Maternal mental health – treatment options in NZ

Maternal mental health is a big thing (most of my data comes from that link this time). Around 15% of pregnant women and new mothers will have some form of mental illness during the perinatal period (from conception through to baby’s first birthday). Floating around 60,000 births per year, that means a lot of mental illness for New Zealand women. 9,000-odd women will have some form of mental illness in the perinatal period. I’m not talking about the ‘baby blues’, either. This means serious mental illness – depression, anxiety, bipolar episodes, schizophrenia, and so on.

To deal with this there is a primary health care plan in place. General practitioners, lead maternity carers, Plunket nurses, and the like are trained to identify maternal mental illness and in many cases treat, whether with reassurance, various forms of support referral, or medication. For many mothers that’s what they need.

What happens when they need more? Well, that’s when it gets a bit hairy. There is no national secondary maternal mental health service co-ordination. Each DHB is on its own, and some do quite well, but some are all at sea. Many leave maternal mental health care at secondary and tertiary level to their regular emergency mental health teams, which does not really cover the special needs of a mother and child.

At the extreme end, some mothers really need inpatient treatment. There are two options for this, one vastly superior to the other. On the crappy hand, you can separate mother and baby while mother receives inpatient treatment – which can last weeks or months. On the better hand, you can have dedicated mother and baby mental health beds. This option is so much better for both mother and baby, as it keeps them together during a crucial phase of attachment and bonding.

We have five mother and baby beds here. Here being the entire country. Five.

Those five beds are located in Christchurch, and they are available to Southern DHB cluster mothers – women from the South Island. Around a quarter of New Zealanders live in the South Island. Northerner? Well, tough.

Around one or two in 1,000 mothers will experience post-partum psychosis. this is an incredibly serious mental health issue, one that really requires inpatient treatment, as the woman can be a danger to herself and others around her.

How do we deal with this? Honestly, I don’t know. Do we separate mothers and babies or do we leave seriously ill women to the care of their families – or lack of care, as the case may be? I suspect the former, but the latter would be horrifying. Some hope is on the horizon, though – maybe. The Healthy Beginnings paper that I linked to, released mid-2012, advocates the establishment of between 16 and 33 mother-baby beds around the country. On the other hand, the paper recognises that there is no new funding for any of its recommendations, so moving forward with them may be rather . . . doubtful.

The number of beds proposed for the country is still problematic. It’s enough to cover the national cases of post-partum psychosis – maybe. Just about. Where does that leave the mothers suffering from schizophrenia or a severe bipolar episode? They’re acutely unwell. And what about the severely depressed? They’re not able to care for themselves. Here, the families must come in.

Let me tell you a little story. When I had my first daughter, I ended up with pretty severe depression. Like, can’t dress myself not eating can’t care for baby depression. My partner was at university full-time, and worked weekends. My family were miles away (literally in Africa). In the evenings things were ok, I managed to cook for my partner and my flatmate because I had to, and somehow I pulled it together enough for that. During the day, though, I just couldn’t do it. I remember just holding my daughter and both of us crying until we were exhausted, then sleeping in a heap on the couch until it was time to do it all again.

My grandmother travelled an hour each way once a week to take me to do my groceries. But that was the extent of the support I received. I desperately needed care of some kind, but it was left up to my family and my family just could not provide the care I needed. And mine was bad, but not as bad as many. There are women who lie in a darkened room all day, feeding baby when it cries and managing little else, every day. They need better.

How do we deal with suicidal women? The ones who have come to the conclusion that their baby and their family is better off without them? The current answer is, we leave them to family care and hope, or we split them from their child. None of this is a good solution.

We don’t have mother-and-child respite care, where mum can go for a few days and be looked after a bit by nurses or social workers, and feel supported and start getting things back on track. There are some day programmes for mothers and babies run by Plunket and others, but there aren’t enough, and they’re not accessible to women who are too unwell to leave the house unaided.

We are failing the mentally ill mothers of this country. We have the beginnings of a good programme in that primary interventions are in place and work well, more or less. But we need higher level interventions to be available, and I’m sick of hearing ‘we don’t have the money’. We find the money for flag referendums, and we waste money on by-elections that didn’t need to happen. We fund a military, perks for retired MPs, ever-escalating MP salaries. Gather together some of these hundreds of thousands, these millions. We can find better uses for them.

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