Meeting of the Parliament (Hybrid) [Draft]
Meeting date: Tuesday, March 29, 2022
Agenda: Time for Reflection, Topical Question Time, Perinatal Mental Health, Scottish Local Government Elections (Candidacy Rights of Foreign Nationals) Bill: Stage 1, Business Motion, Decision Time, Commonwealth Day 2022
- Time for Reflection
- Topical Question Time
- Perinatal Mental Health
- Scottish Local Government Elections (Candidacy Rights of Foreign Nationals) Bill: Stage 1
- Business Motion
- Decision Time
- Commonwealth Day 2022
Perinatal Mental Health
The next item of business is a Health, Social Care and Sport Committee debate on perinatal mental health. I ask members who wish to speak in the debate to press their request-to-speak button now. I call Gillian Martin to speak on behalf of the committee.14:27
As convener of the Health, Social Care and Sport Committee, I am pleased to open the debate and to speak about the committee’s inquiry into perinatal mental health. Throughout our inquiry, and even before it started, we heard from women, partners, grandparents, friends and healthcare professionals who were seeking support for their loved ones or women in their care with perinatal mental health issues.
Before I talk about findings, I would like to thank everyone who has been in touch with the committee. I thank all the individuals, organisations and professionals who responded to our call for views. We are particularly grateful to the families who shared their individual experiences with us in informal sessions and to the organisations—Aberlour, Fife Gingerbread, Home-Start Scotland and MindMosaic—that supported them to do so. I thank those mums and dads for their openness and honesty. We do not underestimate how much it might have taken for them to do that.
Perinatal mental health problems are mental health problems that occur during pregnancy and up to one year after a child’s birth. Attention to them is vital, not only because of the effect on the mother’s health but because they can affect a child’s emotional, mental and physical development and have a great wider family impact. Evidence has shown that perinatal mental health problems can have a far-reaching and long-lasting effect on individuals and their families. Mental health issues do not disappear a year after birth, but research shows that the specific timescales of the perinatal period represent a critical window of opportunity to address them. The period following childbirth is when women face the greatest risk of developing severe mental illness. Although perinatal mental health problems are not always avoidable or preventable, crucially, early recognition coupled with the right support and care can make a substantial difference.
We wanted our inquiry not just to shine a spotlight on people’s experiences but to create a floodlight. We wanted to help to cast out the stigma that is attached to poor perinatal mental health, which can prevent women from seeking help for fear of their children being taken away. Sadly, we heard that from quite a few women.
We want our health and social care services in Scotland to support people through their most difficult moments—to help them to cope with their circumstances by making sure that the right support structures are always in place for them.
During the inquiry, we heard sensitive and at times upsetting accounts of families in which that did not happen. We heard stories of women going through a stillbirth or miscarriage in a ward immediately next to parents giving birth to healthy babies. We still hear accounts of bereaved women who suffered baby loss and did not get the support that they needed.
We heard from a father who, following the death of his wife, experienced not only problems in accessing support services for his own mental health issues but frequent problems in accessing routine healthcare services for his baby. He told us that he felt that some services were geared up to supporting only mothers and tended to ignore fathers or not to have the right support available to them.
It is important to mention that a lot of that evidence came off the back of two years of a pandemic. We must always bear that in mind. It has been a time of unprecedented pressure for all health and social care services. During the pandemic, maternity services and infant feeding teams were prioritised and protected as essential services. Midwives, health visitors, obstetricians and the wider team continued to care for pregnant women, babies and families. However, they faced restrictions in what they could and could not do, and services were impacted, as might be expected. We heard concerning evidence that, in certain health board areas, many support mechanisms were withdrawn during the pandemic, which resulted in women facing extremely difficult situations alone.
No one should have to prepare for birth alone. When antenatal classes were withdrawn, those who could afford to pay a private provider received online support but, in some parts of Scotland, those who could not pay did not receive that support.
No one should have to attend prenatal scans or appointments alone, particularly when they might receive traumatic news, which is something that cannot be prepared for. Again, those who could afford private support could take partners to private scans, so that they could see their babies, but those who could not afford that were unable to do so.
No one should have to give birth alone, and no one should have to spend their first weeks or months with a new baby alone and isolated. However, over the past two years, as we have seen, countless women did all, most or at least some of those things alone. Moreover, they did so at a time of great uncertainty, when everyone around them was scared, including many health professionals, because we just did not know what we were dealing with.
