In my career as a Cognitive Behavioural Therapist I have had the great pleasure to treat a number of women and men who have experienced a common mental health disorder, such as anxiety and depression, in the perinatal period. Very early in my career I also worked on a specialist mother and baby unit that provided care for women experiencing puerperal psychosis. It’s widely known that as many one in six women (and one in 10 men) will experience a mental health problem during the perinatal period. Their symptoms and diagnoses will be wide ranging and may include; worry, rumination, low mood, anxiety, specific phobias, obsessive compulsive disorder, PTSD, health anxiety, social anxiety disorder, depression, suicidality, eating disorders, or psychosis.
The potential effect on the individual, the family and the infant is well documented. A parent who is experiencing a mental health disorder may struggle to meet their child’s needs and this can impact directly on the child’s development. The Center for the Developing Child at Harvard University reminds us that close contact (serve and return interactions) including skin-to-skin contact, social interactions, eye contact and cuddling facilitate the connection of over 1 million neural links every second. These are the neural processes that build the brain’s architecture and form the foundation stones for all later learning, behaviour and general well being.
The Good News
The good news is that these common mental health disorders are treatable. Evidenced based psychological therapies such as cognitive behaviour therapy (CBT) are widely available in the UK and around 90% of patients can be treated in a primary care service such as Improving Access to Psychological Therapy (IAPT) services. CBT works by enabling patients to understand the links between predisposing factors, current triggers or stressors, emotional reactions, thoughts, bodily sensations and actions. Working together with their therapist will develop a shared understanding of why they are experiencing the symptoms they have and what they can do to reduce the symptoms and get better. Successful treatment has wider implications for the family as a whole and positively impacts on parental relationships, adaptation to parenthood and the welfare of the child.
The Bad News
Sadly most people who present with a mental health disorder go untreated. In February this year the Royal College of Midwives (RCM) reported that only 7% of women who experienced a mental problem in pregnancy were referred for treatment and of those that were referred 38% had to wait up to a year to be seen. The RCM stated that 12% of men experienced a mental health disorder during the perinatal period and little or no support was offered.
There are a number of variables that account for the fact that most people go untreated. Arguably, one of these is lack of training in this specialist area.
From time to time I deliver training to groups of midwives, health visitors and students about perinatal mental health. One of my daughters is training to be a midwife and I was a bit shocked to learn from her about how little training there is for midwives on relevant mental health issues. My daughter’s experiences are echoed in the feedback I have heard from the qualified midwives and health visitors I have met when delivering workshops on perinatal mental health. Clinicians articulate that they feel they do not have the skills or training to conduct a mental health assessment and they have little confidence in their ability to provide patients with effective guidance and advice in relation to how they might manage the symptoms of anxiety or depression. Midwives and health visitors alike also report a degree of uncertainty about which services they can refer patients to and if they were to refer whether the patient would receive an effective treatment. The Royal College of Midwives state that this uncertainty is worse in some areas of the UK.
Arguably, its not only midwives and health visitors who are inadequately trained to support patients with mental health disorders in the perinatal period. Psychological therapists too receive little training in this important area of clinical practice. For example, perinatal mental health is not on the curriculum of most clinical training programmes and yet the NHS England Five year Forward mental health policy paper outlines perinatal mental health as one key area to focus on. Training large amounts of therapists is a costly and slow process particularly in a cash strapped NHS. However, there are services across the UK, particularly within IAPT that provide excellent and effective treatment for patients and its essential that midwives and health visitors familiarise themselves with how to refer their patients to these services.
Once referred to a service, patients sometimes face logistical difficulties accessing treatment. Commonly, services operate within office hours and can be located some distance from the patient’s home. Accessing these services whilst pregnant or with all the essential paraphernalia that comes with a small infant can be a struggle in itself. This struggle might be amplified if someone is feeling, exhausted, depressed or anxious.
It’s Not all Bad News
One effective method of delivering CBT is Internet Enabled CBT, this method is delivered by CBT therapists online via written (typed) communication. IECBT is provided by Ieso Digital Health, a CBT service commissioned by over 36 CCGs in the UK. Whilst IECBT is a relatively new method, over 14.000 patients have already completed treatment using this method. The recovery rates for these patients have been benchmarked against traditional face-to-face CBT demonstrating that online CBT is just as effective as face-to-face CBT. Patients who have online CBT are able to arrange their therapy appointments at any time of the day or night and because the appointments, with their therapist, are online, there is no need for the patient to leave the house. In addition, to weekly therapy appointments patients are able to have contact with their therapist between therapy appointments using secure asynchronous messages. This contact can amplify the effect of CBT meaning that very often patients get better quicker. The combined effect of easy access to high quality evidenced based psychological therapy at a time that is chosen by the patient, without needing to leave the house means that more people can be treated.
If you want to find out more about this exciting new method please contact me or visit the Ieso website at www.iesohealth.com
I am currently conducting a survey to understand more about midwives and health visitor’s experience of supporting patients with perinatal mental health disorders. I will be presenting this data at a conference later this year. You can take part in this survey here
If you would liked to be kept informed about the data I collect please contact me at firstname.lastname@example.org