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RCOG: Maternal mental healthcare severely in need of improvement

Women suffering from mental health issues during and after pregnancy are being let down by the quality of care they receive from the NHS at present, a survey conducted by the Royal College of Obstetricians and Gynaecologists (RCOG) has revealed.

The research was based on the responses from more than 2,300 women who had given birth in the last five years in the UK and explored their experiences of prenatal health problems, engagement with professionals and the quality of care they received.

Of those surveyed, 81% said they had experienced at least one episode of a mental health problem during or after their pregnancy, with low mood being reported by two-thirds of women. Anxiety was experienced by half the women and depression by just over a third.

Despite these high numbers, only 7% of women who experienced a problem were referred to specialist mental healthcare – and of those referred nearly two-fifths took over four weeks to be seen by a specialist, with some saying it took over a year.

The survey also alluded to the disparity in support available depending on where mothers lived in the country. For instance, in one area 8% of women were referred to specialist maternal mental health services, compared to another area where the rate went up to 50%.

Professor Lesley Regan, president of the RCOG commented on the research, saying: “Currently the fragmentation of healthcare provision means that women face a number of challenges accessing the care they need.

“Access to specialist community perinatal mental health services is crucial and greater integration between primary and secondary care will ensure that women are referred in a timely manner and receive the right support throughout their pregnancy and beyond.”

“Healthcare professionals are often the first point of contact that a woman suffering with mental health problems reaches out to and we must ensure that all staff involved in the care of women during pregnancy and the first year after birth have relevant education and training in perinatal mental health.”

Prof Regan also emphasised the need to empower women to make decisions about their care to help them help themselves.

“There is a wealth of data, evidence and guidance on good practice. Maternal mental health has been made a key priority by government and funding has been allocated in England and Wales for more highly specialised services,” she said. “Listening to the voices of women gives us the opportunity of a lifetime to ensure that they and their families get the care they need and deserve.”

Chair of the Maternal Health Alliance Dr Alain George, also said: “We know that suicide is a leading cause of maternal death, and that this represents the tip of an iceberg of suffering that has been ignored for too long.

“Despite some additional funding, GPs, midwives, health visitors, therapists and specialists providing perinatal mental healthcare are under extreme pressure, and in half of the UK, pregnant women and new mothers have no access to the care they need.

“Yet leaving this inadequate care for perinatal mental health problems adds costs to society of £8.1bn each year, of which over £1bn is borne by the NHS.”

He added that the women who responded to the survey have reminded us “that the healthcare responsibility and the economic necessity to take action, are joined by a moral imperative to put an end to these unacceptable levels of avoidable suffering”.

The Royal College of Midwives also welcomed the “shocking” report, citing the “post-code lottery” nature of mental health provision for mothers and their partners and urged the NHS to invest further in maternal mental health services.

Janet Fyle, professional policy advisor at the RCM, said: “Perinatal mental illness exerts the most unimaginable toll on women, their baby and families and if we don’t invest in maternal mental health services now as a matter of urgency it will cost society more in the long term. This is an economic decision that must be made.”

She added: “The RCM has consistently advocated for the provision of maternal mental services across the UK and in particular in the community, near where women live so that their condition can be monitored to prevent escalation.

“Currently the variations in the provision of care and delays in referrals often mean women can be waiting up to one year for treatment, this is completely unacceptable.”

Fyle stated that midwives play a central role in promoting the emotional wellbeing of women and their babies and in ensuring that all women with mental health concerns get appropriate and timely care.

“Unfortunately, we remain 3,500 midwives short in England and too few midwives means women are not getting the time they need with their midwife and often signs and symptoms of perinatal mental health issues can be missed,” she concluded.

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