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Part of: Mental Health and Illness

Related to: Births and Fertility, BreastfeedingAnxiety and Depression, Personality Disorders, Psychosis, Safe Places in Health-based Settings , Wellbeing, Emotional Health and Wellbeing of Children and Young People, Self-Harm, Suicide and Mortality of Undetermined Intent, Dementia, Eating Disorders, Patient Experience, Adult Social Care, People with Multiple Needs, Alcohol, Substance Misuse

Key Facts:

  • It is estimated that 1 in 10 new mothers will experience postnatal depression.
  • Estimates suggest that 182 new mothers in B&NES each year are at risk of postnatal depression.
  • Health visitors have estimated that up to 60 mothers a week are referred with post or ante-natal depression.

Definition

Postnatal depression is a type of depression some women experience after they have had a baby. It usually develops in the first four to six weeks after childbirth, although in some cases it may not develop for several months. There are many symptoms of postnatal depression, such as low mood, feeling unable to cope and difficulty sleeping, but many women are not aware they have the condition. It's common to experience mood changes, irritability and episodes of tearfulness after birth – the so-called baby blues. These normally clear up within a few weeks. But if a woman experiences persistent symptoms, it could well be the result of postnatal depression.

The cause of postnatal depression is not clear, but it's thought to be the result of several things rather than a single cause.

These may include:

  • the physical and emotional stress of looking after a newborn baby
  • hormonal changes that occur shortly after pregnancy; it is thought some women may be more sensitive to hormones than others
  • individual social circumstances such as money worries, poor social support or relationship problems. 1

What does the data say?  2

Over the past decade the Confidential Enquiries into Maternal Deaths in the United Kingdom (5,6) have highlighted that suicide in pregnancy and during the first postnatal year remains a leading cause of maternal death.3

In the UK it is estimated that per 1,000 births, at the time of birth:4

  • 100 women are suffering from a major depressive illness
  • 50 women are experiencing moderate to severe depression
  • 80 women are in need of referral to psychological therapies
  • 20 women are in need of referral to psychiatric services due to a new episode of postnatal disorder

Using these national estimates, based on the 2,429 registered births in B&NES in 2009-10 it is thought that annually, at birth approximately:5

  • 243  women will be suffering from a major depressive illness
  • 121 women will experience moderate to severe depression
  • 194 women will be in need of referral to psychological therapies
  • 49 women will be in need of referral to psychiatric services due to a new episode of postnatal disorder.

Local health visitors believe there are as many as 60 women a week being referred with post or ante natal depression. 6

Postnatal depression is more common than many people realise and cases can often go undiagnosed. It is estimated around one-in-seven women experience some level of depression in the first three months after giving birth. 7

Rates of postnatal depression are highest in teenage mothers. 8

Postnatal depression is thought to affect all ethnic groups equally. 9

Women with obsessive compulsive disorders, social anxiety and panic disorder are at risk of relapse in the postnatal period. Particularly vulnerable are those women with histories of psychiatric illness who need to discontinue psychotropic medications during pregnancy. 10

Research by the charity 4Children 11

4Children is a national children and families’ charity which in the summer of 2011 the charity 4Children commissioned the parenting club, Bounty, to undertake a survey of more than 2,000 mums aimed at gathering new evidence about the prevalence, awareness and experience of postnatal depression.

  • The results showed that half of the women (49%) who had suffered from postnatal depression had not sought professional treatment.
  • Further analysis showed that this average figure disguised a significant variation with first time mums less likely (42%) than ‘multi mums’ (54%) to seek professional help.
  • With 700,000 births in England and Wales each year and at least 1 in 10 of these likely to suffer from postnatal depression, that is 35,000 mothers with untreated postnatal depression each year. These figures suggest that about half of women suffering from postnatal depression do not seek any professional treatment.
  • Based on national 2011 births data12 this would suggest that in B&NES there were 182 new mothers at risk of postnatal depression in a 12 month period.

Of those mothers with postnatal depression:

  • almost a third (29%) did not realise they were suffering from postnatal depression.
  • 60% did not believe their symptoms were serious enough to warrant treatment
  • 33% said they were too scared to tell anyone because they were afraid of what might happen to themselves or their child.

What does the community say?

Experiences of recorded by the charity Creativity Works 13

The charity Creativity Works delivers a Mental Health Creative Support Service in Bath and North East Somerset that works with women with postnatal depression, and their families. The following comments are from participants of one of their key projects in this area is called My Time - My Space:

‘I think other people should know about the stigma for those experiencing postnatal depression’

‘There’s a supportive artist who inspires you; there’s a health visitor to support you, and there’s people who are similar to you to listen to express. And there’s time. But all of it added up together becomes more than that. A lot more than that...’

