Perinatal Mental Health Assessments

I beg to move,

That leave be given to bring in a Bill to require the provision of mental health assessments in NHS antenatal care for the purpose of identifying those at risk of perinatal mental health problems and making referrals to appropriate support; and for connected purposes.

We often assume that pregnancy, birth and the year after birth are a time of life to be happy, celebrating the arrival of a new baby and embarking on a new chapter in family life, and for some people that is how it pans out, but for many the reality is much tougher. I have spoken previously in the House about my brilliant friend Sophie, who took her own life after the birth of her third child, who was just 10 weeks old at the time. That was four years ago, and her death remains a huge sadness in my life and for her family, some of whom are in the Gallery today; but the shock of it still sits with me too.

I did not know—and many of us do not—that suicide is the leading cause of death for a woman in that period from six weeks to a year after giving birth, a statistic recently reconfirmed by the latest report from Mothers and Babies: Reducing Risk through Audits and Confidential Enquiries across the UK, known as MBRRACE-UK.

Although Sophie’s death is a particularly serious example, I also did not know of the scale and normality of mental illness at that time in a woman’s life. One in four women experience some sort of mental health difficulties during pregnancy or after giving birth. It can be anything from depression to anxiety to obsessive-compulsive disorder or post-traumatic stress disorder, and it can be completely debilitating for mums and their families. The consequences ripple out more widely, too: the London School of Economics and the Centre for Mental Health estimate that untreated perinatal mental illness costs the country more than £8 billion a year, largely through the long-term impact on the child’s health, education and future productivity.

In theory, women are asked about their mental health early in pregnancy. The guidance from NICE—the National Institute for Health and Care Excellence—specifies that questions about depression and anxiety should form part of a woman’s first contact with health professionals during pregnancy, including at the booking appointment, but in practice women’s experiences vary enormously. Some are asked a few hurried questions between blood pressure checks, while others are not asked at all. Women with a previous history of mental illness may be given more attention, but we know that pregnancy and early motherhood can often be the first times women experience mental illness, so that is not enough. Some GPs and midwives have the training and time to offer support; others are stretched far beyond capacity. Some have established mental health services to which to refer women; some are almost afraid to ask the right questions, because they do not trust that a referral will kick in.

The result is a postcode lottery, whereby a pregnant woman’s access to mental health support can depend on the NHS trust that she happens to fall under, but it is also a lottery that a woman is more likely to lose if she is black, Asian, young, or experiencing domestic violence, poverty or other forms of deprivation. As in so many areas of healthcare, pre-existing inequalities correlate with poorer outcomes. That is why this Bill matters: every woman, regardless of age, ethnicity, background or postcode, deserves the same standard of care and the same chance to be mentally well at that time in her life.

We are not starting from scratch. In the 10-year health plan, the Government have set out their determination and their plan to reorient our health system—away from treatment towards prevention, and away from hospitals towards the community. Ensuring that pregnant and new mums are mentally well is one of the ultimate acts of prevention, setting them and their children up for a healthy, productive future.

On mental health specifically, including better support for suicidal people, the Government have also made their commitment very clear, and have matched it with action. In the last year an additional 6,700 mental health professionals have been recruited, and £120 million is being invested in dedicated mental health emergency departments, ensuring that those in crisis can get help quickly. We are rolling out best start family hubs, a transformative initiative that will give families a single route into support services, including mental health services. My Bill builds on those commitments, but it focuses the mental health support at the very start of motherhood, when women need it most.

We are not starting from scratch in our understanding of good practice either. At a roundtable that I convened here in Parliament in September—bringing together NHS England, the Maternal Mental Health Alliance, the royal colleges, parents with lived experience and other experts—the message was united and clear: professionals want to help, but they need structure, time, and training to do it properly. The Royal College of Midwives has just published a road map for perinatal mental healthcare, which sets out what this could look like and is well worth a read.

