Perinatal mental health
During pregnancy, and up to one year after birth, one in four women will experience mental health issues, ranging from anxiety and depression to more severe illness.
Midwives and MSWs play a vital role in identifying the signs of poor mental health and supporting women who experience it during pregnancy.
The RCM's Perinatal Mental Health Roadmap
The Royal College of Midwives (RCM) has launched the updated Perinatal Mental Health (PMH) Roadmap on world mental health day 10 of October, a key resource setting out the RCMās priorities for improving perinatal mental health care across the UK. Midwives play a vital role in supporting womenās perinatal mental health; whether through routine care, specialist services, strategic leadership, education, or research. However, the scale of perinatal mental health need, combined with workforce pressures, means that greater investment and systemic support are urgently required. This roadmap provides a clear set of recommendations for policymakers, commissioners, and senior NHS leaders, calling on them to commit to sustainable investment in services, workforce development, and education.Ā
The RCM has developed a roadmap for significant improvements in perinatal mental health in the UK. Aimed at midwifery and healthcare leaders and all those working in healthcare planning, the roadmap outlines a series of steps governments across the four nations need to take.
Why perinatal mental health support matters
For most women, pregnancy and childbirth can be a symbolic passage to parenthood, with an expectation of joy and excitement. However, the societal expectation can be very different to the reality, with 70% of women either hiding or underplaying the severity of their mental health problems. For those women experiencing mental ill-health, barriers often exist preventing them from accessing care, including variation in availability of service, care, and treatment. These are often worsened by cultural stigma, previous trauma, deprivation, and discrimination.
Despite perinatal mental illness being the most common health complication during or after pregnancy, gaps remain in the equity of access to treatment including access to a specialist midwife, or a perinatal mental health service in a location near to the womanās home.
The RCMās priorities for perinatal mental health
All professionals working with women in the perinatal period have the knowledge and understanding of perinatal mental health including trauma informed care, and at a minimum, updated annually.Ā
Every Trust or Health Board with a maternity service has a minimum whole-time equivalent Band 7 Perinatal Specialist Midwife supported by a team, which may include maternity support workers, and necessary administrative support.
Access to local maternal mental health system and community based mental health teams.Ā
Education and training in perinatal and infant mental health appropriate to the role working at specialist, advanced or consultant level practice.Ā
All maternity professionals should be equally concerned with mental as well as physical health in pregnancy, childbirth, and postnatal periods.
Resources
This guide provides an evidence-based roadmap for program managers, administrators, and policymakers to develop and sustain high-quality, integrated perinatal mental health services. By focusing on creating a safe, respectful, and non-stigmatizing environment, these services can improve health outcomes for both mothers and children. The guide helps maternal and child health providers promote good mental health, identify problems, and respond effectively within their local and cultural context.Ā Ā Ā
WHO Recommend low intensity psychological interventions ācreate more accessible mental health care that reaches a larger number of peopleā. The Thinking Healthy approach provides instructions for empathic, clear and sensitive communication with women and their families, and mobilizing and providing social support. Activities, psychoeducation, destigmatisation, social networks and overall wellbeing focus. About a psychosocial management approach.Ā
England
- The perinatal mental health care pathways have been developed by the National Collaborating Centre for Mental Health, following a process agreed with the National Institute for Health and Care Excellence (NICE), with involvement from an Expert Reference Group including experts by experience, carers,
practitioners, academics, commissioners, service managers and representatives from national NHS armās-length bodies.
- The NHS mental health dashboard, formerly called the Five year forward view for mental health dashboard, is intended to help monitor progress against the delivery of the Five year forward view for mental healthĀ and now theĀ NHS long term plan and is published on a quarterly basis.
Ā
Wales
- The NHS Wales All-age mental health and wellbeing strategy sets out the government’s aims until 2034.Ā
- The Perinatal Mental Health ProgrammeĀ has been created following a Wales Perinatal Mental Health Network-led review of the way in which support, care and treatment was being
provided for women and their families with mental health difficulties, who were planning a pregnancy, pregnant or had given birth and had a baby under one year old.
Scotland
- An evaluation by the Perinatal Mental Health Network Scotland reviewed the progress of specialist perinatal services against the 2019 “Delivering Effective Services” recommendations, revealing significant service expansion and workforce education improvements, alongside ongoing challenges with capacity and funding.Ā
- Scottish perinatal mental health care pathways
- The Evaluation of the Perinatal and Infant Mental Health Programme explores data related to the mental health service usage of mothers in Scotland, before and during the perinatal period. It has been developed to support the overall Perinatal and Infant Mental Health Programme evaluation being carried
out by Public Health Scotland. This study is focussed on assessing what data is available in this area. Evaluation of the Perinatal and Infant Mental Health ProgrammeĀ
Northern Ireland
- The Regional Perinatal Mental Health Care Pathway has been developed to facilitate the prediction, detection and treatment of mental health problems in women in the antenatal and postnatal periods.
Specialist Mental Health Midwives are vital for effective perinatal mental health care. However, their role and presence vary significantly across maternity services, leading to a gap in consistent support for women. This document is a resource for maternity managers and commissioners, aiming to address this disparity by clarifying the essential functions of this position. It explains the need for Specialist Mental Health Midwives and outlines their key responsibilities, with the goal of improving local service provision.Ā
Maternal Mental Health AllianceĀ
- This report offers a detailed look at how MMHS are being delivered at the local level. The report finds that there has been welcome progress with the establishment of these services in most areas of England, however it also highlights that many of these small services are struggling to cope with levels of demand.Ā
- The Maternal Mental Health Alliance Information Centre, including signs and symptom checker.
- The MMHA also has a Resource Hub where you can discover a wealth of resources designed to help you support women and families impacted by perinatal mental health problems.
Ā
- The costs of perinatal mental health report is part of the Maternal Mental Health Allianceās āEveryoneās Businessā campaign, which calls on national Government and local health commissioners to ensure that all women throughout the UK who experience perinatal mental health problems, receive the care they and their families need, wherever and whenever they need it
Ā
- ‘It is advisable to view the non-clinical roles as delivering maternity services rather than midwifery care.’ Click here for a list of Non-Clinical Midwifery Roles.
Further resources
i-Learn
This i-learn module provides an understanding of the problem and its scale within pregnancy and the postpartum period in the UK. It provides information on understanding and identifying how disorders may present, the way to ask about mental wellbeing during an appointment and which services can help with information and support.
The module will also consider the responsibilities of midwives and support workers in identifying women who need support, practical steps to ask about mental wellbeing, women at higher risk of mental illness in pregnancy and why it is important for mental illness to be identified and treated early for both the woman and her unborn child.
MIDIRS perinatal mental health pack
Prepared by our information specialists at MIDIRS, this search pack encompasses the treatment and experiences of women and partners experiencing mental health problems during the perinatal period. Includes service provision and interventons, rates of mental illness and levels of provision, and the impact on the infant. The pack does not include postnatal depression (PN16, PN115, PN116), antenatal depression (P132) or women with specifc diagnosed mental disorders (MS54).
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