The 'Hidden' Illness of Post-Natal Depression

Artwork by Nick Scott

It started slowly, almost imperceptibly, when Evan was tiny. The worries about his health, his breathing, our bond. In snatches of sleep I'd be back on the caesarean table, asking the doctors if our baby, silent in the respirator, had made it. Their lack of answers, the silence, the three minutes that lasted eras, are still as vivid as life.

A few months after Evan was born, the panic spread to my days. I felt anxious, heavy, sick. A long-winded referral process through a health visitor recommended a support group. It started in four months. I didn't have four months. I called up a mental health coordinator. My call wasn't returned. In tears, I went to my GP, who suggested anti-depressants, dismissing my suggestion of having someone professional to talk to—I just needed someone to talk to—as the support "wasn't there."

Fifteen weeks after I first asked for help I found a different support group, by chance, at a children's center a mile from my house. Six months later, here I am, a different person entirely. I am white, middle-class, feisty, a first-time mom to a healthy baby boy, and someone who lives in an area rated 1—the top rating—on the UK Specialist Community Perinatal Mental Health provision map. I am also someone who nevertheless had to use all her resources, repeatedly, to get help with post-natal depression, as if it were an unknown, relatively easy condition. But it isn't.

Perinatal mental health illnesses (perinatal meaning the period between conception and the baby becoming a year old) are hugely common. They range from adjustment disorders and distress after becoming a parent, to depression that results in anxiety, fatigue, and persistent sadness both before and after birth, to post-traumatic stress disorder after traumatic births, as well as rarer, severe conditions like postpartum psychosis, which causes paranoia, delusions, and hallucinations. Most researchers agree that at least one in ten women are affected by perinatal mental health illnesses, which sounds hefty enough. Forego statistics for numbers, however—as Sally Hogg's 2013 NSPCC report Prevention In Mind did—and you find that an estimated 284,890 women are affected in England every year. That's more than a quarter of a million mothers—women, people—every year, in one country.

These numbers are staggering, but this is more so: in the UK, nearly half of all women live in an area with no perinatal mental health provision at all, and few of the services that exist elsewhere in the UK meet national quality standards as of April, 2015.

"An incredible amount of people are affected," confirms Sam Challis, Information Manager at Mind. So why the treatment gap? "The trouble is, pregnancy is often seen as a physical transition for the mother, rather than a physical and psychological transition. This is the main issue that needs to change, urgently." The amount of mental health training in medical fields rather than psychiatry being limited is also a factor, he adds. "There should be a mental health nurse in every maternity unit, and health visitors [the professionals who see parents in a baby's first year to assess a child's weight and development] should be trained much more rigidly. A mental health check for mothers should be divorced from the general social care check, too."

Then there's the stigma around mental health in maternity. Mothers are often reluctant to tell professionals how they're feeling because they worry they will be considered someone who can't look after their baby. Culture and advertising doesn't help: new parenthood is painted as hazy, soft-focus, and smothered in love, the torture of sleep deprivation and the leaden weight of new responsibility not being part of that picture. Everyone experiences this to some degree: I remember happy afternoons with my son followed by stressed, troubled nights, how exhaustion numbs your emotions, leaves you empty, absent, all gone.

Often, it's only the extreme, heartbreaking cases of perinatal mental health illness that are reported by the media. Like the case of Charlotte Bevan, the Bristol mother who left the hospital with her three-day-old daughter Zaani last December and committed suicide by jumping from the Avon Gorge. "These are rare cases," stresses Challis, "but they make many women feel this will happen to them, too."

It's important to note that a much bigger story lay behind this terrible tragedy: Bevan was a schizophrenic who already had a care team in place. The system failed her. An inquest is ongoing, but breakdowns in care and communication are likely to be part of that story—as is the case for so many other women.