Those negative experiences during the pandemic will undoubtedly have knock-on, on-going effects on the mental health of the women affected. Support organisations are already seeing a sharp rise in reports of birth trauma incidents during the pandemic.
The committee is clear that high-quality perinatal mental health services, including bereavement support, should be available throughout Scotland for everyone who needs it. There are also lessons to be learned from people’s experiences of maternity and perinatal care and support during the pandemic. Although, as I have said, the pandemic has had a direct impact on the provision of perinatal mental health services, some issues predate it and have been exacerbated by it. However, as a positive legacy from the pandemic, perhaps we can embrace the opportunity to resolve any longer-term issues and ensure that suitable support services are in place for future families and babies.
The committee’s report highlights several areas for improvement and action. We would like there to be equitable access to mother and baby units for new mothers with complex needs, and consistent access to specialist community perinatal mental health services for all mothers who need it, regardless of where in Scotland they live.
We would like there to be a service specification for perinatal mental health services as a mechanism for delivering better and more-joined up care.
Tackling poor mental health is a major public health challenge in Scotland and beyond. It is a priority for the Scottish Government, and we would like to ensure that there is continuity of perinatal mental health support through adult mental health services when those who are affected leave the specified perinatal period.
Having a well-trained and appropriately supported workforce is equally crucial to ensuring that individuals get the support that they need. Through our inquiry, we heard of staff shortages and a lack of time for staff to help women prepare for birth or to support them afterwards. We heard that there is a need to improve and increase the training that is available for healthcare professionals, in particular midwives and health visitors, on key areas such as specific mental health conditions that can impact on perinatal mental health; early detection of mental ill health; and support for breastfeeding, birth trauma and bereavement. That applies both to undergraduate and postgraduate educational settings and to continuous professional development in health boards.
As a committee, we welcome the Scottish Government’s commitment to introduce specialist baby loss units for parents who are going through miscarriage and stillbirth, but we would like new units to be established as a matter of urgency. In the interim, we would like women to be consistently treated with respect and compassion in a trauma-informed way, in an area that is separate from maternity wards. As standard practice, every bereaved parent should be met by a specialist bereavement midwife when they arrive at hospital.
I briefly touched on some areas of economic inequality that arose because of the pandemic. However, during the inquiry, we were very aware of other barriers to care and support for some women and families, in particular those in vulnerable groups. As I highlighted, we desperately need to address the issue of stigma around perinatal mental health to ensure that new mothers have the confidence to get the help and support that they need.
I am grateful to the Minister for Mental Wellbeing and Social Care and the Minister for Public Health, Women’s Health and Sport for their joint response to the committee’s report, which we received yesterday. From the response, we note the Scottish Government’s commitment to engaging with women and families to inform services and improve care and support, and we look forward to hearing further updates on the development of perinatal mental health service specification, regional provision and the options appraisal for mother and baby unit capacity.
I look forward to hearing further contributions during the debate, and I again thank the mothers and fathers who helped us in our work. We hope that, if they are watching the debate today, they feel that our recommendations reflect their experiences.14:37
I am pleased to respond to the debate on behalf of the Scottish Government. I thank the convener and members of the Health, Social Care and Sport Committee for raising much-needed awareness of perinatal mental health through the inquiry. I offer thanks in particular to all those who made the effort to contribute through the consultation and the evidence sessions.
As I acknowledged when I gave evidence, the importance of perinatal mental health right now in Scotland has been demonstrated by the impressive range of responses and engagement from professionals, organisations and individuals with lived experience. The inquiry has opened the door further to conversations about mental wellbeing both during the perinatal period and more widely. In doing so, it helps us to further reduce stigma and actively promote awareness. It also helps us to ensure that our work is aligned with the core values of the women and families maternal mental health pledge.
That is especially important at present, as we acknowledge the impact that the pandemic has had on the mental health of new and expectant parents. Since 2019, the programme board has provided strategic oversight of significant investment across community perinatal mental health services, the third sector, mother and baby units, infant mental health services and maternity and neonatal psychological interventions. More than £16 million has been invested across Scotland, and as a result 10 boards now have specialist community perinatal mental health teams and eight have maternity and neonatal psychological intervention services. We continue to work with boards on developing services further on a local and regional basis to ensure that specialist support is available across all areas of Scotland by March next year.