‘If I hadn’t done My Time My Space, and if I’m not involved with Out of The Blue then I definitely would not be here today. Things would have got so bad that one day I might have taken my life.’

‘If I hadn’t have done My Time My Space firstly my husband and I would definitely not be together now without a doubt. We went through a really rough patch. Everybody in our family benefits from it – From it the boys are happier, because obviously when they were younger I was sad and it rubs off on them. And now my confidence is pretty sky high and I am a much, much stronger person…

I’ve managed with their support to come off anti-depressants and be healthy and happy again.’

The following comments are from health visitors working with Creativity Works:

‘It’s truly transformative. This is a multifaceted approach that meets the needs of women socially, creatively and psychologically’

‘I feel we are helping them to start on a journey to recovery… It has had so much impact on so many people’s lives I just wish I could offer it to more women’

Are we meeting the needs?

Nationally 14

The survey carried out by the charity 4Children in 2011 illustrates the lack of information available on postnatal depression, with

  • 65% of respondents wanting more information on support groups
  • 46% not satisfied with the information they received about the symptoms of postnatal depression, and
  • 52% asking for information on counselling and other talking therapies.

The survey shows how difficult postnatal depression can be for male partners who are not given external support:

  • 53% of women wished their partners had been given more information from health visitors
  • 39% said their partner needed to discuss his anxieties with someone
  • 11% wanted treatment for their partner who was also depressed.

The report concluded that, nationally, thousands of women are not getting their postnatal depression treated quickly or effectively enough because of serious shortcomings in the system of screening and referral, an over-reliance on the use of antidepressants and because of a sense of stigma attached to admitting to experiencing the symptoms.

  • need to do more to diagnose postnatal depression early and ensure mothers are being provided with appropriate and timely treatment.
  • despite NICE guidelines stipulating that talking therapy should be offered to women with a mild or moderate diagnosis, 70% of survey respondents were prescribed antidepressants by their GP compared with 41% referred to talking therapies.
  • The majority of Primary Care Trusts do not collect information on the prevalence, severity or treatment of postnatal depression at a local level.
  • The Department of Health admit that they do not hold national data on the prevalence or treatment of postnatal depression.
  • There is a postcode lottery for inpatient care of mothers suffering from severe depression.

Bath and North East Somerset

Local health visitors start assessing for antenatal depression, and the potential for postnatal depression during antenatal visits, and continue on each visit through to the 3-4 month contacts. 15

Local health visitors also routinely measure mothers according to the Edinburgh postnatal depression scale between 5-8 weeks after their birth, in order to identify individual needs. 16

Numbers of local health visitors are increasing and therefore there is an expectation that they will have a greater capacity to support mothers with postnatal depression. 17 However, there is an awareness that there are limited services available for women once they have been identified as suffering from postnatal depression. 18

The charity Creativity Works develop projects that aim to improve the health and wellbeing of specific communities and groups of people through creative activities. It delivers a Mental Health Creative Support Service in Bath and North East Somerset includes working with women with postnatal depression. 19

One of Creativity Works projects in Radstock is My Time - My Space. This has been running for over 12 years and it works to do the following:

  • Help women with postnatal depression to overcome their illness and re-discover a sense of self.
  • To provide a caring, supportive, and creative environment for women with postnatal depression through partnerships with health visitors and withChildren’s Centres. 20

Creativity Works project My Time - My Space has helped hundreds of women and their families in Bath and North East Somerset to cope with postnatal depression. According to their Enterprise Manager it has:

  • It has reduced postnatal depression scores and made significant positive impacts on individual and family well-being.
  • Meant that many participants have gained confidence and have gone to access other social and creative activities, courses at college and employment.
  • Enabled the establishment of longstanding independent participant run groups, such as Out of the Blue. 21

Another local project is called Open House Therapies which has been commissioned directly by First Steps in Twerton to deliver courses.The sessions involve group discussions as well as creative activities to help express some of the complex thoughts and feelings mothers' may be experiencing. They cover issues like pregnancy, birth and body image, as well as some of the less talked about issues such as how relationships may change and the often conflicting feelings mother's may have about their new role 22

Sirona’s Psychological Therapies Service project - Sirona Care and Health, which provides community health and adult social services in the B&NES, is training health visitors to provide a new programme of supportive sessions for parents struggling after the birth of their baby. During the sessions mums can talk through current problems that are connected with feeling depressed or anxious and learn some techniques from cognitive behaviour therapy. 23

