An Independent Social Affairs Magazine
Issue 47, 2018
We need to talk about maternal mental health
We need to talk about maternal mental health
VIEW, Issue 47, 2018
or the last several weeks I've been working on a maternal mental health issue of VIEW. It has been challenging and stimulating in equal measure. A couple of years ago I met maternal mental health campaigner Lindsay Robinson in her home in Belfast. She had contacted me about doing an interview with her about her own battle with postnatal depression. I was immensely impressed with her resolve and determination and her willingness to become an advocate for better support for mother and infants. After that initial meeting, I met Lindsay several times at events she had helped organise. From those meetings the idea of a themed edition of VIEW, which would look at maternal mental health, was born. The Maternal Mental Health Alliance – an umbrella body in the UK – leant its invaluable support to the concept. I am delighted that so many women shared their stories with VIEW. I am shocked by the fact that there is no mother and baby unit on the whole island of Ireland and specialist services are really poor in Northern Ireland compared to the rest of the UK. Why is it that women who play a key role in shaping future generations have
the implementation of better support services. VIEW backs their demand.
By Brian Pelan VIEW editor Email: firstname.lastname@example.org
been so poorly served by successive governments? It’s time for mental well-being to stop being treated as the Cinderella of the health service. Too many women have been allowed to suffer inadequate treatment. We also owe the creation of a better maternal mental service to those mothers who have taken their own lives because of postnatal depression and their desperate battle to seek help. The tide may be turning though. I recently attended the first Maternal Mental Health conference held in Northern Ireland. Hundreds of women and a handful of men met at Riddel Hall, Belfast, to urge
• The articles in this issue which mention the impact on children is not intended to make mums who may already not be feeling well, feel any worse. These are increased risk factors aimed at policy makers who must take these into account and be held accountable for any gaps in service provision. Mums do the best they can with or without mental health conditions, even in the most challenging circumstances
• If you are a mum who is currently experiencing any form of mental health distress either during pregnancy or the first year after childbirth, it is important also not to despair at the current shortfall of specialist perinatal mental health services. It is important to speak to your GP or other health professional and you can find the links to support organisations here: https://maternalmentalhealthalliance.org/re sources/mums-and-families/
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Contact VIEW editor Brian Pelan at firstname.lastname@example.org Contact VIEW deputy editor Kathryn Johnson at email@example.com Contact VIEW publisher Una Murphy at firstname.lastname@example.org
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Editorial VIEW, Issue 47, 2018
hree years ago, if someone had told me that I’d be the guest editor for an issue of VIEW on Maternal Mental Health, I could not and would not have believed them. That’s because three years ago I was in the midst of my own, personal battle with maternal mental illness. Before becoming pregnant and giving birth in 2013, I was completely unaware of maternal mental health and the importance of it. I didn’t have any idea of the signs and symptoms when someone is struggling, or what support is or should be available. Due to this, I also didn’t realise that my mental health started to deteriorate during pregnancy and I was showing clear signs of antenatal depression and anxiety. Unfortunately that went undiagnosed and remained untreated until two years after giving birth. So the first two years of my little boy’s life were all about daily survival. I simply willed myself, each morning, to make it to the end of day, just once more. Each day I awoke to face the same battle as before. That made me very ill – mentally, emotionally and physically. As time went on, I couldn’t sleep, eat, leave the house or even be on my own for long periods of time. I was a shell of a person, feeling hopeless, useless, unable to cope, frightened, isolated, lonely, walking a tightrope, battling a darkness and despair unlike anything I had ever known before. I now know that suicide is a leading cause of death for women during pregnancy. One year after giving birth I personally got to the point where I wanted to give up on life altogether, as I was so devastated by what I was experiencing. Thankfully, when I was finally diagnosed, I began a journey of recovery. Part of my recovery included writing and sharing my story. From that, I was inundated with mums and families sharing their personal experiences and the impact of maternal mental ill-health on their lives. As I recovered and regained my voice, I knew I had to do something with all I was hearing and learning. All of that led me to start Have You Seen that Girl? which is a website, blog and
VIEW, an independent social affairs magazine in Northern Ireland
By guest editor Lindsay Robinson Founder of Have You Seen That Girl? and maternal mental health campaigner
The first two years of my little boy’s life were all about daily survival. I simply willed myself, each morning, to make it to the end of day
movement dedicated to raising awareness of maternal mental health; reaching out to other parents with a message of hope, community and support; and campaigning for better services and support. Have You Seen That Girl is also a member of the Maternal Mental Health Alliance (MMHA) and a supporter of their Everyone’s Business campaign. From MMHA, I learned that 80 percent of Northern Ireland does not have access to specialist perinatal mental health services and there is no Mother and Baby Unit. I was shocked and angry, so I joined the MMHA to get involved in campaigning for change in Northern Ireland and across the UK. Specialist community perinatal mental health services are vital for the health of our mums and families in Northern Ireland as timely access to services can make all the difference. Despite many people here campaigning (for years) and actively working to improve services, the investment needed to see this happen has not been released. This is in stark contrast to other areas of the UK where significant improvement and targeted investment for specialist services has occurred and is now making a huge difference to lives and communities. And so together, many of us continue to call for the necessary funds to be released in Northern Ireland, ensuring women, infants, families and communities get the support they need and deserve. I’m delighted the team at VIEW have created this issue and that so many different aspects of maternal mental health and a variety of voices are included – that has been very important to me, as the guest editor. It’s great to be able to celebrate where fantastic support and programmes are available and how people are making a significant difference. It’s also vital we highlight the urgent need for specialist services across Northern Ireland – lives depend on them. That’s what this issue is all about. • Read Lindsay’s blog at www.haveyouseenthatgirl.com
the big interview
VIEW, Issue 47, 2018
Dr Alain Gregoire, chair of the Maternal Mental Health Alliance in the United Kingdom, tells VIEW editor Brian Pelan why the organisation is committed to campaigning for better perinatal mental health services for mothers and infants Question: Why did you help create the Maternal Mental Health Alliance? (MMHA)?
Answer: It started with just a few corridor conversations with friends and colleagues who were also involved in the field and seemed to me, after 25 to 30 years of working in the field, and in my own little way of trying to get services to develop across the United Kingdom. It occurred to me that the only way we were going to make the rapid progress that women and families needed was to bring together all the organisations involved and speak with one voice and bang the table together so to speak.
Q: What were the biggest challenges you faced?
A: The biggest challenges when we started was that nobody took perinatal mental health seriously apart from people who were already working in perinatal mental health and sufferers. Our colleagues in mental health services, both adult and child thought this was a trivial marginal issue. Politicians had no interest whatsoever and were not prepared to make any sort of investment. I think we’ve come a long way in achieving things but there’s a lot further to go.
Q: What are the links between mums who are depressed during pregnancy and the future development of their children?
A: This is obviously a really sensitive issue because an inevitable aspect of parenting is that one is desperate to do the best possible job for one’s children and one inevitably feels guilty about the slightest thing that we get wrong. It’s an inevitability that during the most difficult job we ever do, we do get things wrong and there is a pervasive stigmatised attitude towards mental health that it’s somehow our fault if we have a mental health problem.
The biggest challenges when we started was that nobody took perinatal mental health seriously apart from people who were already working in perinatal mental health and sufferers Statistically speaking there’s no doubt there’s an impact. Individually there are so many other factors that come into play… it’s by no means inevitable, but the risk is increased of children having emotional behavioural, intellectual, learning challenges as they grow up, and it’s certain that parental mental health problems are associated with a higher risk of mental health problems in older children.
Q: What are the economic costs of perinatal mental illness?
A: The London School of Economics conducted a study in 2014 which we commissioned from them using money from Comic Relief. What they found was the cost to the public purse was about £8.1 billion for each one-year cohort of births in the UK.
Q: Is the work of the MMHA aimed at improving mental wellbeing for future generations?
A: Absolutely. Perinatal mental health is about the health and wellbeing of mother but also the rest of the family and in particular, the relationship between the mother and the baby. The infant is at that very young age where they are completely dependent on their wellbeing and their development, both mentally and physically, on their primary care giver, which usually in our society is mum, jointly sometimes with other parties, and obviously dads are important to this. Research is telling us, study after study, that this intergenerational effect of mental health in parents is one that passes not just across one generation but across several generations because of course their child may become a parent and their child is likely to be at somewhat greater risk of mental health problems, and that will impact on their children. So we have an opportunity here to break a cycle that has existed as far back as humans have existed. For the first time we have this unbelievably important knowledge, and we have the responsibility for future generations to act on it, and act on it now. Q: Are Scandinavian countries much better at funding and supporting perinatal mental health services?
A: It’s not quite fair to say that Scandinavian countries have a better approach to perinatal mental health care. What they undoubtedly invest in generally is support for parents. That’s slightly different. Their support to parents is undoubtedly a greater investment than we make in this country and of course that overlaps with mental health care around this very critical time at the very beginning of parenthood and motherhood. Investing in supporting parents will have an impact on mental health. What we’re calling for specifically is improvements in the mental health care that women get from health services. Of course we also want to see better support for parents because
VIEW, Issue 47, 2018
Dr Alain Gregoire: “The biggest challenges when we started was that nobody took perinatal mental health seriously apart from people who were already working in perinatal mental health and sufferers” that will have an impact, but that is a wider social issue than just healthcare that reaches into areas of government policy which include benefits, child support, housing, local authority responsibilities, and the protection of children. We do very badly compared to Scandinavian countries across those areas of social policy. Q: What effects has the policy of austerity had on maternal mental health provision?
