Perinatal Mental Illness

Wera Hobhouse Excerpts

Thursday 19th July 2018 Westminster Hall

[Wera Hobhouse (Bath) (LD)]

It is a real pleasure to serve under your chairship, Mr Davies. I congratulate the hon. Member for Stockton South (Dr Williams) on securing this excellent debate, which perfectly brings together my personal and political lives. I am a mother of four and, like the hon. Member for Canterbury (Rosie Duffield), I had them 20 years ago so I know what it feels like to have children completely outgrow me.

This issue does not go away. When I speak to mothers in my constituency, I know that the issue of perinatal health is as alive as when I was a young mum. Some things are getting better, but others are getting worse, particularly because of the time that health professionals can give to people who come to a surgery or the time that a health visitor can give to someone in their home.

I am here because I serve on the all-party group for the prevention of adverse childhood experiences. ACEs are well known in the United States, and the APPG is doing excellent work with the WAVE—Worldwide Alternatives to Violence—Trust. I also pay tribute to the #HiddenHalf campaign group, which came to the APPG the other day and specifically campaigned on the additional six-week check-up for mothers after childbirth.

Pregnancy, childbirth and the first year of a baby’s life is one of the most life-changing experiences in a woman’s life and her partner’s life. It is meant to be amazing, exciting and wonderful. All the folklore and our societal expectations are around how wonderful all that is. Actually, it is a time of profound change. In my experience, it is not only physical change, but mental change. Most women who have experienced pregnancy and childbirth will testify that a big mental change happens, too. All women are at a vulnerable point at that time in their lives. Apart from the physical exhaustion, there is the pressure to prepare and provide for another person’s life. All parents ask themselves how they will cope, how it will all work out, and whether they will love this new being.

While medical attention is focused on the physical health of the mother, the unborn child and, later, the born child, little medical attention is given to mental health during pregnancy and after birth. We are missing out on a vital aspect of health, with enormous consequences for the mother and the child. The APPG is concentrating on this particular issue: adverse childhood experiences and what affects a child’s health from the start.

We know how vital the first 12 months are for a new baby. An enormous amount of development is happening not only physically, but mentally and emotionally. If a mother is mentally unwell—for example, if she is depressed or suffering from anxiety—she will not bond properly with her newborn baby. She cannot give the baby the attention it needs, and the child will suffer. We know that a lack of attention during the first 12 months puts a child at a severe disadvantage for the rest of their life. To address that, they will require a lot more intervention later on, with a lot of extra resources. It therefore makes utter sense to focus our attention on a mother’s mental health before, during and after pregnancy. No woman can be expected to be in perfect mental health during those profound changes in her life. Even mild mental health problems can lead to much bigger problems, with severe consequences for mother and child.

I fully support the call for a six-week check-up in addition to that which already exists and which focuses mainly on the baby. The additional check-up should focus on the mother and her mental health. In my experience, I was never asked how I felt; I was expected to get on. If anybody had asked me, I would probably have cracked up and cried—and why not? It would have brought out that I felt utterly exhausted, inadequate and isolated. I felt that I was letting people around me down. I would probably have been reassured that that was normal, and people would have kept an eye on me.

We still do not know enough about mental health, but as with physical health, early detection and intervention are key. Sometimes symptoms go away on their own, but unlike with physical health, many people will not go back to their doctors if mental health problems do not go away. Those problems can fester and grow bigger. With a six-week check-up, we have a chance of early detection and early intervention. To conclude, let us ensure that all new parents receive the full support they need and deserve. It will be of great advantage to us all.

--- Later in debate ---

[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.

[Wera Hobhouse]

Valuable and important as that exchange is, the point about the #HiddenHalf campaign is that often attention is diverted away, because the baby and the dad are there. #HiddenHalf is looking for quality time for the mother in particular. I want that space to be preserved, however much is done by the GP. It is important that a woman who has gone through the trauma that the Minister described is able to feel, “Someone is just looking after me.” It is important to recognise that.

[Jackie Doyle-Price]

I agree and do not think the two points are in conflict. We need both—we need the wider package of support.

The theme we have been considering—of women not always being asked about themselves, and its being all about the baby—is not confined to the issue of perinatal mental health. Women face that across the board with respect to their health. The hon. Member for Worsley and Eccles South (Barbara Keeley) spoke about a women’s health strategy and women’s mental health. I co-chair a women’s mental health taskforce with the chair of Agenda, and in the coming weeks we will present our report on a year-long piece of work. It will have information about tools to enable the health service in general better to support women’s mental health. I am also doing more to raise the whole issue of women’s mental health, because I feel strongly that women are often disempowered in health settings. We need to give them the tools to take control of their own care and to feel empowered to engage in good conversations with medical professionals, to benefit their health.

We have heard anecdotal accounts of women’s experiences, and what has come across is the arrogant behaviour of some medical professionals. They see a large number of patients and they are not always sensitive to how best to communicate with certain individuals. We need that practitioner-patient relationship to work a lot better, particularly in the case of women. I am open to representations from everybody about what tool we can use.

The hon. Member for West Ham (Lyn Brown) is no longer in her place, but I have been impressed by her work on hysteroscopies with women. We are developing tools on that. I reassure all Members that women’s health and the way in which the national health service can better serve women are high on my agenda. I am not going to stand here and say that the world is perfect, but we have made perinatal mental health a priority in the five year forward view. We are midway through that review, so I should give Members an account of how far we have got and what more needs to be done.

To go back to 2010, the situation was really quite poor. Only 15% of localities had fully fledged specialist services in the community, and 40% of communities provided absolutely no service at all. People talked about a postcode lottery; clearly, we could not allow that to continue. We need to work towards universal provision. We are implementing the recommendations of the five year forward view for mental health taskforce, which reported in 2016. From 2015 to 2021, we are investing £365 million into perinatal mental health services. NHS England is leading a transformation programme to ensure that, by 2021, at least 30,000 more women each year are able to access specialist mental healthcare during the perinatal period. In May, NHS England confirmed that, by April next year, new and expectant mums will be able to access specialist perinatal mental health community services in every part of the country. We are making progress. The key to that is community provision.