Hansard

As convener of the Health, Social Care and Sport Committee, I am pleased to open the debate and to speak about the committee’s inquiry into perinatal mental health. Throughout our inquiry, and even before it started, we heard from women, partners, grandparents, friends and healthcare professionals who were seeking support for their loved ones or women in their care with perinatal mental health issues.

Before I talk about findings, I would like to thank everyone who has been in touch with the committee. I thank all the individuals, organisations and professionals who responded to our call for views. We are particularly grateful to the families who shared their individual experiences with us in informal sessions and to the organisations—Aberlour, Fife Gingerbread, Home-Start Scotland and MindMosaic—that supported them to do so. I thank those mums and dads for their openness and honesty. We do not underestimate how much it might have taken for them to do that.

Perinatal mental health problems are mental health problems that occur during pregnancy and up to one year after a child’s birth. Attention to them is vital, not only because of the effect on the mother’s health but because they can affect a child’s emotional, mental and physical development and have a great wider family impact. Evidence has shown that perinatal mental health problems can have a far-reaching and long-lasting effect on individuals and their families. Mental health issues do not disappear a year after birth, but research shows that the specific timescales of the perinatal period represent a critical window of opportunity to address them. The period following childbirth is when women face the greatest risk of developing severe mental illness. Although perinatal mental health problems are not always avoidable or preventable, crucially, early recognition coupled with the right support and care can make a substantial difference.

We wanted our inquiry not just to shine a spotlight on people’s experiences but to create a floodlight. We wanted to help to cast out the stigma that is attached to poor perinatal mental health, which can prevent women from seeking help for fear of their children being taken away. Sadly, we heard that from quite a few women.

We want our health and social care services in Scotland to support people through their most difficult moments—to help them to cope with their circumstances by making sure that the right support structures are always in place for them.

During the inquiry, we heard sensitive and at times upsetting accounts of families in which that did not happen. We heard stories of women going through a stillbirth or miscarriage in a ward immediately next to parents giving birth to healthy babies. We still hear accounts of bereaved women who suffered baby loss and did not get the support that they needed.

We heard from a father who, following the death of his wife, experienced not only problems in accessing support services for his own mental health issues but frequent problems in accessing routine healthcare services for his baby. He told us that he felt that some services were geared up to supporting only mothers and tended to ignore fathers or not to have the right support available to them.

It is important to mention that a lot of that evidence came off the back of two years of a pandemic. We must always bear that in mind. It has been a time of unprecedented pressure for all health and social care services. During the pandemic, maternity services and infant feeding teams were prioritised and protected as essential services. Midwives, health visitors, obstetricians and the wider team continued to care for pregnant women, babies and families. However, they faced restrictions in what they could and could not do, and services were impacted, as might be expected. We heard concerning evidence that, in certain health board areas, many support mechanisms were withdrawn during the pandemic, which resulted in women facing extremely difficult situations alone.

No one should have to prepare for birth alone. When antenatal classes were withdrawn, those who could afford to pay a private provider received online support but, in some parts of Scotland, those who could not pay did not receive that support.

No one should have to attend prenatal scans or appointments alone, particularly when they might receive traumatic news, which is something that cannot be prepared for. Again, those who could afford private support could take partners to private scans, so that they could see their babies, but those who could not afford that were unable to do so.

No one should have to give birth alone, and no one should have to spend their first weeks or months with a new baby alone and isolated. However, over the past two years, as we have seen, countless women did all, most or at least some of those things alone. Moreover, they did so at a time of great uncertainty, when everyone around them was scared, including many health professionals, because we just did not know what we were dealing with.

Those negative experiences during the pandemic will undoubtedly have knock-on, on-going effects on the mental health of the women affected. Support organisations are already seeing a sharp rise in reports of birth trauma incidents during the pandemic.

The committee is clear that high-quality perinatal mental health services, including bereavement support, should be available throughout Scotland for everyone who needs it. There are also lessons to be learned from people’s experiences of maternity and perinatal care and support during the pandemic. Although, as I have said, the pandemic has had a direct impact on the provision of perinatal mental health services, some issues predate it and have been exacerbated by it. However, as a positive legacy from the pandemic, perhaps we can embrace the opportunity to resolve any longer-term issues and ensure that suitable support services are in place for future families and babies.

The committee’s report highlights several areas for improvement and action. We would like there to be equitable access to mother and baby units for new mothers with complex needs, and consistent access to specialist community perinatal mental health services for all mothers who need it, regardless of where in Scotland they live.

We would like there to be a service specification for perinatal mental health services as a mechanism for delivering better and more-joined up care.

Tackling poor mental health is a major public health challenge in Scotland and beyond. It is a priority for the Scottish Government, and we would like to ensure that there is continuity of perinatal mental health support through adult mental health services when those who are affected leave the specified perinatal period.

Having a well-trained and appropriately supported workforce is equally crucial to ensuring that individuals get the support that they need. Through our inquiry, we heard of staff shortages and a lack of time for staff to help women prepare for birth or to support them afterwards. We heard that there is a need to improve and increase the training that is available for healthcare professionals, in particular midwives and health visitors, on key areas such as specific mental health conditions that can impact on perinatal mental health; early detection of mental ill health; and support for breastfeeding, birth trauma and bereavement. That applies both to undergraduate and postgraduate educational settings and to continuous professional development in health boards.

As a committee, we welcome the Scottish Government’s commitment to introduce specialist baby loss units for parents who are going through miscarriage and stillbirth, but we would like new units to be established as a matter of urgency. In the interim, we would like women to be consistently treated with respect and compassion in a trauma-informed way, in an area that is separate from maternity wards. As standard practice, every bereaved parent should be met by a specialist bereavement midwife when they arrive at hospital.

I briefly touched on some areas of economic inequality that arose because of the pandemic. However, during the inquiry, we were very aware of other barriers to care and support for some women and families, in particular those in vulnerable groups. As I highlighted, we desperately need to address the issue of stigma around perinatal mental health to ensure that new mothers have the confidence to get the help and support that they need.

I am grateful to the Minister for Mental Wellbeing and Social Care and the Minister for Public Health, Women’s Health and Sport for their joint response to the committee’s report, which we received yesterday. From the response, we note the Scottish Government’s commitment to engaging with women and families to inform services and improve care and support, and we look forward to hearing further updates on the development of perinatal mental health service specification, regional provision and the options appraisal for mother and baby unit capacity.

I look forward to hearing further contributions during the debate, and I again thank the mothers and fathers who helped us in our work. We hope that, if they are watching the debate today, they feel that our recommendations reflect their experiences.