Meeting of the Parliament (Hybrid) 29 March 2022
I declare an interest as a practising national health service doctor.
Perinatal mental health problems can include mood disorders, depression, anxiety and even psychosis. Maternal suicide is the leading cause of maternal death between six weeks and a year after the end of pregnancy. Amazing work is done by the obstetrics teams on looking after the physical health of mums. If they are left untreated, however, perinatal mental health problems can have long-lasting effects, including on the mother’s relationship with her baby and other family members, and on the child’s cognitive and emotional development.
It is a huge problem; it is mainstream. Perinatal mental health problems affect about 20 per cent of women—one in five—in Scotland. The Scottish Conservatives welcome the Health, Social Care and Sport Committee’s report and recommendations, but let us be frank: the report paints a worrying picture of mental health services under the SNP-Green Government. Consistency, accessibility and structure are all seriously lacking.
The report also highlights the stresses on the midwifery profession from years of inadequate workforce planning. Call the midwife? Well, if only we could. Between 2009 and 2012, the then health secretary Nicola Sturgeon slashed nursing and midwifery training places by a fifth and cut 2,000 nursing jobs. NHS Education for Scotland reports that, as of September 2020, there are more than 3,200 nursing and midwifery vacancies.
The committee heard from Dr Mary Ross-Davie from the Royal College of Midwives, who said that recruitment is particularly difficult in remote and rural areas and that just three universities in Scotland provide pre-registration midwifery education. We are all experiencing some déjà vu: from general practitioners to anaesthetists, and from nurses to oncologists, the SNP-Green Government’s workforce planning has been abysmal.
However, it is not all about recruitment. What about retention? Dr Ross-Davie was, again, clear that decent working conditions and flexible working opportunities are not consistently available. When there are discussions about perinatal mental health and how services could be improved, midwifery is often sidelined or is not at the centre of descriptions of possible solutions.
The committee also heard evidence that access to services is a major barrier. Waiting lists can be long and support is often available only for acute cases. The British Medical Association told members that the bar for referral is set high. Under the SNP-Green Government, women are waiting more than the maximum six weeks from referral to accessing perinatal mental health services. The committee heard extensive evidence that that commitment has not, so far, been met.
Perinatal mental health services have traditionally focused on women who are pregnant or who have a living baby. That means that mothers whose babies have died do not meet the inclusion criteria. Bereaved parents have been invited to attend clinics in which they are surrounded by families who have living babies. Surely that should not be happening.
The committee also heard that there are no services that directly address birth trauma in Scotland, despite there having been an increase in women experiencing trauma at birth—an experience that my family and I underwent at the birth of our first child. In Scotland, there are two regional six-bed mother and baby units. It is clear—evidence agrees—that mothers do better with their relationship with their baby when they are in those units. I am glad to have heard the minister say that the Government is in listening mode. We are getting the first mother and baby unit in the north of Scotland, which is welcome for mothers who will not have to travel so far.
The report makes a host of recommendations across a wide range of themes, including access, mother and baby units, workforce recruitment and retention, birth trauma, baby loss and inequalities. Not all midwifery students get perinatal mental health training. Such training should be offered to all midwifery and nursing students as a priority. There should be progress updates on implementing workforce training, along with timescales. We should be aware that perinatal issues carry stigma in relation to disclosure—speaking out about the problem—so staff who are educated in that will be able to engage fully and discern problems.
As for access to services, the Government should implement specific preventative measures, such as automatic referrals for at-risk mothers.
There should be an update on any work that the Government is planning to do or that is under way, and we should be looking to improve how perinatal mental health services are viewed: we want them to be held in the same esteem as direct physical clinical care.
We also want to ensure that every health board has a specialist baby-loss unit. Those need to be sympathetically located within maternity units. Ideally, they should have a separate points of entry and exit, because we do not want people who have suffered loss to have to walk through areas where there are lots of people with their healthy babies.
The SNP-Green Government should ensure, as a matter of urgency, that every bereaved mother and parent who accesses maternity services is met by a specialist bereavement midwife.
The Scottish Conservatives would increase mental health funding to 10 per cent of the front-line health budget. We would kick-start a permanent shift towards community mental health services by expanding programmes such as cognitive behavioural therapy, social prescribing, exercise referral schemes and peer support.
The committee’s inquiry is a very important one. As we learned, it is clear that, despite the heroic efforts of our NHS staff, the SNP-Green Government urgently needs to overhaul perinatal mental health services if it is to adequately meet the needs of vulnerable women and their families.
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