Perinatal mental health

Mental health conditions are some of the most common illnesses experienced during the perinatal period, which is defined as the period from conception to 24 months after birth (1). Around 10 to 20% of mothers will experience a perinatal mental health condition (1); and although anyone can be affected, some groups are more at risk.

Perinatal mental health conditions have a significant influence on maternal mortality, as well as foetal development and child outcomes (2). In Cambridgeshire and Peterborough, there are a range of services offering support and treatment across the perinatal period, ranging from those available to all parents and infants, such as the Healthy Child Programme, to those offering specialist perinatal mental health support. This chapter will describe:

• The importance of perinatal mental health
• The local and national policy context
• The local picture of perinatal mental health
• Inequalities in perinatal mental health and barriers to accessing care
• Services providing support and treatment for perinatal mental health, including gaps in provision
• The evidence base for prevention of perinatal mental illness

Figure 1: Structure of chapter 3 of the mental health needs assessment

Each of these topics is covered in the attached local data pack. The full chapter can also be downloaded as a word document or pdf.

Areas for future work

The following questions were raised in the writing of this chapter and highlight potential future areas of future work needed.

Policy Context

• Align integrated care system work and planning with the 7 priorities for perinatal mental health

Local Picture

• Investigate why there are higher levels of anxiety and depression reported in 12-month maternal mood reviews in Peterborough
• Maternal mood reviews provide data on postnatal mental health. Midwives across Cambridgeshire and Peterborough collect data on the prevalence of antenatal mental health conditions. Work with midwives to collate and publish this data, to improve understanding of local antenatal mental health need.

Barriers and Inequalities

• Develop estimates of the number of new and expectant parents who have low levels of social support
• Improve understanding around local uptake of maternity exemption certificates, with the aim to encourage uptake in families who are eligible but do not currently receive support.
• Improve understanding around local uptake of Healthy Start vouchers, with the aim to encourage uptake in families who are eligible but do not currently receive support.
• Work with midwives to develop the local picture on domestic abuse occurring the perinatal period.
• Investigate the level of unmet perinatal mental health need amongst (add links):
  • Asylum seekers and refugees
  • People with a personal or family history of mental health conditions
  • Disabled parents
  • Young people in care and care leavers
  • LGBTQ+ parents
  • Military families
  • People who have experienced adverse life events
  • New and expectant parents in contact with the criminal justice system
  • Parents of disabled infants, including up to the first 2 years
  • People with experiences of severe multiple disadvantage
  • Gypsy, Roma and Traveller Communities

Service Provision

Questions that arose through the service review include:

• Evaluate progress in services and pathways using the Pathway Assessment Tool, to identify strengths and gaps in local services and monitor progress over time.
• Develop mental health pathways for parents who experience pregnancy loss and birth trauma.
• Investigate if all women and birthing people with enduring or serious mental health conditions are able to access pre-conception advice.
• Investigate the experiences of dads and partners in Cambridgeshire and Peterborough in terms of mental health support.
• Explore the evidence base around infant mental health and map current service provision.
• Work with commissioners to improve understanding of data around service quality, and to strengthen lived experience pathways.

Other areas for future work included:

• Investigate awareness among new parents of services provided by the local community and voluntary sector and how this could be improved.
• Understand reasons why people may be offered an assessment from the specialist perinatal mental health team, but not attend.
• Staff at NCT breastfeeding groups told us that there was low uptake of support by women from ethnic minority groups. Investigate if there are any disparities in engagement of different ethnic minority groups in breastfeeding support and stay-and-play type of activities, and if so, the reasons behind this.
• Understand the implications of social isolation on mental health issues during the perinatal period and the effectiveness of local groups providing opportunities to make social connections.
• Explore the barriers to mental health assessment faced by delivery suite inpatients with acute mental health need (raised by the expert advisory group for this chapter).
• Investigate how a communications strategy could be developed to improve new and expectant parents’ understanding of perinatal health mental health, self-help and support services, including services provided by the local community and voluntary sector.
• Evaluate wider support services (including adult mental health services and learning disability services) against Royal College of Psychiatrist guidelines around perinatal mental health.
• Work through the Birth Charter toolkit which explores the experiences of pregnant women and new mothers in prisons and helps stakeholders address gaps (note that a previous review has evaluated HMP Peterborough’s compliance with 3 out of 10 elements).

References

1. Bauer A, Parsonage M, Knapp M, Lemmi V, Adelaja B. The costs of perinatal mental health problems. LSE & Centre for Mental Health. 2014;(November).
2. Howard LM, Khalifeh H. Perinatal mental health: a review of progress and challenges. Vol. 19, World Psychiatry. 2020.

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