Let me now turn to the detailed proposals in the Bill. It sets out a clear, practical framework for mental health assessments, and it has four core pillars. The first is to ensure that every pregnant woman has a structured, evidence-based and compassionate mental health assessment. While mental health check-ins must continue after the birth of a baby too, the evidence shows that outcomes are better when interventions happen sooner. That is why my Bill will focus on improving support in the antenatal period first. The assessment would form part of routine antenatal care; it would not be an extra. It would use validated tools such as the Whooley questions or the Edinburgh post-natal depression scale, adapted for pregnancy, and it would be rooted in NICE guidance, although that might need updating to ensure that better practice was embedded. Crucially, it would be delivered through trauma-informed conversations, not tick-box exercises. Staff would be trained to create a safe space for disclosure, recognising that women may have histories of trauma that affect their mental health during pregnancy, or may have no history of trauma or mental illness at all.

Secondly, the Bill would improve training and supervision for all professionals involved in maternity care. GPs, midwives, obstetricians, health visitors and community mental health practitioners all need the knowledge and confidence to ask the right questions, to do so compassionately and to recognise when something is not right. This Bill calls for a national training standard that will be endorsed by NICE and the royal colleges, and delivered across NHS trusts and integrated care boards. It should include regular clinical supervision, so that staff are supported to ask questions and make decisions safely. Importantly, the training must equip professionals to recognise and respond to the specific needs of women from diverse backgrounds—understanding cultural differences in how mental health is expressed and experienced, and addressing the stigma and barriers that prevent some women from seeking help.

Thirdly, this Bill sets out the need for clear referral pathways. Although midwives, GPs and others involved in routine maternity care should be equipped and able to identify mental health risks, they should not also be delivering specialist care when it is needed, so clear referral pathways into specialist mental health services are vital. The Maternal Mental Health Alliance recommends that a specialist perinatal mental health midwife be embedded in every maternity service to ensure that risks are identified and referrals made effectively. The appropriate support will be different for every woman, but one important option is the NHS Talking Therapies programme, to which I know the Government are committed. I have seen in my own constituency of Aylesbury how helpful that can be for women, and I urge NHS Talking Therapies services to consider women in the perinatal period a priority group for support. There are also fantastic voluntary services in communities across the country, such as PANDAS and many of those under the umbrella of the Hearts and Minds Partnership, yet many women are not made aware of them through their routine antenatal care, and they should be.

Fourthly, and finally, this Bill calls for clear accountability to ensure effective delivery of perinatal mental health assessments. NHS England and integrated care boards would be responsible for ensuring that local maternity systems introduce the single standardised assessment process, but then also, crucially, capture data through the maternity services dataset, allowing outcomes to be tracked. There must also be improved oversight of these services from the Care Quality Commission as part of its maternity inspections.

I hope my Bill’s aims are clear, and I hope that the Government and colleagues in this House will look upon them favourably. I know resources are tight across the NHS, and I know there are particularly acute challenges in many of our mental health and maternity services, including the national shortage of midwives, but I also know how transformative the relatively modest measures in this Bill could be for the women at the heart of the Bill and for our society. I believe that it could have made a difference for Sophie, and it could still make a difference for the many women who are struggling with their mental health now or who will do in future.

Ultimately, this Bill is about more than mental health care for women; it is about the kind of country that we want to be. When parents are mentally well, they thrive, their children thrive and our communities become places not of fear and insecurity, but of hope and opportunity. That is the kind of country that we want to be, and improved perinatal mental health care is such an important part of it. I commend this Bill to the House.

That Laura Kyrke-Smith, Paulette Hamilton, Sojan Joseph, Dr Danny Chambers, Liz Twist, Sarah Hall, Maya Ellis, Jen Craft, Michelle Welsh, Anna Sabine, Lee Pitcher, Dr Simon Opher present the Bill.

Laura Kyrke-Smith accordingly presented the Bill.