A:Undoubtedly austerity has had an impact on the NHS, particularly on expenditure in public health services and family health services. I’ve seen the figures for dramatic closure in children’s health centres and in health centre numbers. The impact of austerity has also affected the health service, even though the NHS is supposedly protected in real terms. Of course, the funding is static or decreasing when you take into account health inflation. When it comes to perinatal mental health services in England there’s actually been an increase in funding, partly as a result of our campaigning and the increase in awareness by politicians of the importance of this field. But in other areas of care which aren’t specialised perinatal services, professionals in services are really struggling to give the support to women that they need, and it’s very clear that women aren’t getting the care in most parts of the country that is defined as standard quality care by bodies such as the National Institute for Health and Care Excellence.
Q: Are women frightened to report mental health issues?
A:Yes. Right across the board, women are
I think the women of Northern Ireland are a formidable force, and if they decide that they want to ensure there is better mental health care at the most important time in their lives, they will get it reluctant to talk about mental health problems, partly to do with the negative attitude towards mental health problems. It’s still commonplace in our society for people to perceive those with mental health problems as being somehow weak. We have these myths around mental health which makes it difficult for people to put their hand up and say ‘I’ve got a mental health problem’, but that is happening increasingly and slowly chipping way at those frankly damaging and harmful perceptions and views. And particularly in the perinatal period when there’s a young baby around, it’s very common for women
with mental health problems to have fears about how they’re functioning as a parent, and how good a mum they are. They’re overly critical and they believe very commonly that other people will be critical of their parenting and will believe that they’re a bad mother, just as they often do, and in extreme cases that someone will come and take their baby away. The result of this is that the majority of women – seven out of 10 who are depressed – are reluctant to come forward, so that has got to change.
Q: What do you think of the situation in Northern Ireland, that apart from the Belfast Trust, that there are no Specialist Community Perinatal Mental Health Teams or that there is no mother and baby unit on the whole island of Ireland?
A: It’s utterly scandalous. In Northern Ireland, it can’t get worse. It can only get better, so how can you be anything but optimistic. And frankly it was the action of women that transformed living in Northern Ireland not that many years ago, and I think the women of Northern Ireland are a formidable force, and if they decide that they want to ensure there is better mental health care at the most important time in their lives, they will get it. Q: Finally, are you optimistic or pessimistic about the MMHA campaign to improve maternal mental health services for mothers and infants?
A: I am completely optimistic. I’m a patient man, I can hang on, even though I think it should happen now.
VIEW, Issue 47, 2018
Nuala Murphy, Moment Health, left, with Lindsay Robinson, Seana Talbot, manager, Sure Start, Catherine McCusker, volunteer, National Childbirth Trust and Michele Bradley, Pangs NI Image: Brian Pelan
Journalist Jane Hardy reports on the NI Maternal Mental Health Conference which was held recently at Riddel Hall in Belfast
ain could not dampen the sense of purpose among the 270 delegates attending the first ever NI Maternal Mental Health conference held at Riddel Hall, Belfast, earlier this month. Professor Siobhan O'Neill's keynote address referred to the celebration of motherhood in non-Western cultures. In one Ugandan tribe, the new mother is ushered back into society, after some weeks with her baby, carrying a warrior's spear. To borrow Professor O'Neill's neat term, the warrior-women present wanted their voices to be heard. Raising awareness of maternal mental health was a top priority. As chair Nuala Murphy, who has made this health issue her business via her company Moment Health, said: “Three hundred thousand women suffer from perinatal depression in the UK and Ireland and 70 percent didn't recognize their symptoms. We want to make it mainstream.”
Seana Talbot, UK President of the National Childbirth Trust, who was also representing Sure Start, ran through some further shocking statistics. “One in seven perinatal deaths of mothers is a result of suicide,” she said, adding: “And that figure isn't coming down. These women are dying 50 to 60 years before their time." On top of this, there is potential damage to the family. An unintentional legacy of illness and under-achievement may be handed on by maternal, and sometimes paternal, mental illness. Ms Talbot revealed that children of women with poor maternal mental health are twice as likely to suffer mental illness themselves. Ms Talbot said: “To help families, it is vital to intervene early.” She called for universal, targeted and specialist services including separate appointments for mothers and babies at check-ups. When organiser and mental health campaigner Lindsay Robinson shared her story in the afternoon, it illustrated the
sheer courage of women coping with postnatal depression. She admitted her severe anxiety had made it difficult to even ask for help: “The worst kind of fear keeps you silent. For two years I didn’t say words like ‘I need help.’ or ‘I can’t go on like this’.” Having experienced the joy of becoming pregnant, Lindsay Robinson didn't develop the usual pregnancy bump. This led to the need for weekly checks on foetal growth, gossipy comments, and self-doubt. After son Reuben was born, Lindsay’s anticipated relief and joy didn’t materialise. Nor did she get the support she needed. “I felt I couldn’t tell anyone or they’d disown me.” It was only when she consulted a third doctor that she gained a diagnosis, treatment and hope. On top of the effect on individual woman, maternal mental illness has a social cost. In her talk on Transgenerational Trauma and Maternal Mental Health, Professor O'Neill examined the pressure that may be attached to motherhood in
VIEW, Issue 47, 2018
The good work being done in the field of maternal mental health was recognized by the NI Maternal Mental Health Conference awards. The winners were: • Outstanding Professional – winner Geraldine Scott Hayes, highly commended Dr Janine Lynch (Sponsor: Moment Health) • Champion for Change – winner Rosemary Deans, highly commended Una Leonard (Sponsor: Have You Seen That Girl?) • Peer Support (Group) – winner Support2gether, highly commended the Mum Chorus (Sponsor: PANGS NI) • Special Recognition – winner Shona Hamilton, highly commended Anne Marie McKinley (Sponsor: Public Health Agency) • Peer Support – Individual – winner Naomi Palmer, highly commended Anne Glover (Sponsor: Belfast Telegraph) • Stand-out Nominee – winner Helen Donaghy (Sponsor: NCT) • Future Star – Student – winner Deirbhile Murphy (Sponsor: Relax Kids Belfast & Warren York Hypnotherapy) • Future Star – Volunteer/Professional – winner Dee McConnellogue, highly commended Suzanne Brown (Sponsor: Relax Kids Belfast & Warren York Hypnotherapy) Keynote speaker: Professor Siobhan O’Neill from Ulster University
our culture. “In America, women are back at work after six weeks. We need to protect the mother.” She added that untreated perinatal mental illness leads to problems such as low birth weight plus “if the mother is anxious, that can lead to lower IQs at 11 and 16 to 20 points lower for boys.” The importance of the professionals’ approach to mothers experiencing mental illness was underlined by NSPCC Senior Policy Researcher Susan Galloway’s presentation on new research into the experience of regional health visitors and midwives. It showed the main barriers to women disclosing their problems is fear. She said: “Fear of the baby being removed, fear of stigma but also worries about the lack of continuity of care.”
Images: Catherine McCusker Michelle Bradley, founder of the online support group PANGS NI, said being a wife and mother was the only career she ever wanted. After having her first child, though, she plummeted into a destructive postnatal depression. Her account of alienation and the moment she contemplated self-harm when cutting bread silenced the room. The conference featured music during the lunch break when the Mums Chorus from Banbridge entertained delegates with a beautiful mini-concert. An impromptu creche, which formed to one side, reminded those present of the potential joys of parenthood. Improving perinatal mental health provision for women across Northern Ireland, not just in Belfast, is a big task. The Belfast Health and Social Care Trust has
made an important new appointment. The new Midwifery Co-ordinator for Perinatal Mental Health and Social Complexity in Pregnancy Lisa Darrah is linking up with various bodies, some charitable, some not. Funding is key, as some of the speakers indicated at the conference, but as they pointed out the State has an obligation to ensure women’s maternal mental health needs are being met. Summing up, Lindsay Robinson displayed a map of Northern Ireland on a screen, much of which was coloured red, which represents poor maternal mental health provision. However, there was a sense as the conference ended that the battle may just have begun for the much-needed creation of vital specialist services for mothers and infants.
Why the MMHA Everyone’s Business campaign has sponsored this edition of VIEW magazine VIEW, Issue 47, 2018
More than one in 10 women
he Maternal Mental Health Alliance (MMHA) Everyone’s Business campaign is deeply concerned about maternal mental health provision for women and families living in Northern Ireland. Through sponsoring this edition of VIEW, it wishes to raise the alarm about the current unacceptable gaps, especially in specialist community perinatal mental health provision in Northern Ireland, and it would like to thank VIEW for this opportunity. The situation in Northern Ireland
The good news is that Northern Ireland has committed to implement the NICE Guidelines on Antenatal and Postnatal Mental Health and produced the Integrated Perinatal Mental Health Care Pathway (Public Health Agency 2012). The shocking news is that due to inadequate investment, women and their families face the stark and unacceptable situation of a postcode lottery in provision. There is no specialist inpatient mother and baby unit in Northern Ireland, and indeed none on the island of Ireland, and only one specialist perinatal mental health service in the Belfast Health and Social Care Trust; education and support programmes by voluntary and community organisations are limited; and there is an inconsistent approach within professional training. Northern Ireland is being left behind. While England, Scotland and Wales have all faced similar challenges with gaps in their perinatal mental health services, each have experienced significant improvements due to specific and targeted investment, which mean that lives are being changed and saved. This is not the case in Northern Ireland. While all stakeholders are supportive in principle of making change,
Develop a mental illness during pregnancy or in the first year after having a baby
• More than one in 10 women develop a mental illness during pregnancy or in the first year after having a baby • Seven in 10 women hide or underplay the severity of their illness
• Suicide is a leading cause of death for women during pregnancy and one year after giving birth the investment has not yet been made available.
