National study finds mixed level of perinatal mental health care in Scotland

The report, by the Mental Welfare Commission (MWC), found that, over a three month period, two thirds of postnatal women who needed to be cared for in hospital were treated in one of Scotland’s two specialist mother and baby units (one in Glasgow, the other in Livingston). Those women were positive about the specialist care they received, and they had their babies with them throughout their stay in hospital.

In contrast, a third of mothers who needed hospital care were treated in non-specialist mental health wards, without their babies. These women were less positive about their care, and were often separated from their babies for prolonged periods. Arrangements for a mother to have contact with her baby often depended on how often family members could bring the baby in to visit. The environment on those wards was often unsuitable for visits from children.

One year on from the NSPCC report ‘Getting it Right for Mothers and Babies – Closing the gaps in perinatal mental health services’, community services for women with perinatal mental ill health remain limited. Only five of Scotland’s 14 health boards offered a local specialist community mental health service.

Over 90% of (81) consultant psychiatrists across Scotland, surveyed as part of the report, said they would value local perinatal expertise when treating women during pregnancy and after childbirth.

Dr Gary Morrison, Executive Director (Medical) at the MWC, said: “National guidelines recommend that women with severe mental illness who need psychiatric admission late in pregnancy or within a year of childbirth, should be admitted to a specialist unit, unless there are specific reasons for not doing so.

“The Mental Health Act says they should be admitted to hospital with their baby.

“Our survey found that this was not always happening. One reason appears to be the difficult choice many women are faced with – whether to move away from their local community to be treated in a specialist unit, or whether to accept care in a non-specialist ward nearer home. This is a hard choice to make, and can put additional pressure on a mother, and on her family at home.

“Our report contains a number of recommendations for health boards and community mental health teams, including ensuring better training, better child-friendly facilities for families on general mental health wards, and better specialist community services.

“We also recommend that the Scottish Government create a national managed clinical network for perinatal mental health in Scotland. Doing this would allow a much greater sharing of expertise, and a better chance of any woman receiving good quality care, whether in hospital or at home.”

The Mental Welfare Commission surveyed all 43 general adult acute wards and 11 intensive care psychiatric units in Scotland from July to September 2015, to identify women receiving inpatient care who had given birth in the past year.   The Commission also collected data from both mother and baby units (MBUs). Forty four postnatal women received inpatient care during this period. The Commission carried out in-depth interviews with 23 of these women, and interviewed ward staff.

The Commission also surveyed consultant psychiatrists across the country, receiving 81 responses to an online questionnaire, and sought information on services from all of Scotland’s health boards, every one of which took part.

There are two specialist six-bedded units for women, in Glasgow and in Livingston. Over the last four years, the number of admissions to both MBUs combined has been in the region of 100 per annum.  According to regional birth rates across Scotland, some health boards are consistently under-referring women for MBU care.

The full report, entitled ‘Keeping mothers and babies in mind’, is on the MWC’s website.