With regard to the third sector, we have delivered more than £1.8 million of funding, which has led to the delivery of support to more than 3,000 parents, expectant parents and infants. An emerging evaluation shows that the funded work has contributed to parents feeling less isolated and better able to meet the needs of their infants and children.
The programme board will continue to ensure that lived experience is at the heart of service development, implementation and provision. We now have two dedicated participation officers who offer support around perinatal mental health, infants, fathers and equalities. That helps us to ensure that the significant upscaling of existing services and creation of new services are led by the needs of women and families.
One way in which we are listening to the voices of women and families is through our consultation on options to increase mother and baby unit capacity. The issue of how best to support access to that specialist resource is important; the committee picked up on it in its report. We are very much in listening mode on the issue and I encourage anyone who is interested to respond to the consultation, so that a wide range of views can inform the next steps.
I know from conversations with women and families that the location of mother and baby units is of particular concern in the north of Scotland. I am therefore pleased to note that a specialist perinatal mental health community service will launch in Grampian shortly. The service will provide a specialist, multidisciplinary community service to women and families in the north-east and is part of the funding and development work that the perinatal and infant mental health programme board supports.
I recently visited the new service in Aberdeen and spoke to staff and women with lived experience. I know how much difference it will make to families in Grampian.
I want to talk about the committee’s report and recommendations. As the committee is aware and as the convener said, we responded yesterday to the committee’s recommendations—our response was comprehensive. The report contained a broad variety of recommendations, which we considered in depth, and I want to highlight the difference that the recommendations and the continuation of the programme board’s work will make to women, infants and families in Scotland.
We are taking steps to ensure that the service landscape is more accessible to families who need support. That includes work to increase awareness of care pathways and highlight developments in specialist services, and a restatement of our commitment to the rights of women, infants and families.
We are prioritising raising awareness of perinatal and infant mental health and ensuring that families and professionals play an active role in our national work on stigma reduction.
We are supporting local areas to provide seamless transitions for families by tackling difficult issues to do with cross-sector working, so that families can more easily access the right support at the time when they need it.
Finally, we will ensure that our work continues to be informed by evidence and lived experience, by evaluating and assessing the difference that our investment is making to the lives of women, infants and families throughout Scotland.
The inquiry recommendations touch on other areas, such as maternity provision, breastfeeding and baby loss. The Government acknowledges the importance of support across pregnancy, birth and the postnatal period and is committed to supporting mental health and wider wellbeing throughout that time.
Our work around perinatal mental health is action focused and ambitious. We are committed to ensuring that the input to the committee’s inquiry, alongside the findings and recommendations that followed the inquiry, are respected and valued as they further support and inform our continuing programme of work.
Sandesh Gulhane joins us remotely.14:44
I declare an interest as a practising national health service doctor.
Perinatal mental health problems can include mood disorders, depression, anxiety and even psychosis. Maternal suicide is the leading cause of maternal death between six weeks and a year after the end of pregnancy. Amazing work is done by the obstetrics teams on looking after the physical health of mums. If they are left untreated, however, perinatal mental health problems can have long-lasting effects, including on the mother’s relationship with her baby and other family members, and on the child’s cognitive and emotional development.
It is a huge problem; it is mainstream. Perinatal mental health problems affect about 20 per cent of women—one in five—in Scotland. The Scottish Conservatives welcome the Health, Social Care and Sport Committee’s report and recommendations, but let us be frank: the report paints a worrying picture of mental health services under the SNP-Green Government. Consistency, accessibility and structure are all seriously lacking.
The report also highlights the stresses on the midwifery profession from years of inadequate workforce planning. Call the midwife? Well, if only we could. Between 2009 and 2012, the then health secretary Nicola Sturgeon slashed nursing and midwifery training places by a fifth and cut 2,000 nursing jobs. NHS Education for Scotland reports that, as of September 2020, there are more than 3,200 nursing and midwifery vacancies.
The committee heard from Dr Mary Ross-Davie from the Royal College of Midwives, who said that recruitment is particularly difficult in remote and rural areas and that just three universities in Scotland provide pre-registration midwifery education. We are all experiencing some déjà vu: from general practitioners to anaesthetists, and from nurses to oncologists, the SNP-Green Government’s workforce planning has been abysmal.
However, it is not all about recruitment. What about retention? Dr Ross-Davie was, again, clear that decent working conditions and flexible working opportunities are not consistently available. When there are discussions about perinatal mental health and how services could be improved, midwifery is often sidelined or is not at the centre of descriptions of possible solutions.