Maternal Mental Health Alliance and the Everyone’s Business campaign
The Maternal Mental Health Alliance (MMHA) is a coalition of UK organisations committed to improving the mental health and wellbeing of women and their children in pregnancy and the first postnatal year. This acknowledges the extensive evidence that investing in mental health at this early stage can have a dramatic impact on long-term outcomes for mothers,
fathers, children, families and society. The MMHA currently comprises more than 80 organisations, including professional bodies such as Royal Colleges and organisations that represent, or provide care and support to, parents and families. The MMHA’s Everyone’s Business campaign is a UK wide campaign (funded by Comic Relief) which calls for all women throughout the UK who experience perinatal mental health problems to receive the care they and their families need, wherever and whenever they need it. In Northern Ireland the campaign, in line with the recent RQIA report, is specifically calling for: • Single specialist Mother and Baby Unit • Specialist perinatal mental health community services in every Health Trust • National training strategy to ensure delivery of dedicated high-quality training in perinatal mental health care for all health and social care professionals involved in the care of women during pregnancy and post pregnancy up to the first year after birth. Join us
• Are you a national not-for profit organisation based in Northern Ireland with an interest in maternal mental health? Could you help change the perinatal mental health situation for women and families in Northern Ireland? Please consider joining the Maternal Mental Health Alliance. • Are you an individual with an interest in this area? Please consider signing up to our quarterly campaign eBulletin on the MMHA website: www.maternalmentalhealthalliance.org
VIEW, Issue 47, 2018
Sponsored by MMHA Everyone’s Business campaign
There is no specialist inpatient mother and baby unit in Northern Ireland, and indeed none on the island of Ireland, and only one specialist perinatal mental health service in the Belfast Health and Social Care Trust. The end result is that Northern Ireland is being left behind the rest of the UK
Sponsored by MMHA Everyoneâ€™s Business campaign
From the report: The costs of perinatal mental health problems, by Bauer et al., Centre for Mental Health and LSE, 2014
Sponsored by MMHA Everyoneâ€™s Business campaign
The Maternal Mental Health Alliance Our vision
The Maternal Mental Health Alliance (MMHA) is a coalition of UK organisations with a vision to see all women across the UK get consistent, accessible and quality care and support for their mental health during pregnancy and in the year after giving birth.
What we do
We achieve change by bringing the sector together to speak with one voice, campaigning for change and supporting local systems to improve perinatal mental health care.
Who we are
The MMHA has over eighty five national membership organisations. This includes professional bodies such as Royal Colleges and organisations that represent, or provide care and support to, parents and families. We work across England, Scotland, Wales and Northern Ireland.
The MMHA was founded in 2011 by organisations set up by people with lived experience, clinicians, academics and voluntary and community sector organisations coming together with a shared determination to improve care and support for women in the perinatal period. Follow us on Twitter: @MMHAlliance #everyonesbusiness
Email us: email@example.com
Men need to talk about mental health says dad who suffered his own harrowing experiences VIEW, Issue 47, 2018
Journalist Jonny McCambridge, who is fully behind the campaign for specialist maternal health services, writes openly about his own struggles and the incredible joy of becoming a dad
ess than four months after my only son was born in 2013 I was committed as a patient into a psychiatric ward at Lagan Valley Hospital, deemed by doctors to be an immediate suicide risk. It was the most harrowing experience of my life. At the time I held a senior position in a daily newspaper in Belfast and was certainly mindful of my professional reputation and the stigma of it being known publicly that I suffered from mental health difficulties. Through my job I had occasionally encountered stories of maternal postnatal depression, but I had never heard of a paternal case. Was it even a thing? If it was, it certainly wasn’t one that was spoken about. And so I didn’t speak about it, not to anyone, until it was almost too late. To be clear, my own battles with mental health problems went back many years before I was a parent, that was a seed which had been planted long ago. But it was the birth of my son James, added to already formidable work pressures that contributed to a set of forces which brought me to my lowest point. A routine that I had established over years, and which probably protected me, was thrown into chaos when I became a father. Already operating near the edge of my limits with interminable hours in the office and the relentless oppression of working in the
Jonny McCambridge with his son James news media, the added responsibility of parenting pushed me past it. Being a father was just one more thing to worry about. It almost became one thing too many. What makes my story even more infuriating is that I watched my wife deal wonderfully with post natal depression. She talked about it, sought treatment and emerged from the experience stronger and happier. But yet I could not bring myself to say a word, instead allowing myself to sink deeper and deeper into a place of misery and desolation until I could no longer see a way out. When the light at the end of the tunnel goes out then you can no longer see a happy ending for the journey. But things are different now. After a short hospital stay I was released back to the care of my family and I continued to receive medical treatment for several years. The help is there, you just have to ask for it. I’ve made changes to my life, I no longer work in such a high-pressure job and I’ve embraced the role of being a father. From a rocky beginning it is now undoubtedly the greatest privilege and responsibility of my life. There are still tough days but I know how to get through them. I’m lucky to have a family who understand and help me and I’ve learned how to ask for help when I need it. When I was first asked to write this
piece I was reluctant. I knew the focus of this edition was on maternal mental health and I didn’t want to do anything which removed the spotlight from that. It’s a huge issue and I’ve been lucky enough to meet some of the mothers who are leading the campaign for better services here in Northern Ireland. They deserve their place. In the end I was persuaded to write this to help ensure that there are no limits to this conversation and to remind people that there is no section of society which is not affected. Fathers, and men in general, are stubborn and often restrained by the macho culture we have built around ourselves. It’s hard to admit you have a problem, that you are desperate. It was the hardest thing I ever did. But since I’ve spoken publicly about mental health I’ve been overwhelmed by how many other men have contacted me to say they have suffered too. Men who sometimes dare not tell their own families what they are going through because they think they will be considered weak, not strong enough. It is not so. The true strength is in talking about it. • Read Jonny McCambridge’s blog, What’s a daddy for? – https://whatsadaddyfor.blog
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‘Women fear losing their babies if they talk about their mental health’
Susan Galloway: The lack of maternal mental health specialist services in Northern Ireland is unacceptable
VIEW editor Brian Pelan talks to NSPCC Senior Policy Researcher Susan Galloway ahead of new research on perinatal mental illness from NSPCC Northern Ireland, in partnership with the Community Practitioners and Health Visitors Association and the Royal College of Midwives
orthern Ireland is lagging behind the rest of the United Kingdom when it comes to the provision of specialist maternal mental health services, according to a senior policy researcher at the National Society for the Prevention of Cruelty to Children (NSPCC). Susan Galloway, who is based in Scotland, said: “There’s a lot of emphasis on the lack of specialist services, not just in Northern Ireland but in the rest of the UK. We know how prevalent mental health difficulties are for women during pregnancy and in the first years after child birth, but we haven’t developed the services within the NHS and the voluntary sector to match that, and Northern Ireland is actually very much lagging behind the rest of the UK. “It’s really significant, the gap between Northern Ireland and elsewhere. A map that’s just been published by the Maternal Mental Health Alliance highlighted very starkly the lack of provision in Northern Ireland, compared particularly to England and Wales. “Part of the problem is that maternity services from when they were
first established in the NHS have been about the physical health of mothers and babies, and mental health has just not even been part of the equation. So in a sense what we’re doing at the moment is catching up on the evidence base. We now know how important this is. Women’s mental health is linked to a whole load of mental illnesses and disorders, particularly during pregnancy. “In the year after birth, women are very susceptible to difficulties. Our health service hasn’t traditionally provided for mental health needs at this times So we’re having to play catch-up, kind of like developing our maternity services to match the knowledge we have. I asked Ms Galloway what effects has austerity had on the provision of specialist services. “Our research has shown that midwives and health visitors have said that their efforts to protect women have been over-burdened with work and a shortage of staff,” she replied. “The research also shows that professionals are saying that they don’t have the resources to fully support
mothers and infants. And when they refer people they also know that they going to go on a huge waiting list. “Midwives and health visitors are saying that the biggest barrier is the lack of time that they have with women because their services are under such pressure. They’re just trying to get to appointment after appointment and are not able to build a relationship. If you don’t have a relationship many women are not going to be able to open up about their mental health. “Women also have a major fear that if they talk about their mental health that their baby is going to be taken off them. “This is shocking and unacceptable. In Northern Ireland we're talking about one fifth of pregnant women who have got a mental disorder. Depression and anxiety are very prevalent. One of the reasons is some of the underlying causes of depression and anxiety are to do with social circumstances and economic circumstances. “We need to support women so that they and their babies receives the best possible care.”
