Meeting of the Parliament (Hybrid) 29 March 2022
I, too, thank the people who gave evidence to the committee and everyone who is working to improve perinatal mental healthcare in Scotland.
During evidence sessions, the committee heard about the importance of proactively identifying people who are experiencing or at risk of developing perinatal mental health problems. Health professionals who are in contact with people during their pregnancy journey must receive the training that they need to proactively identify such issues. The importance of upskilling the primary care workforce, in particular, was highlighted as a critical first step in building and embedding specialist services locally, as training for health visitors, GPs, midwives and maternity staff can assist with the early identification of perinatal mental health problems.
However, training is only one part of the puzzle. Healthcare staff having the capacity to do welfare checks is a major issue. The committee was told that preventative measures should be in place during birth, but that that would require having sufficient staff on duty who were trained in how to detect early warning signs.
Although someone should go to see parents straight after the birth to check how they are doing, that does not always happen at the moment. Six-week check-ups by GPs have not been happening during the pandemic, due to the incredible pressure that has been placed on practices. When checks happen, they tend to focus on the baby’s welfare alone.
Some people report that, when they were pregnant, there was a lot of concern for their wellbeing, but that, as soon as they gave birth, the focus shifted entirely to their baby. We must ensure that parents are supported throughout the process and that help is not suddenly withdrawn after the birth. Part of that is about ensuring that staff, including GPs, midwives and health visitors, have the time and training to proactively check for mental health issues.
The committee heard about the need for training for all healthcare professionals on how to offer bereavement care after pregnancy loss and baby death. Midwives are experienced in offering bereavement care, but families might come into contact with a variety of health professionals when undergoing pregnancy loss, not all of whom will have the same level of experience and knowledge as midwives. As the committee report makes clear,
“an appropriately trained and supported workforce is crucial to ensure individuals get the support they need.”
It was highlighted in evidence sessions that significant inequalities impact individuals’ experience of perinatal mental healthcare. The charity Sands mentioned the need for translators who are appropriately trained in bereavement care. The committee heard about scenarios in which, in the absence of trained translators, children and family members of non-English-speaking mothers were relied on to tell the mother that her baby had died. That is clearly unacceptable.
Much work is to be done to ensure that services are inclusive and accessible to all. In its briefing for today’s debate, Support in Mind Scotland pointed out that, although Scotland is considered to be one of the most LGBTI-inclusive countries in Europe, perinatal mental healthcare and services in Scotland currently exclude people with some gender identities who give birth. For example, trans men and non-binary people who are pregnant or postnatal can experience perinatal mental health issues and require tailored support for their needs but are likely to face barriers to accessing that.
As the committee’s report notes, it is vital that the development of perinatal mental health services is future proofed. Good quality data will be essential in identifying inequalities. During the evidence sessions, it became clear that we do not have sufficiently disaggregated data about who is accessing our specialist services, and so do not know how inclusive and accessible those services are. For example, ethnicity is not being adequately recorded in the antenatal period, so we are unable to identify disparities in care. That is extremely concerning, given that we know from an MBRRACE-UK report that black women are almost four times more likely to die in childbirth or during the postnatal period. Data collection must be improved if we are to address inequalities and ensure that care is truly person centred.
I conclude by again thanking those who gave evidence to the committee.
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