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Better Mental Health Care Needed for New and Expectant Mothers

The Royal College of Psychiatrists (RCPsych) has called for better routine screening of every pregnant woman for mental health issues at their 10-week antenatal booking appointment. The College said that it estimated 1 in 5 pregnant women and new mothers developed some form of perinatal mental illness, including anxiety, depression, post traumatic stress disorder (PTSD), eating disorders, and psychosis.

"Left untreated, these illnesses can have a devastating impact on the lives of the woman, their newborn child, and other family members." Yet the latest data from NHS England (NHSE) showed 1 in 6 NHS Trusts were "still struggling to report if they are screening every pregnant woman for mental health issues" at the 10-week appointment, in line with clinical guidelines. 

Other recent research found that only 83.4% of women reported being asked about their mental health antenatally in 2020. The antenatal booking appointment "is a critical opportunity to identify women who may need professional mental health support during and following pregnancy", the RCPsych said.

Mental Illness 'Leading Cause of Maternal Death in the First Year After Birth'

In highlighting the issue to mark Maternal Mental Health Awareness Week (1-7 May ), it pointed out that mental illness "is the leading cause of maternal death in the first year after birth". Pregnant women and new mothers who are struggling with their mental health were urged "to reach out and ask for professional support", while the College called on NHSE to urgently publish data showing if pregnant women are indeed being screened for mental illness as recommended by the National Institute for Clinical Excellence (NICE).

NICE said that between 2006 and 2008 in the UK there were 1.27 maternal deaths per 100,000 maternal deliveries as a result of mental health problems. "The management of mental health problems during pregnancy and the postnatal period differs from [that] at other times because of the nature of this life stage and the potential impact of any difficulties and treatments on the woman and the baby," it noted.

Clinicians Urged to Quiz all Pregnant Women

NICE antenatal and postnatal mental health guidelines promoted "early detection and good management of mental health problems, to improve women's quality of life during pregnancy and in the year after giving birth". They recommend that all pregnant women be asked about their mental health history, family history of mental illness, and risk factors for mental illness at the 10-week antenatal appointment. 

Yet, although NHS Trusts report on whether they are following the guidelines, the actual data has never been published, according to the RCPsych. Furthermore, the latest figures from NHSE showed that 20 of 122, or 1 in 6, NHS Trusts providing antenatal services were still not fully reporting whether they are screening every pregnant woman for mental health issues in line with the clinical guidelines.  

Dr Trudi Seneviratne, consultant perinatal psychiatrist and registrar of the RCPsych, said: "Every pregnant woman should be screened for mental health issues at their antenatal booking appointment. More than eight years after routine screening was first recommended, we still don’t know if NHS Trusts are following the guidelines, and there is strong anecdotal evidence to suggest many women are missing out. 

"Suicide and substance abuse are leading causes of maternal death in the first year following birth so it’s vital that women experiencing mental illness receive timely specialist support."

She added: "In my clinic, I treat women from a range of backgrounds who develop serious mental illness while pregnant or after giving birth. Many of these women suffer in silence for too long. They are often embarrassed to ask for help, fearing people will view them as weak or unfit to be a mother. Some didn’t realise they were very unwell, while others didn’t know how to get help."

Asked to comment by Medscape News UK, an NHS spokesperson said: "Record numbers of women in England are benefiting from specialist perinatal mental health support, with an estimated 51,000 new mums treated over the last year – up nearly 60% compared with two years ago."

The spokesperson added that every local health system now had access to a specialist community perinatal mental health team, and that "we are working with the small number of Trusts that are not fully publishing data on the mental health screening of pregnant women, to ensure that this changes".