I beg to move,

That leave be given to bring in a Bill to make provision about the appropriate level of access to NHS services and accommodation for mothers with perinatal mental illness; and for connected purposes.

The Bill is in addition to my other Bill on the need for accountability and transparency in the commissioning of mental health services. I thank the Minister for Community and Social Care for meeting me and the team from the Royal College of Psychiatrists, led by the president, Professor Simon Wessely. The royal college fully supports the Bills.

We have come a long way in improving attitudes to mental illness over the past few years and I pay tribute to the work of the current Government and the coalition Government for their efforts to improve the quality and provision of care for people with mental ill health. Nowhere is improvement needed more than for women with perinatal mental illness. Perinatal mental illnesses are those that start or are already present during pregnancy and the initial year after birth, which is a time when the risk of mental illness is heightened. Approximately 10% to 20% of women will experience a mental illness in the year after childbirth. In fact, a woman is 33 times more likely to be admitted to a psychiatric ward after giving birth than at any other time in her life. That means tens of thousands of women in England every year.

The consequences of not intervening adequately can be severe. These women might be catatonic or delusional, experiencing hallucinations or suicidal thoughts, and they might be unable to recognise their family or even their baby. Not only is this a traumatic experience for them, but, unsurprisingly, the child’s development can be severely impaired. Tragically, suicide is a leading cause of maternal death associated with approximately 15% of overall deaths in the perinatal period. Although such cases are rarer, some women will kill the child as a result of their illness. Recently, we will all have seen in the media the coroner’s report on the tragic case of Charlotte Bevan, who committed suicide along with her baby. Her parents call for extra perinatal units, and the coroner has called for better services.

Aside from the tremendous human cost, there is an economic cost that far outweighs the cost of providing adequate treatment. A comprehensive economic evaluation conducted last year by the London School of Economics and the Centre for Mental Health calculated that the annual cost of perinatal mental illness to the NHS is £1.2 billion and that the total cost to society is £8.1 billion. Although many cases of perinatal mental illness can be managed by services based in the community, specialised care is required in thousands of cases each year and the mother will have to be admitted to hospital. In such circumstances, typical adult psychiatric wards are inadequate as they are not equipped to allow the baby and mother to remain together and bond. Specialised mother and baby units, which are the subject of the Bill, are designed with that in mind, and research shows that women with serious perinatal mental illness will have better outcomes and better relationships with their infants if cared for in these specialised units.

Guidance from the National Institute for Health and Care Excellence accordingly recommends that mothers who require in-patient treatment for any mental health problem in the perinatal period should be admitted to such a unit with their child. Last month, I had the pleasure of seeing the fantastic work that the specialist units do first hand when I visited the Margaret Oates mother and baby unit in east London. The Scottish NHS is some years ahead of ours when it comes to providing such vital services. Since 2003, the Mental Health (Care and Treatment) (Scotland) Act, which was the inspiration for this Bill, has stipulated that commissioners must provide enough mother and baby unit services so that women with depression who require in-patient admission and their infants can be accommodated together.

There is no similar provision in English law and both NHS England and NICE have acknowledged that there is a significant national shortfall in the provision and distribution of mother and baby units of approximately 60 to 80 beds. As a result, women with serious mental illness are forced either to be admitted without their babies to general adult psychiatric wards or to travel hundreds of miles out of their area to a specialist mother and baby unit. Both have damaging consequences for the mother and baby. Dr Liz McDonald, one of the country’s leading perinatal psychiatrists, calls this

“the bleakest of all postcode lotteries”.

I agree, and the Bill seeks to correct that.

It is important to note that the number of beds needed is not the only consideration. Thought must also be given to where they are located. I recently met Dr Giles Berrisford, a senior perinatal psychiatrist who runs an excellent mother and baby unit in Birmingham. He told me that he has received patients from as far away as Cornwall and that new motherhood, the onset of mental illness and having to travel huge distances for care, being separated from families, friends and communities, are a toxic combination. That is why the Bill will make it a requirement that 95% of the women who need such services should be able to access them within 75 miles. Those figures were recommended to me by experts at the Royal College of Psychiatrists, who strongly support the Bill.

The distance element is innovative. I appreciate it might raise an eyebrow or two in the Chamber, but it is just a different way of conceptualising the rights that already exist. For years, patients have had the legal right to access NHS treatment for physical illnesses within a maximum period of 18 weeks. Unfortunately, this 18-week target would not be relevant to acute perinatal mental illnesses, whereas, as I have explained, the problem is with both the shortage and the location of these services. That is why the Bill thinks slightly differently and uses distance, rather than time, as a basis. This is novel for the NHS, but innovation is not a bad thing.

If we can enshrine a time-based right in law, with no ill effects, why not a distance-based one? It is not unheard of. In the United States, Kentucky, Illinois and Minnesota have laws about the maximum distance patients have to travel for care. Moreover, the financial implications of the Bill are actually positive. An evaluation by the London School of Economics and the Centre for Mental Health estimates the cost of providing the 60 to 80 beds that NHS England and NICE say are needed to be approximately £7 million. I am pleased that the Government have already earmarked extra funding for perinatal mental services more generally. In the March 2015 Budget, a pledge was made to spend £75 million over five years on improving perinatal mental illness services, but no detail has been forthcoming about what it means in practice.

The Bill complements existing Government spending plans, but importantly would serve to compel NHS England to act and focus its attention on these much-needed mother and baby units. When I have spoken to colleagues about the Bill, some have cautioned that it might lead to legal action being taken if these services are meant to be available but are not. I am pleased to say that these concerns are unfounded. The Royal College of Psychiatrists informs me that it is not aware of the similar Scottish law having led to any such cases.

I have also been asked why these services are a special case, deserving of their own Bill. There is a particularly strong argument for action in this case. As we know, the Government have set the laudable objective of giving mental health parity of esteem with physical health, reflecting the fact that unfortunately mental healthcare has lagged behind physical healthcare for so long, and perinatal mental healthcare has lagged behind other areas of mental healthcare and so has been doubly disadvantaged in many ways. This and the consequences of not getting this care right for mothers and babies justify the Bill and the novel approach it takes. As for whether the Bill will set a precedent, that, as right hon. and hon. colleagues will know, is ultimately within Parliament’s control.

In summary, the Bill reflects current NICE guidance and will result in better outcomes for the mothers and infants concerned—

[Mr Speaker]

Order. I am extremely grateful.

[Rehman Chishti]

We have a moral duty to make sure the Bill is fully considered and taken on board by the Government.

[Mr Speaker]

Order. We have got the thrust of it. I am afraid that people will have to rediscover the habit of staying to time. The hon. Gentleman did so in the last Parliament, but he will need to brush up a little bit. None the less, we are grateful to him.

Question put and agreed to.

Ordered,

That Rehman Chishti, Norman Lamb, Frank Field, Tim Loughton, Fiona Bruce, Tom Brake, Jim Shannon, Valerie Vaz, James Berry, Jeremy Lefroy and Kelly Tolhurst present the Bill.

Mr Rehman Chishti accordingly presented the Bill.

Bill read the First time; to be read a Second time on Friday 20 November 2015, and to be printed (Bill 78).