The committee also heard evidence that access to services is a major barrier. Waiting lists can be long and support is often available only for acute cases. The British Medical Association told members that the bar for referral is set high. Under the SNP-Green Government, women are waiting more than the maximum six weeks from referral to accessing perinatal mental health services. The committee heard extensive evidence that that commitment has not, so far, been met.
Perinatal mental health services have traditionally focused on women who are pregnant or who have a living baby. That means that mothers whose babies have died do not meet the inclusion criteria. Bereaved parents have been invited to attend clinics in which they are surrounded by families who have living babies. Surely that should not be happening.
The committee also heard that there are no services that directly address birth trauma in Scotland, despite there having been an increase in women experiencing trauma at birth—an experience that my family and I underwent at the birth of our first child. In Scotland, there are two regional six-bed mother and baby units. It is clear—evidence agrees—that mothers do better with their relationship with their baby when they are in those units. I am glad to have heard the minister say that the Government is in listening mode. We are getting the first mother and baby unit in the north of Scotland, which is welcome for mothers who will not have to travel so far.
The report makes a host of recommendations across a wide range of themes, including access, mother and baby units, workforce recruitment and retention, birth trauma, baby loss and inequalities. Not all midwifery students get perinatal mental health training. Such training should be offered to all midwifery and nursing students as a priority. There should be progress updates on implementing workforce training, along with timescales. We should be aware that perinatal issues carry stigma in relation to disclosure—speaking out about the problem—so staff who are educated in that will be able to engage fully and discern problems.
As for access to services, the Government should implement specific preventative measures, such as automatic referrals for at-risk mothers.
There should be an update on any work that the Government is planning to do or that is under way, and we should be looking to improve how perinatal mental health services are viewed: we want them to be held in the same esteem as direct physical clinical care.
We also want to ensure that every health board has a specialist baby-loss unit. Those need to be sympathetically located within maternity units. Ideally, they should have a separate points of entry and exit, because we do not want people who have suffered loss to have to walk through areas where there are lots of people with their healthy babies.
The SNP-Green Government should ensure, as a matter of urgency, that every bereaved mother and parent who accesses maternity services is met by a specialist bereavement midwife.
The Scottish Conservatives would increase mental health funding to 10 per cent of the front-line health budget. We would kick-start a permanent shift towards community mental health services by expanding programmes such as cognitive behavioural therapy, social prescribing, exercise referral schemes and peer support.
The committee’s inquiry is a very important one. As we learned, it is clear that, despite the heroic efforts of our NHS staff, the SNP-Green Government urgently needs to overhaul perinatal mental health services if it is to adequately meet the needs of vulnerable women and their families.14:51
I am pleased to open for Scottish Labour and to welcome the Health, Social Care and Sport Committee’s report into perinatal mental health, which is an overlooked and important subject that requires much greater attention, as was acknowledged by the committee in its report.
The report exposes a great number of problems that we must address, as a Parliament and as a country. Significant concerns are contained within the report. Those concerns expose the Scottish Government’s far from ideal record on supporting women who experience perinatal mental health problems. I hope and trust that some of those concerns can be addressed today.
In many parts of Scotland, there is a complete lack of accessible mother and baby units, which are vital in ensuring positive perinatal mental health. Furthermore, the report highlights that there is completely inconsistent access to specialist community perinatal mental health services across the country, which we have heard about. As is the case with so many things in our health service, it seems that there is a significant postcode lottery in access to this facet of healthcare. Generally, and despite its positive rhetoric concerning mental health, the Scottish Government is simply not doing enough to address this particular concern from mothers.
Women should not have to wait more than six weeks for initial referral to perinatal mental health services. It appears that, like for so many other targets, that was just a shot in the dark and that very little planning or funding was put in place to meet the target.
Another familiar story is the problem of recruitment and retention of staff—in this case, midwives, who are a cornerstone of our entire health service. Not only do we need more midwives; we need more who have the training that is necessary to deal with the very specific nature of perinatal mental health problems.
One account that is in the committee report, from a member of the Royal College of Midwives, was particularly concerning. I will quote this, because it is important that we hear from the staff. The respondent said:
“I cannot remember the last time we had safe staffing within our unit. On a daily basis, we are struggling to provide a decent standard of care to our women and their families.
I am an experienced midwife and am considering [leaving] the profession because I can’t keep working under the high levels of stress. The continuous staff shortages [are] horrendous and make me worry that errors and mistakes could be made.”
