Perinatal mental health problems carry a total economic and social long-term cost to society of about £8.1 billion for each one-year cohort of births in the UK, according to our report The costs of perinatal mental health problems written with the London School of Economics.

The cost to the public sector of perinatal mental health problems is five times greater than the cost of providing the services that are needed throughout the United Kingdom. So the NHS would need to spend just £337 million a year to bring perinatal mental health care up to the level recommended in national guidance.

The report is part of the Maternal Mental Health Alliance's ‘Everyone's Business' campaign, which calls on national Government and local health commissioners to ensure that all women throughout the UK who experience perinatal mental health problems, receive the care they and their families need, wherever and whenever they need it.

There is clear guidance from the National Institute for Health and Care Excellence (NICE) and other national bodies on the treatment of mental illness during and after pregnancy. Yet the current provision is best described as patchy, with significant variations in coverage around the country:

  • About half of all cases of perinatal depression and anxiety go undetected and many of those which are detected fail to receive evidence-based forms of treatment.
  • Specialist perinatal mental health services are needed for women with complex or severe conditions, but less than 15% of localities provide these at the full level recommended in national guidance and more than 40% provide no service at all.

The role of GPs in perinatal care

GPs have a distinctive role as family doctors, with a lifelong responsibility for the health of their patients, and now additionally as the commissioners of local health services in England. Yet current policy and practice guidance largely overlooks the role of GPs in offering improved mental health support to women during pregnancy and in the year after childbirth. 

The biggest barrier to providing better support to women experiencing poor mental health in the perinatal period is the low level of identification of need. There are a number of barriers, including:

  • Insufficient training and confidence among GPs
  • Poor awareness of perinatal mental illness among patients
  • A lack of contact between GPs and women during pregnancy and inconsistent team working between GP practices and midwives and health visitors
  • Time pressures on GP consultations
  • Significant inconsistencies and discontinuities in the system
  • Considerable stigma and a fear among women that their baby might be taken away if they admit their difficulties

Once a woman has asked for help and need has been identified, the way GPs and other professionals respond is then crucial to ensure women get the treatment and support they require. Many women find the range of options they are offered tended is narrow and often strongly reliant on prescribing. This may be related to a lack of faith described by GPs in the availability of timely help from local specialist services. Women who were referred quickly for psychological therapies found them helpful. But some had to wait a long time to get treatment and this required a great deal of persistence.

Women appeared most positive about the care they received when it felt personalised and integrated, when they were involved in making decisions about their care and when it was experienced as wrapping around their needs. But there was little evidence of most GPs linking women up with broader sources of support in the community.

What you can do - policy

The Government should commission a taskforce to examine how to ensure that NICE guidance on perinatal mental health is implemented in full during the 2015-2020 Parliament.

The Government and NHS England should take action to reduce pressure on general practice to enable longer consultations to be offered to women at risk of or with perinatal mental health problems.

The Government should commission targeted work to reduce stigma among women with perinatal mental health difficulties.

The Department of Health should ensure that there are more systematic opportunities to focus on the mental health and wellbeing of mother and infant before a child’s first birthday. This may include improved focus on mother and infant wellbeing by health visitors and practice nurses during the second half of the first year following birth. 

The Department of Health should identify opportunities to collect monitoring data to reinforce the importance of supporting mother and infant mental health and wellbeing.

Health Education England (HEE) should work with the RCGP Clinical Champion to support specific perinatal mental health training provision for qualified GPs.

Local Education and Training Boards and Deaneries should develop curriculum competences relating to perinatal mental health through their GP training programme and these competencies should be assessed by workplace-based training and Membership of the Royal College of General Practitioners (MRCGP) assessments.

What you can do - commissioning

NHS England and clinical commissioning groups should urgently address postcode inconsistencies in the availability of community specialist perinatal mental health teams/consultants and good quality integrated care pathways (ICPs) to support women with perinatal mental illness. 

Consistent with NICE guidance, clinical commissioning groups should ensure that local IAPT services fast track mothers with common perinatal mental health difficulties into treatment on the basis of the dual risks to mother and foetal/infant mental health. Waiting times should be routinely measured for this target group. GPs will also need to be made aware of fast tracking systems. 

Clinical commissioning groups should ensure that there is adequate commissioning of parent-infant interventions and that these are well-publicised to GP practices, to mothers and integrated within ICPs.

There are further steps to help local areas commission good perinatal services available on the everyonesbusiness website.