Submission from The Royal College of Midwives (SPR0116)

1. The Royal College of Midwives’ response to Health Committee Inquiry into Suicide prevention

2. The Royal College of Midwives (RCM) is the trade union and professional organisation that represents the vast majority of practising midwives in the UK. It is the only such organisation run by midwives for midwives. The RCM is the voice of midwifery, providing excellence in representation, professional leadership, education and influence for and on behalf of midwives. We actively support and campaigns for improvements to maternity services and provide professional leadership for one of the most established clinical disciplines.

3. Summary

4. The RCM believes maternal mental ill-health is a pressing public health issue. Suicide is a leading cause of maternal death. Midwife competencies and guidelines for both community and acute perinatal mental health services are in place. What is required is the resources and political will to make sure every woman is given the highest quality care by specialist teams to save her life.

5. Maternal Suicide – the facts

6. Suicide remains a leading cause of maternal deaths and it is shocking that in the last five years in the UK, 101 women were known to have died as a result of suicide, representing 2.3 deaths per 100,000 maternities in pregnancy and up to one year post birth.  The  MBBRACE UK Report published in 2015 showed that between 2011-13,  1 in 7 maternal deaths were caused by suicide and almost a quarter of women who died between six weeks and a year after the birth of the baby died from mental health related causes.[1]

7. Maternal mental health illness and its consequences cost the UK on average £8.1 billion for each year cohort of births - £10,000 for each birth.[2] Perinatal mental illnesses during pregnancy and post birth are a major public health issue. The period leading up to and a year after the birth of a child is when a woman is at greatest risk of developing mental ill health. Mental illnesses have long-term health and psychological consequences on both mothers and children - severe mental health problems can impair the woman's ability to care for herself and her children, and of course, maternal deaths deprive children of their mothers.

8. Workforce issues

9. In 2014, the Royal College of Midwives (RCM) conducted a survey[3] to determine what support and expertise are available in the maternity services in UK to support and enable midwives to identify women with perinatal health difficulties and support and care for them as appropriate. Almost three quarters of women asked did not seek health care for mental health problems because they felt that midwives were ‘busy’ and they did not want to bother them. The midwives in that survey said that time pressures, lack of knowledge and not knowing where to refer women to for further help prevented them from giving the most appropriate care to women with mental health difficulties. This is why the RCM, NSPCC and the Maternal Mental Health Alliance came together in 2014 to recommend that every maternity provider (for example, NHS trusts or Welsh Health Boards) should have a midwife specialist in maternal mental health at a senior level. We believe this recommendation must be viewed as a suicide and seriously mental illness prevention tool.

10. The RCM has created Standards and Competency Framework for Specialist Maternal Mental Health Midwives, which describes the competencies expected of all post-registration midwives in relation to maternal mental health. It also sets out the standards and competencies expected of midwives specialising in maternal mental health within a locality (Trust/Health Board).

11. These specialist midwives have deep knowledge and understanding of mental ill health and are crucial in identifying women early to prevent their condition deteriorating. These midwives coordinate the care of women affected by perinatal mental health in partnership with primary care, mental health services and social care up to a year following childbirth. This also includes coordinating the training of other staff, develop, monitor and implement care pathways and liaising with other health professionals involved in the women’s care. The RCM believes that there should be an appropriate number of midwives to support all women needing help and that all health professionals working with women in the perinatal period should have knowledge and understanding of perinatal mental health problems, and take the adage No Health Without Mental Health to heart.[4]

12. In a forthcoming intercollegiate statement (to be published) we will be highlighting why UK public health strategy should recognise perinatal mental health as a risk factor for the health and well-being of women and their children. We would be happy to send this Committee a copy of this statement when it is published in due course.

13. Specialist perinatal mental health services

14. Currently, there is clinical guidance, from the National Institute for Health and Clinical Excellence (NICE) and the royal College of Psychiatrists,[5] that could prevent maternal suicide. The guidance includes recommendations to make sure women have access to specialist multidisciplinary perinatal community services, so that they receive specialist perinatal mental health care and treatment and their condition is monitored to avoid deterioration, so further intensive treatment in the acute sector is not needed, and a woman’s suffering is ended as soon as possible.

15. There are also recommendations in the guidance for inpatient psychiatric mother and baby units for women with severe mental health problems. Yet, specialist service provision for women with perinatal mental illness is patchy at best and non existent at worse. This type of postcode lottery means that for example, 40% of the women who died from suicide between 2011-13 would be unable to access specialist perinatal mental health care if they became ill now, with only 25% getting a high standard of care.

16. We have been delighted with the Secretary of State’s commitment to halving the rate of stillbirth – we believe a similar goal to reduce maternal suicide would be beneficial for focussing minds and driving a  ‘whole system approach’ to providing  perinatal mental health care within each Trust/area, crossing professional and organisational boundaries.

September 2016