VIEW, Issue 47, 2018
Helping mums who say ‘I can’t cope’ Marina McCully, a Training and Education Officer in the charity AWARE NI
AWARE NI’s Marina McCully tells journalist Jane Hardy how her organisation supports women who are suffering from postnatal depression
eople might think postnatal depression is easy to define, but according to Marina McCully of AWARE NI, that isn’t the case. "Postnatal depression may be hard to diagnose, partly because the new mother might think 'Is it a low mood, is it just me or am I a bad mother? And it's not talked about." The charity – founded in 1996 to tackle the depressive spectrum – now finds over a quarter of its workshop clients have postnatal depression. Their programme Mood Matters is designed for expectant and new parents and over the past two years, has reached nearly 1,000 women. Marina McCully (45), the Training and Education Officer, said: “Stigma can be a problem. A new mum may not want to admit to her family and friends that she isn’t coping very well, yet in the group she can.” The charity's evidence-based programme works by introducing participants to CBT (cognitive behavioural therapy) and self-help strategies. Marina McCully said: “Our programme is for everyone but 28 percent of the women attending have been
diagnosed with postnatal depression. Half of the women report some anxiety and depression but are undiagnosed.” Ms McCully thinks cases of postnatal depression may not be being picked up by the health services as mothers are embarrassed to come forward. Ms McCully is one of the leaders of the Mood Matters programme, funded by the Public Health Authority. Some clients' stories remain with you, she revealed: “One girl I recall in her late 20s had no family support at all, having moved here from the north. Her first baby had been born with Down's syndrome and other medical complications, and she was crying a lot. She said she felt very alone and hadn't talked about the situation before. The big words that emerge and reveal a problem are 'I can't cope.'." The woman had received no diagnosis and was advised to consult her GP, which she did. There is no easy way of measuring the severity of maternal mental illness, Marina said: “We deal with mild to moderate cases which can be still be debilitating without support.” Yet the condition can be life-threatening. Figures revealed recently
by the Northern Ireland Maternity System study, carried out at Queen’s University, showed 101 deaths of new mothers by suicide between 2009 and 2013. Also, the research suggested a higher rate of maternal mental health than was previously thought. AWARE NI teams have also discovered that pregnant women who are finding it hard to quit smoking may already be under increased pressure. It's a question of stress. Workshops help women to tackle that, to be in the moment, one area where children are excellent guides. Marina McCully said: “With a baby, you have no choice, they locate you in the moment.” When Marina McCully’s mother experienced depression before she was born in the 1970s, there was little understanding or help available. “She already had three children under four, went to her doctor but couldn’t be prescribed medication as she was pregnant and there were no other services available. My grandmother visited every day and one day the ‘black cloud’ just lifted.”
VIEW, Issue 47, 2018
Breaking the cycle of ignorance
Support 2gether co-founder Una Leonard, left, with illustrator Barry McGowan, postnatal specialist counsellor Liz Wise and Brenda McCaskie
By Jane Hardy
virtual conspiracy of silence about ante and postnatal depression has prevented many women getting the treatment they deserve, according to Support 2gether co-founder Una Leonard. “It was not mentioned over 12 years ago when I had my daughter. We talked about the children's emotional well-being, never the mother’s and father’s." So although Una Leonard had a wealth of experience as a nursery nurse, when postnatal depression descended, she was not prepared. “If I'd been more self-aware, it would have helped. The risk factors were there. I'm a caring person and can still see myself downstairs with Caitlin at four in the morning, thinking I must be there when she wakes up. It was all about my daughter.” When the health visitor arrived, Una fobbed her off. “She used the Edinburgh Scale questionnaire to assess my mental health and I lied to her and to myself. When she left, I knew I'd done the wrong thing.” The sense of her despair did not go away. Una said. “I postponed thinking about the christening party. The illness isolated me and I didn’t want to wake up in the morning.”
After visiting her doctor and giving honest answers to the test, she was discovered to have extreme postnatal depression. The solution was medical, a course of anti-depressants, plus emotional support from family and friends. Out of this experience, Una Leonard and her sister Brenda McCaskie came up with the idea for Support 2gether which began eight years ago. They wanted to break the cycle of ignorance and embarrassment. Una said: “You get silence. My husband didn't know what to say to me, nobody had the words. People remarked ‘How could you be depressed? You're always so jolly.’ “But when you’re in the darkness, you can stay in that stigma.” Apparently some women park at a distance from the charity’s offices to try and conceal where they are going. Support 2gether helps women cope with maternal mental ill health through different initiatives and since August 2017 has supported 175 families, and more online. Una, who now also has a son Padraig (10), said: “There’s the monthly gathering where up to 20 mums enjoy laughter and shared experience, groups like Bumps Together for pregnant women. We offer
counselling, which has been very successful, reflexology, roadshows to help women back. This illness robs you of yourself and you find a different version.” Donna (38), who was helped by the charity after a breakdown following her baby daughter’s serious illness, said “I’ve found me again.” At one fundraiser, Una Leonard found a poem, Hug Me, which described a mother’s experience and needs and she posted it in the men’s toilets. “It showed that women want affection. We had men thanking us, saying they just hadn’t understood.” Grants from banks HSBC and Santander have also helped to support the charity. Una said: “We tell the women to leave the word ‘perfect’ at the door.You can see the Duchess of Cambridge holding her baby but she has a nanny and support.” She added that she wants real change. “It’s starting to happen with more people approaching us. Knowledge is so important and I support the #Everyone’sBusiness campaign for more provision. “We did a radio programme and a 72-year-old woman rang in to say ‘Finally, I know what was wrong with me'. “I think I will be talking about this for the rest of my life.”
VIEW, Issue 47, 2018
Support: Alison McNulty, right, with a young mother and baby at TinyLife’s offices in Belfast
A lifeline for mums of premature babies
The chief executive of TinyLife tells Jane Hardy why she backs the demand for more specialist maternal mental health services
he chief executive of a charity which supports mothers with premature babies has told how some young women who are suffering from postnatal depression are desperate for help when they come to the organisation. Alison McNulty, who heads up TinyLife in Northern Ireland, recounted how one young mum, who had delivered premature twin boys in 2016, had said at the time: “The babies are not mine. I can’t bond with them. I’m in a bubble and I don’t want to be here.” She belongs to a vulnerable group as mothers who give birth prematurely are 40 per cent more at risk from maternal mental health issues, said Ms McNulty. Research by Smallest Things into 1,624 premature babies born in the UK revealed the greater risk for these mothers of postnatal depression and post-traumatic stress disorder. “There may be other psychological factors as well,” said Alison. “One third talked about feeling isolated, 44 per cent had flashbacks and 61 percent talked about feeling guilty.” “Only 38 percent of them felt confident using a normal parent and toddler group as their babies were tiny, maybe tube-fed, which might cause comments,” said Alison. TinyLife was founded 30 years ago to support families of premature babies and increasingly helps them with psychological issues. They offer a befriending service and can identify perinatal mental health problems early.
There is no designated mother and baby psychological unit in Northern Ireland. It’s a Cinderella service Ms McNulty said: “Our work starts in the neonatal unit alongside the medical staff. We're the listening ear support for any mums or dads that staff think are having a bad day. We spend time with them, provide reassurance. We don’t offer counselling but will advise them to see their health advisor or GP. Alison added: “Mental health services are overwhelmed. We're the stop gap if implemented early enough.” The need for tailored care has resulted in TinyLife's regular parent and baby group sessions. Alison explained the philosophy: “We've worked on a programme with
AWARE NI as their original Mood Matters programme didn't always work well for our parents. “For their clients pressure meant juggling work with childcare and doing the laundry, for ours it meant trying to get to the neonatal unit and ‘has my child survived the night?’” She said a mother had recently attended the TinyLife parents' group in distress. "She has a very young baby, eight weeks out of the neonatal unit and hadn’t slept for a while. Our Family Support Officer took the baby and gave her a cup of tea. The mum, who admitted to feelings of guilt, then broke down and said: ‘Why am I happy to hand my baby over to someone else?’ ” The charity's task is to try and normalise the situation when anxiety like that takes hold. The charity’s nine Family Support Officers and 70 trained volunteers offer home visits if required which helps restore a normal routine. Ms McNulty added: “We totally support the call for improved maternal mental health services. The government only discovered parents in the 1990s. There is no designated mother and baby psychological unit here. It’s a Cinderella service.” • For more details about TinyLife, call 028 9081 5050 or email firstname.lastname@example.org
VIEW, Issue 47, 2018
Helping mums onto road of recovery Supportive: Rachel Cashel and Ursula Meehan
Rachel Cashel tells VIEW about the Mums Wellness Project in County Fermanagh, Northern Ireland, which was set up by the mental health charity MindWise
he Mums Wellness Project delivered by MindWise aims to support the maternal mental health needs of expectant mothers and mums with an infant up to 12 months and their family, in the Co Fermanagh area. MindWise secured funding from Comic Relief last year and have been delivering the Mums Wellness Project for the past year. To date the project has supported 45 mothers and expectant mums. MindWise have also just received additional funding from Lloyds Banking which will be used to employ another member of the Mums Wellness Project staff. Sarah, who was referred to the project by her Health Visitor after experiencing low mood following the birth of her baby, said: “The project definitely helped me through a few dark months and sent me on my journey to recovery.” The services available include a one to one home-based programme, monthly support groups, a weekly drop-in and volunteering opportunities. Health visitor Siobhan from the Western Health and Social Care Trust said: “As a health visitor I now have somewhere to refer mums who need additional support and get their needs met.” A Child and Family Support Worker will meet with a mum or expectant mum on a weekly or fortnightly basis for around 12 sessions. Sessions last an hour and take place in the home or a community venue. The Child and Family Support Worker
‘I feel more confident’ “I was filled with hope, encouragement and a focus me on improving my emotional health.”