That says everything that we need to know about the strain that so many midwives are under.
The report notes:
“The British Medical Association highlighted that the demand placed on midwives on overstretched postnatal wards resulted in pressing clinical needs taking precedence over emotional and psychological needs.”
If we cannot properly fund, train and retain more midwives with the necessary skills, that problem will continue, and hard-working staff will continue to consider leaving the profession.
In closing, I say that Scottish Labour has genuine concerns regarding the Scottish Government’s ability to meet basic waiting time targets and to recruit, train and retain adequate numbers of staff. That was demonstrated by recent statistics that show that there are more than 6,600 whole-time equivalent nursing and midwifery vacancies across Scotland, 128 of which are in midwifery. For such an important role, that is very concerning. We must tackle the number of vacancies in midwifery. To address that, Scottish Labour is calling on the Scottish Government to update Parliament on its progress in implementing the 28 recommendations from the report, “Delivering Effective Services: Needs Assessment and Service Recommendations for Specialist and Universal Perinatal Mental Health Services”, which was published in 2019. We have not heard a lot since then.
My party believes that we must, in the short term, provide specific support to women who experience postnatal depression as part of a much wider increase in mental health spending. We need to improve breastfeeding support work by providing a home visit in the first week that a baby spends at home, and we need to carry out further consultation to ensure that women’s needs are met. We should also launch a “babies meet babies” programme to promote socialisation and interaction by bringing together parents and carers of babies.
Those are effective and important steps that could be taken relatively soon and would immediately have an impact in improving perinatal mental health in Scotland. I hope that the Scottish Government will endeavour to consider those ideas and address them in its response and in taking forward the core actions that the report suggests.14:56
I commend the committee on its work on this vital issue, and I am pleased to rise for my party to speak in the debate. Scottish Liberal Democrats were proud to be the first party in the Parliament to set out a comprehensive and dedicated strategy for improving detection and treatment of maternal mental health issues. It was gratifying when the Government adopted much of that blueprint.
However, despite the good work that has been done in the area and the good progress that has been made, there sadly continues to be a postcode lottery for perinatal mental health services in Scotland. Women across Scotland cannot afford the Government resting on its laurels on the issue. Protecting mothers and giving newborn babies the best possible start in life has to be an absolute priority—not just for the Government but for every party in the Parliament.
Having a child is a life-changing event, but for many people, sadly, that change is not as straightforward as they had assumed it might be. The impact on the mental health and wellbeing of mothers can be huge. Perinatal mental illness affects thousands of women across Scotland; we have heard about some of that in the debate. It can have a crippling impact on their daily lives and can, in some cases, even threaten their lives.
The most recent report that we have was conducted by Embrace UK in 2015 and it paints a very bleak picture. It found that almost a quarter of women who died between six weeks and one year after pregnancy died from mental health-related causes. That equates to one in seven women dying by suicide, which makes it the leading cause of death among new mothers, as we heard from Dr Gulhane. That statistic serves, as much as anything, to illustrate the need to support those women in the most effective ways possible.
The necessity for that has only increased in recent years. As a result of the isolation that mothers have had to deal with in pregnancy and immediately after childbirth during the pandemic, many more have suffered. I have raised the issue several times with the First Minister, particularly in relation to the virtual coffee mornings that I have had with isolated new mums. As a result of the cost of living crisis, which is piling on yet more strain, uncertainty is further mixed with anxiety.
It is clear that early intervention to support new mothers who are struggling is the most effective way of alleviating a potential crisis before it takes hold. That has led to some third sector organisations setting up specific perinatal mental health services. The numbers of women who are coming forward for support is increasing, and we should be glad of that. The children and families charity Aberlour Child Care Trust, for whom I worked prior to being elected, has reported that referrals to its perinatal service have continued to rise since its inception in 2016.
However, all too often in Scotland, the support that women can expect to receive depends on where in the country they happen to live. Currently, Scotland’s only mother and baby units that specialise in perinatal mental health care are in the central belt, which creates a significant barrier for women who live in rural areas, and highlights the need to prioritise digital inclusion, which would allow women to access online services from home.
Third sector organisations are doing a marvellous job of plugging the gaps in provision and getting help to the people who need it, but they need to know that they will have access to adequate funding for the long term. There must be no danger of their having to cease the brilliant support that they provide because of a lack of core-cost recovery.
