Possible gaps in NHS screening could be leaving pregnant women at risk of perinatal mental illnesses such as anxiety, depression, eating disorders, post-traumatic stress disorder and psychosis, a royal college has warned.
An analysis of NHS England data by the Royal College of Psychiatrists has suggested one in six NHS trusts is struggling to report if they are screening every pregnant woman for mental health issues at their 10-week antenatal appointment, as they should be doing in line with clinical guidelines.
For nearly a decade, since 2014, the National Institute for Health and Care Excellence (NICE) has recommended that all pregnant women are asked about their mental health history, family history of mental illness and risk factors for mental illness at the 10-week appointment.
This is a critical opportunity to identify women who may need professional mental health support during and following pregnancy, the college has emphasised.
An estimated one in five new and expectant mums develop perinatal mental illnesses, it has highlighted. Left untreated, these illnesses can have a devastating impact on the lives of the woman, their newborn child and other family members. Mental illness is the leading cause of maternal death in the first year after birth.
However, while NHS trusts do report on whether they are following the guidelines, this data has never been published.
Perinatal mental illness
The latest figures from NHS England show that 20 out of 122 NHS trusts providing antenatal services are still not fully reporting whether they are screening every pregnant woman for mental health issues in line with the clinical guidelines, the college has said.
With this week (1-7 May) being Maternal Mental Health Awareness Week, the college has called on NHS England urgently to publish this data to allow the wider profession to gauge whether NHS trusts are indeed offering this screening.
While the report does not specifically consider the role that occupational health professionals may be able to play in providing help, it stands to reason that access to workplace-based mental health support for pregnant employees could be useful.
It may be valuable for OH teams to be actively targeting mental health education and health promotion at their organisation’s pregnant employees. This could include highlighting the risk of perinatal mental illnesses, the importance of asking for help, what support is available, and signposting to workplace-based mental health resources, such as any employee assistance programme, apps or counselling.
Dr Trudi Seneviratne, consultant perinatal psychiatrist and registrar of the Royal College of Psychiatrists, said: “Every pregnant woman should be screened for mental health issues at their antenatal booking appointment.
“More than eight years after routine screening was first recommended, we still don’t know if NHS trusts are following the guidelines, and there is strong anecdotal evidence to suggest many women are missing out.
“Suicide and substance abuse are leading causes of maternal death in the first year following birth so it’s vital that women experiencing mental illness receive timely specialist support,” she added.
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Pregnant women, Dr Seneviratne warned, often suffer in silence for too long. “They are often embarrassed to ask for help, fearing people will view them as weak or unfit to be a mother,” she said.
“Some didn’t realise they were very unwell while others didn’t know how to get help. If you experience mental health issues during or following pregnancy, please don’t be embarrassed to ask for help. Speak to your GP or your midwife who can offer advice and, if appropriate, refer you to specialist mental health teams,” she advised.