“I learnt that it is ok to feel emotionally and mentally unwell sometimes but with the right support you can and will become well again and that’s OK.”
“I now feel more confident and prepared to manage and cope when the new baby arrives, both emotionally and mentally.”
will support the mother to develop a Wellness Recovery Action Plan. Rachel Cashel, Child and Family Services Manager said:, “As mums we can be guilty of meeting everyone else’s needs first and our needs can be bottom of the list but mums’ needs are the most important and sometimes we need help prioritising them. “One mum’s feedback always sticks out in my mind. On week one, she felt the programme was not for her, by week eight she said she didn’t realise how much she needed the programme.” The monthly support groups are based in Lisnaskea and Irvinestown and the weekly drop-in is held in Enniskillen. Child & Family Support Worker Ursula Meehan said: “The support groups
and drop-in are a safe place for mums and expectant mums to come together, offering each other support, friendship and challenges the feeling of isolation which is commonly felt by mums.” Mum Chloe said: “I now feel more confident and prepared to manage and cope when the new baby arrives.” The hope is that mothers will feel empowered to avail of volunteering opportunities within the Mums Wellness Project. One mum, who recently completed the programme and has now registered as a volunteer, said: “The programme has been life changing, “I am in such a strong place now and I want to give back to offer hope to other mother and their families.”
VIEW, Issue 47, 2018
Looking out for mums
Sure Start Health Visitor Karen Cox who started Mums-R-Us
Health Visitor Karen Cox tells VIEW why she loves her job
love my job! What’s not to love about visiting parents when a little bundle of joy enters their lives for the first time and brings such happiness? Thankfully for many families, things are usually fine when I first visit but unfortunately this is not the story for every family. Many parents experience feelings of inadequacy, fear of the unknown, and an overwhelming sense of ‘this is not how we thought it would be’. Both mothers and fathers go through a steep learning curve while simultaneously suffering from sleep deprivation and trying to make rationale decisions. Parents will often tell me that they weren’t prepared for the reality of having a baby, despite attending numerous classes to prepare for their little one’s arrival. Feelings of insecurity and doubt are shared by most parents and usually with reassurance, support and advice, they gain confidence and become the experts in relation to their own baby. As part of my job I offer a variety of baby courses, for example, massage, yoga,
reflexology and baby swim. I have many opportunities to spend time with mums and hear how life has changed since the baby has arrived. As the number of mums sharing their worries and anxieties was increasing, I discussed starting a group for mothers to share their feelings and support one another. We all know the message: it’s good to talk. So Mums-R-Us started out as an opportunity for mums to be listened to and a safe place to be heard. Today, Mums-R-Us is a formal eight-week course that focuses on the mother’s mental health. It supports mums who have been diagnosed with post-natal depression, some with anxiety or panic attacks, and some who are struggling to remember who they were before the baby arrived. Pre and post-evaluations are carried out, with very positive outcomes for the mums. Many referrals come from the generic health visitors and every course is over subscribed. Mums are introduced to “Candy Bear” who is a large cuddly teddy bear they hold when sharing details of
their week. Mums have the right to pass if they do not wish to share. Goals are set weekly by each mum and celebrated when achieved by the group as a whole. There is a topic discussed each week but after week three, the mums choose the topics. Interestingly, over the years the topics that groups choose for themselves haven’t changed that much. Mums write letters to themselves and cards to each other. The support they give and receive is extremely powerful and it both encourages and empowers the mums. One month after the course finishes there is a reunion and sometimes we meet with the mums on an individual basis depending on need and we can also make referrals to GPs, where necessary. At present, the Mums-R-Us course is only available to mums if they live within the Dalriada Rural Sure Start area so if you know of anyone who could benefit from it, please signpost them to us. If you would like to learn more about Mum-R-Us, please get in touch – email@example.com or Tel 02820730444
COMMENT VIEW, Issue 47, 2018
A vital need for a mother and baby unit
Siobhan O’Neill, Professor of Mental Health Services at Ulster University, says we need to give practical and emotional support to new mothers and time to adjust to having a baby
ental health and well being issues in pregnancy and after childbirth are now so common they may be considered normal. A National childbirth Trust (NCT) study found that around half of women suffer from low mood around the time of pregnancy and childbirth. The National Council for the Prevention of Cruelty to Children (NSPCC) Prevention in Mind report tells us that mild-moderate depressive illness or anxiety disorder is a feature of 10 to 15 percent of pregnancies, and in up to a third of pregnancies the woman suffers from adjustment disorder or distress. It is unacceptable to have any group experience this level of suffering, and it is particularly unacceptable when we consider the enormously important job that mothers are doing. The evidence overwhelmingly demonstrates that a mother’s wellbeing in pregnancy and after the birth influences her child’s lifelong developmental, health, and educational outcomes. The recent paper from the Avon longitudinal study shows that maternal depression can last up to 11 years, it doubled the risk of child behaviour disturbance, increased the risk for behavioural problems at three to five years, and was associated with lower mathematics grades at 16 years. Children of depressed mothers have a higher prevalence of depression themselves at 18 years of age, and the cycle often continues so that their children may also be affected. Those of us who have been through it know the other ‘facts’ because we are told them often enough. Women have been having babies since time began, pregnancy is a natural process not an illness, and children and families are apparently valued in our ‘pro-natalist society’. So it should be very, very different. These impacts are so profound and long lasting, because maternal stress influences the child’s stress response, and the child’s stress response in turn influences their social development, how well they do at school, and their own resilience to life’s stressors. The chemicals released through the body’s ‘fight or fight’ response to the brain’s interpretation of stress, shape the child’s response. This has evolved as a way to prepare the child for living in the same
Northern Ireland, perhaps even more so than other places, needs to nurture our mothers, we need to acknowledge their vital role in shaping the brain development of the next generation
stressful environment as their mother, where they will need to fight or run away quickly and frequently. However, the rapid activation of the stress response and problems controlling that response, can create many difficulties and subsequently mental health problems. The risk factors for perinatal mental illness include having a history of mental illness, an unintended pregnancy, being younger and having insufficient support generally, and support from the child’s father.
There are certainly biological changes that may make women more vulnerable at this time, however the majority of these risk factors are social and relate to issues around how the pregnant women feels that she is perceived (whether she has a supportive partner and the social acceptability of the pregnancy) and how much help she has, or is able to afford. The child’s stress response is further shaped and moulded in the first few years of life through interactions with parents and other caregivers. Again, having a happy and content mother or carer is crucial to the child’s development, and any disadvantage conferred by having a mother with a mental illness during pregnancy and after the birth is reversible at this stage of life. The research shows us that the influence of treatments and interventions that provide support to mothers can be transformational and the effects can be tracked biologically. Much of my own research is about the impact of the high levels of trauma and violence that the Northern Ireland population has experienced. The mental health effects do pass from one generation to the next, and mothers play a key role in this. Northern Ireland, perhaps even more so than other places, needs to nurture our mothers, we need to acknowledge their vital role in shaping the brain development of the next generation. The shift in thinking must start at school age, where girls and boys are viewed as potential parents, and taught about child development, mental well being and resilience. We must identify and provide treatments to mothers who develop mental illness, and access to a specialist mother and baby unit is vital. Looking after a young child is demanding, exhausting, and yet so very important. We can learn valuable lessons from other cultures, where the precious work that women do in pregnancy and the post-partum period is revered, and where the emphasis is put on the new mother’s needs. Rather than focusing on whether her body, sleep, and working life, have returned to ‘normal’, we should give her practical and emotional support, compassion, and time to adjust. In other words, we should honour and value the work that these armies of warrior women are doing in recognition of their important role in shaping the future.
VIEW, Issue 47, 2018
Maeve Brisk, far right, conducts the Mum Chorus at the recent NI Maternal Mental Health conference in Riddel Hall, Belfast Image: Catherine McCusker
Mum who thought about taking her own life tells how choir helped to turn her life around
mother who contemplated taking her own life after the birth of her third child because of postnatal depression has told VIEW how starting up a choir has helped to give her a new lease of life. Thirty-two-year old Maeve Brisk said: “I thought about leaving home, about taking my own life because they would better off without me.” The Mum Chorus is a group of 16 women who meet every week in Banbridge to sing and socialise. Children are welcome and at the rehearsal I attended, 14 babies and toddlers played round the performers. On the day I visited the choir sang a number of songs, including I Can See Clearly, Let It Shine and Coldplay's Fix You. Maeve said: “I choose songs with relevant, sometimes poignant, lyrics.” The positive effect on the singers' maternal mental health is backed up by research, said Maeve. “The evidence that music heals is overwhelming, particularly singing in a choir.” She showed me two brain scans on her computer. "You can see the difference, the lit-up areas in the brain of the person making music show that singing boosts the
endorphins or pleasure producing hormones. It’s also something to do with community.” Founding the choir helped Maeve to navigate her experiences of perinatal ill health. She said: “When I set it up 18 months ago, it helped my recovery. “It was good to be back singing, something I'd done when I took my music degree in Cardiff. I was still having counselling though and not totally coping. My relationship with my husband was at risk but my mother-in-law, who's a therapist, stayed for a week and gave me an action plan. I did some CBT (cognitive behavioural therapy) and started to treat my depression as a physical illness." The Mum Chorus has won recognition, performing at the recent Northern Ireland Maternal Mental Health Conference in Belfast. Between 10 to 15 percent of women suffer from postnatal depression and some of the singers have had their own brushes with maternal mental illness. Denise McKeown (38), who was at the choir practice with her two-year-old Ruben and baby daughter Martha, said she had experienced postnatal
depression. “I remember I got the baby blues on day three. I tried to battle through on my own but was very weepy. Breastfeeding was difficult and I was hardly getting any sleep. My GP asked had I bonded with my son but I didn’t understand what he meant. As I wasn’t communicating with him, I started singing each time I changed his nappy.” That was the communication, and when Denise saw the Mum Chorus perform, she said it touched her. She signed up for 10-week course Maeve ran in her area and now travels to Banbridge as a member of the choir. “It helped to lift me out of my slump.” And choir member Lesley Hanna (32) said going to the choir's meetings was a “preventative” measure to protect her mental well-being. Maeve has also set up a social enterprise called Mood Sings which provided a range of community based activities. She also works on an inter-generational choir with members from a school and a care home and has ambitious plans for the future. “I feel this has happened for a reason. With so many cutbacks, I'm keen to promote the arts and music as it makes the most difference to people's lives.”
