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More than just the ‘baby blues’

14th March 2017

Dr Liz McDonald, Chair of the London Perinatal Mental Health Network, explains why London CCGs need to ensure high quality and timely mental health services are available for pregnant women and new mothers.

As a perinatal consultant psychiatrist for over 30 years, I have seen first-hand just how many women struggle with mental health problems during their pregnancy or in the first year after their baby’s birth.

Up to 20 per cent of women are affected by mental health problems at some point during this time.

People often talk about the ‘baby blues’ but it’s important to recognise that there’s more to it than that.

Mental health problems experienced by women in the perinatal period can range from mild to severe and if untreated they can have a devastating impact on women and their families.

They can include postpartum depression, anxiety and psychosis. Whole families are affected with postpartum depression linked to depression in fathers and problems within relationships and families.

At their very worst they can be deadly.

Mental health problems in the perinatal period are one of the leading causes of maternal deaths.

Women are losing their lives to suicide and other mental health related causes.

Figures show that in 2015 around 23 per cent of women in England who died between six weeks and one year after pregnancy died from mental health related causes.

We need to ensure that all women receive compassionate and competent care from skilled professionals, during pregnancy and in their baby’s first year.

In 2015, there were 129,600 births in London so that is potentially 25,920 women in need of support in just one year alone.

I believe that right now we have a unique opportunity to develop comprehensive and equitable perinatal mental health services across London.

Our new commissioning guide, produced by Healthy London Partnership and the London Clinical Networks, clearly sets out what is needed and why. It demonstrates how excellent provision can be achieved and is a map for what the NHS, social care and the voluntary sector can achieve in partnership with women and their families.

The task is complex. The guide highlights that collaborative commissioning is vital.

Managers and clinicians from multiple disciplines and agencies need to work together.  These include maternity services, GPs, health visitors, mental health teams and other hospital and community specialists.

London has already shown its potential for effective multi-agency working and there are plenty of examples of good practice for us to share and learn from.

The healthy development of infants and children depends on having well parents who can love, nurture and guide them. Our communities and society depend on having resilient, happy, thriving children and young people who are able to learn and contribute positively.

Ensuring the wellbeing of families by enabling appropriate and prompt interventions and support when things go wrong is essential.

The cost of attempting to repair the damage done by not providing services for perinatal women is five times that of providing the services in the first place.

Commissioners and providers must work together in a systematic, thoughtful, responsive and timely manner to ensure that services are in place for all women and their families across London.

Our new guide provides clarity of purpose and action for all involved in the commissioning of perinatal mental health services. I hope that all CCGs in London find it useful.

About the author

Liz McDonald is Chair of the Pan London Perinatal Mental Health Clinical Network and Hon Consultant Perinatal Psychiatrist at East London NHS Foundation Trust.   She worked clinically and in service development in east London, was a Guideline Development Group member for the NICE APMH guidelines (2007 and 2014) and is a member of the IAG for MBRRACE. She is Clinical Lead for the NHSE funded Bursary Project for training perinatal psychiatrists at the RCPsych and Clinical Associate at the Tavistock and Portman Trust.

For more information about our Prevention programme contact Jemma Gilbert, Senior Lead, at

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