Maternal Mental Health Alliance (MMHA) - Written evidence (PSR0037)

1. The Maternal Mental Health Alliance (MMHA) is a coalition of over 90 UK organisations, including professional bodies such as Royal Colleges and organisations that represent, or provide care and support to, parents and families at a local and national level. We work together to ensure that all women get consistent, accessible and quality care and support for their mental health during pregnancy and in the first years after birth.  

2. Many MMHA members are from the voluntary and charitable sector (VCS), including some of the largest mental health charities through to smaller specialised organisations, providing support to new and expectant mums. 

3. We welcome this House of Lords Select Committee on Public Services call for evidence re public services / lessons from coronavirus.  We acknowledge that this Committee is considering public services in the broadest sense, for the purpose of this submission we have focused on the role voluntary and charitable sectors have played in the delivery of perinatal mental health services. Alongside this MMHA submission, we have encouraged our individual member organisations to also contribute to this call for evidence.  

4. Background to perinatal mental health  

More than 1 in 10 women develop a mental health problem during pregnancy and the first year after having a baby.  Currently, not all pregnant women and new mothers can access the perinatal mental health (PMH) care they need. Perinatal mental illnesses can be life threatening and suicide is the leading cause of death over the first year after pregnancy.  

5. As well as the human costs, there are huge economic costs. A report by the London School of Economics and the Centre for Mental Health ‘The Costs of Perinatal Mental Health Problems’ (2014 ) showed that the costs of perinatal mental illness for every annual cohort of births were £8.1bn. 

The role of the voluntary and charitable sector (VCS) in the delivery of perinatal mental health public services 

6. The role of the VCS critically supports the provision of services for pregnant women, new mothers and their families, for example peer support, signposting of local community groups, identifying women from seldom heard groups and supporting them to approach clinical services. 

7. Across all of these VCS members we know COVID-19 has presented huge challenges which they have responded to. For instance:

• Rapidly modifying face to face services to virtual support
• Creatively providing services for women and families without internet access
• A reduction of public fundraising activities has meant a reduction of income
• Many staff having to be furloughed despite the perinatal mental health needs of women.

8. It is testament to these voluntary and charitable organisation how they were able to respond quickly and have modified their services to enable women and families to access support during lockdown, and are actively considering the services required as lockdown is easing.   

9. We have heard anecdotally a number of issues that speak to the three of the four areas the committee is concerned with: the integration of services; inequalities in access and outcome and the relationship between local and national services. 

10.                     Please see below an overview of some observations from the perinatal mental health sector: 

11.                     Integration of services

•       Services may need to consider a ‘blended’ approach in the future of both virtual and face to face provision, this will need funding, operational support  and liaison with the VCS sector to ensure women from seldom heard groups are heard and provided for
•       Service agility (creativity and quickly being able to respond to need) will need to be supported 
•       There are concerns regarding families experiencing both perinatal mental health problems and domestic abuse, services will need to communicate with each to ensure women are being supported 

12.                     Inequalities in access

•       Charities that have delivered virtual support during lockdown, have not been able to reach mums who choose only to be supported face to face. The consequence of this is an increased risk of women becoming more unwell 

•       We know that women/families have equal rights to appropriate timely and safe support, including seldom-heard groups (including those from the BAME and LGBTQ+ communities) however due to health inequalities, we know this is not the reality. Public services must learn from the VCS already supporting these groups in order to help address these inequalities. 

13.                     Relationship between local and national services. 

•       There are concerns that as lockdown eases, services will be overwhelmed with a wave of women due to either an exacerbation of perinatal mental health problems or increased risk of onset due to coronavirus, by working with the VCS more women can be supported.

•       During lockdown (and beforehand) some of our member organisations have been able to work closely with public services to provide for women and families during the perinatal period. 

14.                     Perinatal mental health experts fear an increase of referrals is on the horizon due to the COVID-19 pandemic.  It is important that government acknowledges the impact of the crisis on the already high rates of perinatal mental health need, and the potential long-term consequences. 

15.                     In the uncertain times of Covid-19 three things remain clear regarding the mental health of pregnant women, new mums and their families:

• Even in normal times more than 1 in 10 women will experience a mental health problem during pregnancy or within the first year after having a baby. Their stress and mental health needs are increased from an already high level
• If left untreated, mental illness during pregnancy or in the first year after birth will continue to have a devastating impact during and for a long time after the Covid-19 pandemic
• Perceived and real access to care at every level is reduced; a proactive approach is needed to overcome these barriers.

16.                     To ensure women and their families receive the care they need during and beyond Covid-19, we urge national and local decision makers to PLAN with the mental as well as physical health needs of women and their families in mind.

17.                      The MMHA would welcome the opportunity to assist collective thinking and action across government if that would be helpful to the Committee.  

18.                     We have committed to gathering and analysing the range of coronavirus research linked to perinatal mental health, to inform our understanding of how front-line services responded to the needs of the communities they serve, the impact on women and families and gathering best practice for services. We would be happy to share and discuss this research with the committee on completion.  

Thank you for the opportunity to submit evidence.