COMMENT VIEW, Issue 47, 2018
Urgent need for investing in specialist services
Victor Robinson, a lecturer in nursing at Ulster University, argues that better support being made available for pregnant mothers will save lives in the long run and reduce attendant costs
orthern Ireland represents an incredible case study in the evolution of care associated with pregnancy and mental health. Almost one in five pregnant women are reported to have a mental health disorder linked to poor health outcomes for babies. Mothers with a history of mental illness, including depression and anxiety, are more likely to give birth prematurely, deliver underweight babies and more likely to experience pre-eclampsia. APGAR (Appearance, Pulse, Grimace, Activity & Respiration) scores, a test which midwives use to measure the general health and wellbeing of a baby, are considerably lower if the mother has had a history of mental health problems. Premature birth and low birth weight are aso two key factors adversely affected in women with mental health problems. These two factors are often used to measure how a baby will develop in the future, and the potential detrimental impact these factors may have on their future lives. Perinatal Mental Health (PMH) problems are those which complicate pregnancy and the postpartum year. They very often present as a constellation of disorders and severities in a variety of health and social care settings. They are currently managed by many different services, wherein ‘management’ is used to encompass medical, psychological and social interventions and care. These conditions can develop suddenly and range from mild and moderate to extremely severe, with suicide ranking as the most common cause of death (101 deaths between 2010 and 2015). PMH illnesses are also of major importance as public health issues, not only because of their adverse impact on the mother, but also because they can impact the emotional, cognitive and even physical development of the child, with potentially serious long term consequences. The Regulation and Quality Improvement Authority undertook a review of PMH service provision in Northern Ireland (January, 2017), and made
Northern Ireland has now reached the stage where an urgent need for major investment in specialised hospital and community services needs to be made a priority
11 recommendations for improvement, one of which was the provision of specialist PMH education and training. In response to this call, Ulster University devised an academic stand-alone module. However, despite its widely reported success, it fell foul of funding issues and was later withdrawn. Following the RQIA report and its recommendations, the Regional H&SC Board subsequently set up (June, 2017), a working group under the ‘Maternity Strategy Implementation Group’, to take forward all 11 RQIA recommendations and any other identified areas of need. However, none of these expectations ever come to fruition, and whilst it was encouraging to see intentions in this regard, it is clear these now need transferred into action. Outcomes of recent research by Northern Ireland Maternity System (NIMATS) is of international significance and cannot be ignored by politicians and health professionals alike. We now have absolute clarity about something we suspected for a long time, and it is clear we are facing a massive problem. However, despite clear national guidelines from the National Institute for Health and Care Excellence (NICE), 80 percent of pregnant women in Northern Ireland continue to have no access to specialist community PMH services. Furthermore, no funding has been pledged to address this anomaly, neither are there any plans to install a designated mother and baby unit. In comparison, 19 mother and baby units exist in England, two in Scotland and one in Wales. No such unit exists on the entire island of Ireland. Elasticity of inertia only stretches so far. Northern Ireland has now reached the stage where an urgent need for major investment in specialised hospital and community services needs to be made a priority, to address the kaleidoscope of issues associated with maternal mental health care, and therein after, save many lives and reduce attendant costs.
VIEW, Issue 47, 2018
Support: Rosemary Deans, left, and Sarah-Jane McCann
Centred Soul, founded by Rosemary Deans, is a not-forprofit organisation, based in Newry. Rosemary's background is in social work, working with children and families, adults with mental health issues and learning needs. Centred Soul is all about working with families, with a particular focus on keeping ourselves 'centred' and well during pregnancy, following the birth of our babies. On the right is the story of how one young woman, SarahJane McCann, started to volunteer alongside Rosemary
Sarah Jane’s story
VIEW, Issue 47, 2018
‘Before I was taken away, Keith was called in and told to say his goodbyes because they didn’t think I was going to make it’
am 35 years old. I’m engaged. My partner Keith and I were meant to get married and then the children came along. I live in Bessbrook. It’s a little village just outside Newry. I had a fantastic pregnancy with my first child Robin, who is now three, but I had a pretty difficult birth, it was quite traumatic. I had to have an emergency caesarean and I lost an awful lot of blood and needed a transfusion. I was in hospital for five days and I found the recovery very difficult. When I thought about the birth or had flashbacks I would feel anxious. I wouldn’t necessarily have a big cry, but I would become weepy if I was maybe talking to my partner about it. And he was very traumatised by it as well because he witnessed everything. He was there at the birth. I eventually went back to work and we had a brilliant lovely family life and then I fell pregnant with my son Jude. The birth of Jude was unreal, it was awful. We went down to the labour ward at Daisy Hill hospital in Newry and the medics again performed a caesarean section. Everything seemed to go fine, but when Jude was actually delivered and lifted up over the screen I just stared at him and completely blacked out. Afterwards in the recovery unit I was breastfeeding Jude and for an instant I thought ‘you know what, everything’s okay’, but a few seconds later, again, I felt like the life had just drained out of me. The next thing there was a team of consultants and doctors and they said ‘we need to take you back into the theatre’. I think there was just this kind of tense feeling and and everybody knew this was serious. The baby was taken away from me,
Support from Centred Soul • BTAPS (Birth trauma and perinatal support). Meet-ups every first Tuesday of the month
• Moaning Mummies meet-ups. Relaxed non-judgemental events for new hands at parenting. Every last Wednesday or Friday of the month. • Alternative therapies to support men and women.
• A new maternity wellness programme to start this summer
• Parent and child classes
I lost a lot of blood and I was eventually rushed to the Royal Victoria Hospital (RVH) in Belfast. Before I was taken away, Keith was called in and told to say his goodbyes because they didn’t think I was going to make it. The surgeons in the RVH performed a hysterectomy (a surgical procedure to remove the womb) on me the following day. I’ve always longed for another child. I think my family especially would have said ‘health wise, you couldn’t have risked a pregnancy or a baby’ and I understand that
and I probably wouldn’t have, but it’s just that the choice was taken away. I know that I’m 35, I’m relatively young. It’s just something that you’re not prepared for, and it’s kind of like your womanhood as well has been removed. I didn’t have post-natal depression, but I definitely had post-traumatic stress disorder. Rosemary Deans and I had chatted a few times, and I said there needs to be more support for mothers and families. I also know that Keith was totally affected by both the births. Rosemary held an event on the issue in Newry recently. Maternal mental health campaigner Lindsay Robinson attended. Lindsay and Rosemary both got up and spoke about their experiences which led to post-natal depression. And they also spoke about perinatal mental health. It was the first time I’d ever heard the term and I thought what does this mean? When they discussed it further I was like ‘Oh my God, that is what I experienced through my pregnancy’. That’s when I said to Rosemary I wanted to do something because a traumatic birth can bring on any type of feeling or issues or depression or worry. We have 67 members in our support group and around 10 people come to our meetings. It’s very early days for us. I was very lucky in the support I got. I don’t think every woman gets the type of support I had. There is definitely the need for more specialised services to help women. It’s absolutely shocking that there is no mother and baby unit on the whole island of Ireland. • For more information go to www.centredsoul.co.uk/
VIEW, Issue 47, 2018
The stigma felt terrible and I was really worried that if you have depression when you have a child, social services might take him. That was the big fear
obody knows how hard postnatal depression is until they have it but the worst thing for me was worrying that social services might come and whip my baby away. I cried a lot after he was born but was very protective of my baby son. I did every night feed, every bottle and nappy change. But there was pressure on my extended family who I was living with. I was 17 when I had my son, who’s now six, and the postnatal depression hit almost straight away. I came home from hospital after six hours and was very thrilled and excited. It’s lovely when a new baby comes into the family. My mum made me pizza, it’s my favourite food, but I had a queasy feeling and couldn’t eat it. I wasn’t interested and eventually developed anorexia. At my six-week check-up I was
diagnosed with postnatal depression. I was given anti-depressants and they had to up the dose a few times. Then I was referred for cognitive behavioural therapy and I really found it brilliant but nothing else was offered. I was given ten sessions which took place every few weeks. Not everybody gets this and I really feel we need more support for everyone, to pick up on this awful disease. So I support the #everyonesbusiness campaign. I had six months of depression and my eating disorder lasted a year. It then ended and for years my eating has been normal. Nobody ever said that I had anxiety. It was difficult for me to go on and to be honest, I felt cross about the whole situation with my son’s father. His dad disappeared and so it was me doing everything – all the loving and providing. . The stigma felt terrible and I was really worried that if you have depression
when you have a child, social services might take him. That was the big fear. I was not worried about affecting him with my mood as I was very loving towards him. I was only a moody bitch to everyone else. When it happens to you, you don’t necessarily think it is depression. It did click eventually, though, that I did have postnatal depression. It’s a hard subject to deal with. Gradually things improved. As I ate more, I felt happier. I found a new partner and that helped a lot with my self-esteem. It’s not something I’d wish on anyone. • Some details, including ‘Laura’s’ real name, have been changed to help protect her identity
• As told to journalist Jane Hardy
What do you think?