Initiatives run by campaign groups and charities usually plug the gaps that professional services can't offer. One is Two in Mind, a pan-Welsh initiative that addresses how 70 percent of women in Wales have no access to support. Its website offers free cognitive behavioral therapy (CBT) courses for families entering new parenthood, and real-life video stories from parents. There is Sara, who had a miscarriage, then a ruptured uterus during her caesarean section; afterward she "felt empty and numb… with no feelings towards my baby." Lucy gets pregnant straightaway and reads every book she can during her complication-free pregnancy, but then feels "shell-shocked," "overwhelmed," not wanting to leave the house. Tabitha suffers after her partner abandons her during pregnancy and after birth; Mark's wife has post-natal depression, before he develops it, too (which shows just how psychological a transition parenthood is, divorced from the physical experience).

Two in Mind's approach to perinatal mental health addresses something many services fail to, explains Project Manager Jenny Burns. "We are [often] dealing with two people here—the mum or main carer and her emotional wellbeing, and the baby and his or her wellbeing. The 'client,' or 'patient,' cannot be divided up or separated." The initiative's "Enjoy Your Baby" courses are freely accessible online and shared with local Mind offices, as well as third party charities and statutory services. The site has also had visitors from around the world, which Burns is delighted by.

Her proudest achievement is personal, though. First-hand, she has watched a teenage single mom—once struggling with anxiety, low self-esteem, and moving back home—engage with the project as a volunteer and recover remarkably. "Over the past year I have watched her blossom in confidence in her abilities and skills as a parent," Burns beams. "More than that, she has now approached her local Flying Start [early years] school and persuaded them to take her on one day a week as a student occupational therapist. Remarkable!" Engagement with accessible resources genuinely changes lives.

There are many other impressive organisations doing similar work, such as national charity PANDAS (Pre and Postnatal Depression Advice and Support), which offers online resources and a dedicated helpline, and local groups run by women who have experienced perinatal mental health illnesses themselves. Two notable examples are Mothers for Mothers in Bristol and House of Light in Hull. But a national approach is slowly being implemented too, thanks to one active, flag-waving umbrella coalition.

The Maternal Mental Health Alliance [MMHA]—an alliance of professional bodies, patient organizations and charities—launched a project last July called Everyone's Business, funded for two years by Comic Relief. The title is simple, short, all-embracing, perfect, addressing how PND shouldn't be marginalized as a "women's issue," but recognized as something that can affect relationships, lives, and even the wider economy.

Last October, a MMHA report conducted in association with the London School of Economics revealed that £8.1 billion ($12.2 billion) is lost every year from women and their children not getting support during the perinatal period. At first, the analysis of mental health repercussions in economic terms feels like a chilly, Ballardian way of measuring impacts on women's lives. However, look closer at the MMHA's work and you see it's about making women be considered as vital cogs within wider society.

"There are lots of needy causes out there," explains Maria Bavetta, Campaign Communications Officer of the MMHA, "so we had to go in with an approach that balances hard facts with our arguments, that affected both hearts and minds." There are many real-life stories on their site as well, including the tragic story of Joe, who wasn't offered dedicated support for severe PND after suffering several miscarriages, and then committed suicide when her daughter was a few months old; and of Sally, who feels like she only survived after seeking out volunteer-run support. "If you broke your arm you would go to the hospital to get it 'fixed,' but mental health doesn't have that luxury," she writes. It's a sentiment that echoes through every story, and pulses fiercely through my own experience.

Since last July, the MMHA has been working with the Department of Health and the Royal College of GPs on these issues—indeed, the latter has just made perinatal mental support one of their priorities for 2015, so doctors like mine might start to change their behaviors. Their approach is centered around raising what they call ACT: Accountability for perinatal mental health care being clearly set at a national level, and complied with; Community specialist services meeting national quality standards and being available for women nationwide; and Training in perinatal mental health being delivered to all professionals involved in the care of women during pregnancy and the first year after birth. George Osborne also announced £75 million over the next five years for perinatal mental health services in the March mini-budget—something cynics might think has the ring of mom-courting electioneering about it, but at least acknowledges the issues and pushes things in the right direction.

"Osborne also actually mentioned it in his speech, which is good," adds Bavetta. "It's important that issues like this are mentioned out loud—that helps them to be normalized." And then she says the most important thing of all: "We have to give women permission that it's OK to feel this way, and that it's OK to speak about it, for them to know that it's common and that they can get help—and know exactly where to get it."

If you are concerned about your mental health or that of someone you know, visit the Mental Health America website.

@juderogers

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