Perinatal mental health issues: early recognition and management in primary care

Abstract

Learning objectivesYou should be able to participate confidently in the early detection of perinatal mental health conditions.• To identify and be aware of 'red flags' that constitute a psychiatric emergency.• To assess a mother's mental state more thoroughly.• To provide emotional support to families experiencing perinatal mental health problems and recognise the value of such interventions. What is perinatal mental health?Perinatal mental health refers to the mental and emotional health of parents during pregnancy and up to two years after a baby is born. This can include the worsening of an existing mental health condition, or the development of a new illness. Pregnancy and childbirth are major life events, with significant impact on physical and mental wellbeing. Up to 20 % of women are thought to be affected by perinatal mental health problems, with the most common being depression and anxiety (National Institute for Health and Care Excellence, (NICE), 2016). However as with other mental health statistics, this figure is likely to be higher due to underreporting of mental health problems.Perinatal mental health challenges do not just affect women. The challenging transition to parenthood impacts dads, mums, co-parents and intended parents. Post-natal depression is no longer exclusive to women, with an estimated 1 in 10 fathers experiencing post-natal depression (Hanley & Williams, 2020).If a child is born into a two-parent family unit, equal importance must be given to the wellbeing of both parents. However, partners are still often ignored or overlooked in preference to the childbearing parent (Hanley & Williams, 2020). This is something that all services and practitioners need to improve upon.There has been recent investment into specialist tertiary perinatal mental health services. The NHS five year forward view for mental health (Mental Health Taskforce, 2016) contained a clear objective for improving perinatal mental health services. A financial investment of £365 million up to 2020/21 was focused on increasing inpatient mother and baby (MBU) beds, and specialist community perinatal mental health teams. They boldly estimated that when implemented this would give 30,000 women access to evidence-based care closer to home. The truth of this claim is now up for debate as 2021 was the target date of full implementation.Whilst this investment is much welcomed and needed, it could be argued that it side-lines primary care services. NICE (2014) estimate that most women experience mild to moderate perinatal mental health