VIEW, Issue 47, 2018
Sarah Bruce went out onto the streets of Northern Ireland to ask members of the public if they think the issue of maternal mental health is talked about enough and if they believe that better specialist services are needed for women and babies
Gemma, north Belfast: “It’s ridiculous, given that suicide is a leading cause of death for women in the first year after childbirth that so many women struggle to access support services.”
“I think there’s a massive stigma associated with it and changes are needed to focus on awareness and reducing that stigma.”
Jenny, east Belfast: “There’s still a stigma attached to maternal mental health. I think there’s a problem that women don’t know directly where to go.”
“There’s not enough normal conversation around it either between new mums or between professionals and mothers.”
Gerry, west Belfast:
“It’s never been an issue that’s talked about. It would have been referred to as the ‘baby blues’ and kept behind closed doors.”
“It’s not something I know a lot about which is a shame. I don’t think it’s an issue that’s openly discussed which I think can be problematic for women and their families.”
VIEW, Issue 47, 2018
Michelle Bradley with baby Luna and husband Eoin at the recent NI Maternal Mental Health conference in Riddel Hall, Belfast
Brave Michelle tells of her battle with depression
Belfast mother has told VIEW how she set up an online support group to help women deal with postnatal depression. PANGS NI, which stands for Post and Antenatal Group Support, was set up by mum-of-three Michelle Bradley following the birth of her first child. Thirty-three-year old Michelle from Glengormley has three children; Alexis (5), Cooper (two) and seven-month-old Luna. “I had a really good pregnancy with Alexis. I was excited and couldn’t wait for her to be born. But I found my birth experience to be really traumatic and three days after she was born I had a massive panic attack which kicked off severe anxiety and depression. During the worst part of my depression I was ready to kill myself because I thought I couldn’t live with it anymore. “I set up PANGS NI because I was looking for people who felt like I did. “After a very tough period in my life I
was eventually diagnosed with birth trauma and post traumatic stress disorder. “My husband was worried that he was going to come home some day and I would not be alive. I used to walk around town with Alexis and in case something happened to me I knew there would be other people around. “My birth experience, despite my fears, with Cooper was much better. It was great for about a year and a half. I believed that there was light at the end of the tunnel! “The panic attacks returned when I found out that I was pregnant again with Luna. I had eight weeks of feeling okay after her birth. But in December last year I started getting really low again “I didn’t want to leave my house as I believed that I would drop dead in the driveway. I was also petrified that I was going to be locked away and I would not be able to see Luna.. “The whole experience has also been tough for my husband Eoin. He has been
really supportive. “After I eventually received cognitive behavioural therapy, I started to slowly recover, It’s going well and I am driving again. “There are nearly 500 members in PANGS NI. People come online and they talk about a range of things such as asking ‘Is anyone else on this anti-depressant and should it be making me feel like this?’ or ‘I’ve had a really bad day and I just need someone to tell me that tomorrow is going to be better’. “I’m really conscious, as a Facebook administrator of the group, about what I post. If I write about having a bad day, I’d always add a line at the end saying that I’m going to get better because I got through it before. It’s always important to have a message of hope for other mothers.” • To find out more about PANGS NI or to join the group go to www.facebook.com/PANGSNI
COMMENT VIEW, Issue 47, 2018
Providing sensitive care to new mothers
Consultant clinical psychologist Geraldine Scott-Heyes says Northern Ireland has the weakest perinatal mental health provision in the whole of the United Kingdom
fter several years in Child And Adolescent Mental Health I moved to the regional maternity hospital in Belfast to take up the first specialist perinatal mental health post in Northern Ireland. Knowing that therapy is more effective early in the development of psychological problems, the opportunity to establish a new service working with women during pregnancy was exciting and ahead of its time. Although the service has expanded to include a second clinical psychologist due to heavy demand, and there is now widespread recognition of the vital importance of perinatal mental health, this remains the only specialist perinatal clinical psychology service in Northern Ireland. I work closely with maternity staff, providing training and easy access to consultation related to individual patients, as well as providing psychological therapy for patients of Royal-Jubilee Maternity Services. My main focus is to see pregnant women as quickly as possible following referral by maternity staff. Women are also seen following childbirth. They may be seen individually, or with their partner. Fathers are important in their own right but they also make an important contribution to the well being of their partner and the healthy development of the baby. Women appreciate having appointments in the maternity hospital and the close links between psychology, midwives and obstetricians. This is particularly important for women with mental health problems or a high risk for developing such problems. Many of these women are keen to reduce their need for medication in pregnancy and look to psychological therapy as an alternative way of coping. They are often highly motivated to learn coping skills, which can be sufficient for some, or compliment the benefits of medication for others.
Women appreciate having appointments in the maternity hospital and the close links between psychology, midwives and obstetricians
Some psychological problems specific to pregnancy get in the way of antenatal care, such as fear of hospital, needles, physical examination or severe fear of giving birth. Others doubt that they will make a good enough parent and may struggle to form a relationship with their baby. Medical complications during pregnancy bring great distress. A usually happy event such as a scan, becomes a worst nightmare when baby is diagnosed with a medical problem and scans become forever frightening. Some babies die. Childbirth leads to post trauma symptoms for one in three women and while this usually settles over a month or two, for three per cent, symptoms are sufficiently severe to warrant a PTSD diagnosis. The core of our work is with women who experience both mental health problems and medical complications. We are well placed within the maternity team to provide co-ordinated, informed care, sensitive to a difficult, changing situation. The Regional Neonatal Unit in the hospital cares for the majority of very sick and premature babies in Northern Ireland, however no funding is provided for clinical psychology support to the unit. Given Government policies prioritising vulnerable children and their families this is a strange omission. There have been a few positive changes since I came to work in Royal Jublilee Maternity Services but compared to other regions Northern Ireland has by far the weakest perinatal mental health service provision across England, Scotland, Wales and the Republic. I really hope that, when we have a government, they will take full account of the recommendations in the RQIA Report on Perinatal Mental Health Services (2017), which includes dedicated clinical psychology support for all maternity and neonatal units.
There is not enough help for women
VIEW, Issue 47, 2018
Cliona McLoughlin, left, who lives in Ballinrobe, Co Mayo, enjoying a cup of tea with her aunt Ita Whelan in Kilcoole, Co Wicklow
Former community midwife Cliona McLoughlin tells writer Jillian Godsil that women in the Republic of Ireland need proper resources to help them tackle postnatal depression
t wasn’t until registered nurse Cliona McLoughlin attended a workshop on post-natal depression three years after the birth of her daughter that it hit her like a thunderbolt. “At that moment a lot of things fell into place and I recognised that I had experienced severe post-natal depression. But it was in the 1980s and no one was talking about the condition and there was little care available. “Actually there is still very little for women even if it is diagnosed,” she adds. Cliona had begun nursing back in 1968 and had a strong interest in midwifery but life had intervened and she was too busy to return to training. “I also travelled a lot for work – London, Bangladesh – and there never seemed to be time.” Part of Cliona’s desire to take up midwifery was her own experience of child birth and while she did not identify with the actual condition of post-natal depression until three years after, her physical labour was very traumatic. Her subsequent depression also had a negative bearing on her marriage and would have in part contributed to her separation. “I did know that I wanted to help other women,” she said. “I had become involved with the Childbirth Trust, now called Cuidu in Ireland. This is a support group for many aspects of parenting, including women suffering from post-natal depression. There are a lot meet-ups and
great support but while I really enjoyed this, there were two limitations. The first was that I did not have any qualifications to be specifically helpful and secondly this group was limited in its reach.” And so Cliona went to Belfast to train as a midwife – there was too long a waiting list to study in the Republic of Ireland – and she subsequently qualified in 1989. “I knew I did not want to work in a hospital environment,” she said. “And so I began work as what is now called a Community Midwife. “Working as a community midwife ticked a lot of my boxes. For 20 years I attended women in home births. I really enjoyed this work as I developed a relationship with the woman, her partner and family if there, and it was a very satisfying role. “Compared with hospital midwifery which is very fragmented, community midwifes are really involved with their clients and as such can also spot issues such as post-natal depression much easier.” During this time, Cliona was also teaching, holding the position of head of Social Community Health Studies Department in Bray’s Institute of Further Education. “This role covered many interesting and related topics as diverse as social studies to holistic care. With 300 students we were very busy.” In Cliona’s experience many women who had traumatic first births opted for
home births the second time around. “It can be more healing,” she said. Cliona retired from teaching and moved into Public Health Nursing. “In this role, we meet the mother 48 hours after she comes home and would visit her three times until the child was three months old and this relationship continues until the child is three years’ old.” “We used the Edinburgh Post Natal Depression Scale on those visits,” says Cliona. “It as a very clear indicator if there was anything wrong. The big problem is that while the score is accurate, it is not done routinely across the system.” This 10-question tool is easy to administer and if the woman scores more than 13 then she may need support. Some 80 percent of women suffer from ‘baby blues’ which lasts a number of days, another percentage experience longer depression which kicks off ‘listening visits’ from the public health staff. These visits last an hour each and present a huge pressure on nurses who may have as many as 200 families to mind. “There is not enough help,” says Cliona. “For example, if there is support in the Primary Care sector it is only available for women with medical cards – and even then there may be a waiting list of up to year to be seen. “It is not enough to be aware of the condition, we need to have the resources to tackle it.”
