mental health
Bringing-together-Kings-Fund-March-2016_1
Bringing-together-Kings-Fund-March-2016_1
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Bringing together physical and <strong>mental</strong> <strong>health</strong><br />
1 2 3 4<br />
5 6 7<br />
Priority 9: Providing integrated support for perinatal <strong>mental</strong> <strong>health</strong><br />
The problem<br />
Mental <strong>health</strong> problems affect one in five women during the perinatal period (Davies<br />
2015). Problems encountered include depression, anxiety disorders, postpartum<br />
psychosis and post-traumatic stress disorder. Despite the numbers of people<br />
affected, half of all acute trusts in the UK have no perinatal <strong>mental</strong> <strong>health</strong> services,<br />
and three-quarters of maternity services do not have access to a specialist <strong>mental</strong><br />
<strong>health</strong> midwife (Bauer et al 2014; Hogg 2013). Midwives and <strong>health</strong> visitors receive<br />
variable and often limited training in identifying women who have, or are at risk<br />
of developing, perinatal <strong>mental</strong> <strong>health</strong> problems. Where perinatal <strong>mental</strong> <strong>health</strong><br />
services are available, these are usually part of generic adult <strong>mental</strong> <strong>health</strong> services<br />
and are not always fully integrated with other maternity services (NHS Commissioning<br />
Board 2012). Access to services is particularly poor for minority ethnic groups –<br />
black Caribbean women are less likely to receive treatment for perinatal depression<br />
than their white British counterparts (Edge et al 2004).<br />
Impact on people<br />
There is considerable evidence that untreated <strong>mental</strong> <strong>health</strong> problems are associated<br />
with increased risk of obstetric complications and can adversely affect both the<br />
parent–child relationship and the child’s social and emotional development (Stein<br />
et al 2014; Howard et al 2003). There may be lasting effects on maternal self-esteem,<br />
as well as on partner and family relationships (Oates 2015; Meltzer-Brody and Stuebe<br />
2014). Almost a quarter of maternal deaths occurring between six weeks and one<br />
year after pregnancy are due to psychiatric causes (MBRRACE-UK 2015). Women may<br />
delay seeking help due to stigmatisation and fears that their baby might be taken<br />
from them (Dolman et al 2013).<br />
Impact on the <strong>health</strong> system<br />
Perinatal depression, anxiety and psychosis carry a total long-term cost to society<br />
of about £8.1 billion for each one-year cohort of births in the UK, of which<br />
£1.2 billion falls on the NHS and social services (Bauer et al 2014). In comparison,<br />
estimates suggest it would cost around £280 million a year to bring perinatal <strong>mental</strong><br />
<strong>health</strong> care pathways across the UK up to the standards recommended in national<br />
guidance (Bauer et al 2014).<br />
The case for change: 10 areas where integration is needed most 38