Sirona has linked up with an internationally recognised team from Australia who developed the programme specifically for clinicians such as health visitors to deliver. The programme has been through research trials in Australia which demonstrated that it could be effective in helping mothers overcome depression. The programme is an additional option for patients, who can also access psychological support through Sirona’s Psychological Therapies Service.24

Avon and Wiltshire Mental Health Partnership NHS Trust (AWP) - offers the following services for postnatal depression: 25

New Horizons mother and baby service offers four inpatient beds for mothers and their babies in the Avon area and at times for some out-of-area referrals. Mothers with the most serious post natal illnesses, who need support and treatment usually use the inpatient beds.

Outreach services and antenatal assessment -  for mothers who have a history of severe mental illness or severe post natal depression. During their stay mothers are usually offered some one-to-one support, occupational therapy services including a talking group Mellow Parenting, physiotherapy, attendance at anxiety management and dance therapy groups. Nursery nurses also form part of the team to help support mothers with their general care of new babies. There is also an important referral pathway to the local primary infant mental health specialist team to help support mother and baby interactions and bonding.

Stepping Stones Project 26 27 - aims to support families where there are parental mental health needs, it was set up in January 2013. It has staff from Children Services and Mental Health Services.  It works with families with varying mental health difficulties some of whom are under secondary mental health services and some who do not meet threshold for this. It provides one-to-one support for both, including signposting to alternative support agencies.

Stepping Stones tries to help families in Bath and North East Somerset better understand and manage the effects of parental mental health difficulties on family relationships, with particular emphasis on children. The service aims to provide a sustainable platform for families to direct and manage their mental health thus reducing the impact this has upon their children.

This includes some one-to-one work with children helping them to understand their parent’s mental health and bringing this into whole family work opening up communication between children and parents

The project aims to enable parents, their children and professionals to work together in various activities in a one-to one and family basis and through groups such as the Stepping Stones Club sessions and Peer Support Groups. 

  • The Stepping Stones Club groups currently run for primary and pre-school children and these are activity and play based groups which facilitate strengthening attachments between parent and child through play. They aim to develop improved understanding of each other by better communication, social, emotional and thinking skills. There have been groups in both Bath and Midsomer Norton, but it is hoped that groups will be set up at various locations throughout B&NES.
  • The Peer Support Groups look at how mental health impacts on parenting, and are led by the needs of the parents.  The aim is to provide a safe and supportive opportunity for parents to discuss their mental health needs and how these impact on their family.  They try to promote and build upon parent’s self-esteem and enable individuals to develop their social networks to decrease potential feelings of social isolation. To date they have run two Peer Support Groups, one in Bath and one in Midsomer Norton.
  • The Stepping Stones Project also provides some one-to-one work with families when they are unable to attend groups. 

The project aims to evidence measurable outcomes based on the following criteria from BANES Effectiveness Strategy.

  • Enhanced parent/carer/adult – child relationships
  • Improved parent/carer – confidence/resilience/ health
  • Reduction in impact of trauma
  • Shared family experiences
  • Increased children’s resilience

Between January 2013 and June 2013 the Stepping Stones Project had 29 family referrals. The majority of these referrals were from Children’s Services Social Workers, but they also came from, Adult Mental Health Social Workers, Health Visitors, Children’s Centre Outreach Workers, Southside Workers and Parent Support Advisors.

Out of these 29 families 11 of them had current involvement with Adult Mental Health Teams and 18 had been allocated a Children’s Services Social Worker.  During this period there were 23 women and 6 men referred to the project.

Between January 2013 and June 2013 the children of the families that had been referred to the Stepping Stones Project were of wide range of ages, from months old to 17 years.  There were 6 families out of the 29 that had children subject to Child Protection Plans. 

Postnatal groups

There are many postnatal groups in Bath and North East Somerset and information about these can be found at Children's Centres, GP Surgeries and via health visitors. Mothers can either be referred to them by their GP or Health Visitor, or can self-refer. 28

What can we realistically change?

Nice health visiting maternal mental health pathway

Figure 1:  Local Children’s Health Commissioning, Health Visiting Maternal Mental Health Pathway 29

NICE guidelines call for the effective and timely treatment of postnatal depression, stipulating that ‘talking therapy’ should be offered to women with amild or moderate diagnosis. 30

National Institute for Health and Clinical Excellence (NICE) 2011-2013 guidance