VIEW, Issue 47, 2018
After the C-section, I became ill and couldn’t breastfeed. Severe postnatal depression followed as a consequence
Writer Michele Beck, who lives in Yorkshire, tells VIEW about the traumatic birth experience she suffered and how art therapy helped eased the effects of her maternal mental health problems
he sound of my waters breaking pranged like an elastic band against a hard surface. It was Thursday, October 10, 2013, and unusually warm, as an Indian summer rolled out into autumn. I was 39 weeks pregnant and the heat ebbed my resolve away. That evening, exhausted I’d collapsed on my bed – unintentionally falling to sleep. That same distinguished prang stirred me, my senses alert and ready, a wavering of honey filled my nostrils, an unmistakable smell. I stumbled to the bathroom, declaring loudly to my partner in-between rushes of excitement that I was in labour and soon the world would meet our boy. I went to the hospital three times before they eventually admitted me. Each time I had an internal exam at which they told me, I was at only two centimetres and perhaps my waters had not broken and I’d just had an accident. Tired, in agony and terrified – I told the nurse I was 27 years old and would know if I’d wet myself. It made little difference and I was sent home. I returned to my living room to roll aimlessly on an exercise ball, surrounded with incense sticks and candles, listening to the dulcet tones of Sir David Attenborough’s Blue Planet and reciting positive birth mantras to myself, “I am a warrior.” and “My birth will be effortless and easy.” Six months of hypnobirthing and yoga had mentally and physically prepared my body and mind for this day. Two days after first going into labour and crying down the phone to the triage nurses they told me to come in. I clutched my birth plan and presented it to anyone who I came into contact with, as if it were my only means of communication. It stated natural water birth, no drugs, and no medical intervention but my inner voice screamed ‘Help me, by any means necessary.’. A midwife came and said to me: ‘Why
Michele Beck with her son Dylan
don’t you have something to help you? You’ve still got a long way to go.’ I gave in. Or that’s how I felt. From that moment, the birth plan dissolved, and with it went the dream of having an easy birth. Two lots of Diamorphine later and having been in labour for three days, my labour was progressing with an end in sight. When I reached 9.5cms, I was told to push through for the last part to get to 10cm. I felt a surge of power and an unstoppable will, the warrior was eventually making her appearance. Suddenly the heart rate monitor started beeping frantically and the mood changed. ‘The baby is distressed’ the midwife shouted. The room filled with doctors. ‘You need to have an emergency C-section, we have to get the baby out now.’ Handing me a form to sign, I scrawled an unrecognisable signature. I lay on the surgeons’ table – 77 hours after my waters had first broken – completely at the mercy of the doctors. A solitary tear rolled down my cheek as high heart rhythms shook through my exhausted body. The surgeon tugged at my lower abdomen, feeling very much like someone was washing the pots in my stomach, then at 7.01am on Monday, October 14, Dylan let out his first cry. After the C-section, I became ill and couldn’t breastfeed which made me feel like a failure as a mother and a woman. Severe postnatal depression followed as a consequence. When Dylan was nine months old, I signed up to a birth project ran by Derby University. It was an art therapy course, which really helped me and the other mothers who all had experienced some birth trauma. When the birth of a baby happens, so does the birth of a mother and no-one can write this history for you, or tell you how you should do it, you have to write it yourself.Your story, with your voice, waters breaking and all.
VIEW, Issue 47, 2018
Early intervention is vital to help women
Shona Hamilton, a consultant midwife in the Northern Health and Social Care Trust, says that pregnant women are often fearful of talking about their mental health
regnancy and childbirth is often perceived as a time of great joy and happiness in the media and within our communities and society as a whole.Yet midwives are acutely aware that anxiety, depression and other psychological and emotional difficulties can impact negatively on women and families during this time. Women often express concerns around bonding and childcare when they experience mental ill health in the years after birth. Over the past decade midwives and obstetricians have made considerable changes to their practice to ensure women with mental ill health are provided with care and support during pregnancy and the postnatal period. As midwives we are aware that women are often reluctant to express their feelings and experiences of psychological distress and mental ill health. This reluctance often stems from fear, stigma and feelings of shame.Therefore it is important that women are aware that midwives are interested in more than just the physical symptoms of pregnancy. We recognise that dealing with the emotional and psychological aspects of pregnancy are equally important to women’s health and well-being. It would be remiss of us as midwives to ignore any symptoms, concerns or conditions that will have an impact on pregnancy, childbirth and parenthood. Midwives play a crucial role in ensuring women receive the correct care during pregnancy and the postnatal period, therefore we ask questions at the booking interview, during pregnancy and in the postnatal period. We know that often mental illness in pregnancy and the postnatal period is both predictable and detectable and early intervention can ensure that women stay well during and after childbirth. Therefore I encourage women to share their thoughts and feelings and express how their mood
It is essential that we continue to work as a region to develop specialist perinatal mental health services and a mother and baby unit
is affecting day to day life to ensure quick access to services and help. It is often difficult to share personal and painful emotions with health professionals and we recognise this within maternity services. Using a family member or friend can often make it easier and seeking advice from others with a similar experience can often give women the power and confidence to speak out. Mental illness and psychological distress is no different from a medical condition and seeking help is the first step towards better health and well-being. Recent media coverage has highlighted the lack of services across the UK and in particular Northern Ireland. We know that almost one in five women in Northern Ireland self report a mental health problem in pregnancy, which was revealed in a recent study by Queens’s University Belfast. I am keen to reassure women that if they speak with a midwife or obstetrician we will ensure that you are referred to a mental health practitioner who can provide the support and care you require. It is also important for women to explore some of the excellent support provided within the voluntary sector, recovery colleges and online peer support. It is reassuring to me as a midwife who has been involved in perinatal mental health for over 15 years, that services and community support is improving and that women can access help in a variety of ways. I believe that we are reducing the stigma around perinatal mental illness and hopefully women will feel more able to access support and begin their journey to recovery. It is essential that we continue to work as a region to develop specialist perinatal mental health services and a mother and baby unit. I recognise that women and families deserve expert care at a vulnerable time in their lives.
VIEW, Issue 47, 2018
‘It’s a major public health issue’ Mary Duggan became interested in perinatal mental health when her sister developed postnatal depression
Health visitor Mary Duggan tells Jane Hardy about her work on the frontline
hen a pioneering Magherafeltbased postnatal depression support service (PNDSS) was closed down in 2001, staff health visitor Mary Duggan (59) was devastated. “I’ll never forget getting up to go to work on the day in May the service was discontinued. I was shocked as I knew the value of what we did. It undoubtedly saved lives, and mothers would say to us: ‘If it hadn’t been for you, I don't know what would have happened’.” She added: “We did home visits as well as weekly group therapy. A few women had an active suicide plan so getting the right intervention was crucial. I remember one woman who had the means, the old tricyclic anti-depressants that were very toxic. She shared that information and gave me the tablets. “We picked up her hopelessness via a robust risk assessment and she came through. Now we have crisis teams but they didn’t exist then.” Mrs Duggan, who has 35 years' experience and represents Northern Ireland in the Community Practitioners and Health Visitors Association, was one of two professionals in the team. Their approach had evolved after
discussion with like-minded colleagues as Mary explained: “In 1987-88, then part of the Western Health Trust, we set up a group for mothers. It was health visitor led and quite informal.You might do it differently today but it brought women experiencing the symptoms of postnatal depression together and was also time-effective. “We covered Magherafelt and Cookstown and one psychiatrist said if there was a good place to suffer postnatal depression, that was it.” In fact, one reason the service stopped was management concern that since other areas lacked this targeted approach, women would end up with a postcode lottery. Mary first became interested in perinatal mental health when her older sister developed severe postnatal depression. “I was a student midwife when after having a much wanted first baby, my sister developed serious PND at the age of 26. “As a family we didn't know where to turn.” The illness lasted 18 months and affected everyone. Mary added: “There was no literature, no internet to find out more. When I went into health visiting, I wondered if she was unusual. When asking
mothers the question ‘How are you?’, it became clear she was one of many." In terms of best practice for mothers with mental health issues, Mary believes in an individual approach. She said: “It isn’t one cap fits all. Where women have been too ill to leave the house, we provided childcare support. One mother, whose severe depression had gone untreated, had completely rejected her baby. Her GP and I managed the case and she didn’t have to be hospitalised. We brought in the mental health team, and childcare support was sponsored for the time the dad was at work.” They were successful. “Using a team approach with psychiatry, the GP and the PND service, she recovered and her child is now 23. But she never had any more children.” As Mary Duggan noted, the incidence of perinatal mental ill health may be higher than the usually quoted one in 10. “It’s a major public health issue. While we can’t totally prevent it, we can certainly manage it. If anything else affected this percentage of people, there would be an outcry and a much more proactive approach to education and awareness.”
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