It is also important to note the impact of perinatal mental illness on babies themselves and, subsequently, on older children if illness is not addressed early on. Evidence has shown the devastating effect that poor maternal mental health can have on children’s behaviour, development and ability to learn and grow in order to achieve their full potential. The stakes are really high.
I will finish with a quotation from a woman who, in her time of need, was able to access the perinatal mental health service that is offered by Aberlour Child Care Trust during the pandemic. She referenced the amazing relationships that she forged there. She said:
“Some people arrive and make such a beautiful impact on your life, and they don’t even know. You can barely remember what it was like without them.”
Let us ensure that, now and in the future, every mother in Scotland who is need of such personal and heartfelt support can get it when and where they need it.
Natalie Don joins us remotely.15:01
I was very pleased to see the committee undertaking the inquiry and I am thankful to be included in the debate. This is a matter that is very important to me, as it is to many. Given my own experience, I want to focus on perinatal mental health during lockdown, which I know the committee has picked up on.
There should always be a focus on perinatal mental health services and support, but the issues have been hugely exacerbated by the pandemic. I welcome the actions that the Scottish Government is already taking through the perinatal and infant mental health delivery plan. In light of the details that the minister laid out, I know that that is a priority.
Pregnancy in itself is tough, and dealing with postnatal depression complications, a difficult birth or, at the very worst, loss is difficult during normal times, but it is even harder during a pandemic. My daughter was two months old when the first lockdown restrictions began. I count myself lucky that I experienced a few weeks of normality, but it was not long before I and many others were plunged into a world of solitary confinement with our new babies. At times, that was a blessing, and I know many new parents—myself included—who enjoyed bonding with their baby a lot of the time. However, anyone who remembers the intensity of being a new parent will, I hope, understand how hard it was at times.
Please ignore my cat, which appeared there—I am sorry about that.
People were stuck at home in the depths of exhaustion, up during the night with no chance of a breather in the morning, and with absolutely no one there to let them know that they are doing it right and being a good parent. There was no popping round to their mum’s or their friend’s to ask for advice. All the things that pregnant women and new parents took for granted were gone. There was less contact with health visitors and GPs. Baby classes and support groups stopped, which meant no social interaction with other mums. There was no opportunity to make connections and no interaction for the baby.
Breastfeeding support during lockdown was limited—that has been touched on. That was especially difficult. I thank the Breastfeeding Network volunteers and the community, which continued to offer much-needed support. I welcome any moves to tailor support and further support women in their breastfeeding journeys.
That all accumulated and led to feelings of loneliness and isolation, and that is enough to impact on the mental health of any pregnant woman or new mother. For mums who were experiencing postnatal depression, lockdown only served to compound and magnify it. My heart truly goes out to those who experienced loss during the period. It is vital that we continue to ensure that services are there for people who miscarry and experience loss. I am confident that we are working towards that.
I am pleased to see a focus on stigma in the committee’s recommendations. There is much pressure on new mums with the idea of perfect parenting. With the world opening back up again, many women and, indeed, parents who have suffered in silence may now be hesitant to open up. We need to encourage them to do so.
I want to highlight the importance of baby classes and support networks, which continued through lockdown. Local baby groups put a great effort into keeping a little bit of normality in the lives of new parents. Logging on to Facebook Live in the morning and seeing messages from other mums and babies gave us all that little feeling of interaction. I am very thankful to the groups throughout Scotland that put so much effort into keeping that going. We need to recognise the importance of those groups, which have been on the front line as an essential service for new parents, and we need to work with them and improve access to them for all parents who, perhaps through financial difficulties, might not be able to afford to attend some of those classes.
Conversations in such settings are so important, whether they are about sleep schedules, feeding or what a little one had for breakfast. That can be all the interaction that a new mum needs to help her through her day. Such settings could be vital in reducing stigma, improving new parents’ mental health and helping women to open up.
I welcome the plans for perinatal mental health and look forward to progress being made on the committee’s recommendations. We should always choose to support and invest in such services. The lockdown magnified that need even more, and I have no doubt that all that I have described has made many pregnant women and new mums more withdrawn and anxious. We owe it to a whole generation of women and parents out there to make this right, ensure that support is available and ensure that our children’s early development remains a priority for the Scottish Government.
Thank you, Ms Don. I apologise for not telling your cat that there should be no interventions or interruptions during your speech.15:05
I am pleased to take part in this debate on perinatal mental health and I thank the committee for its report. I am told that having a baby can be the happiest period in someone’s life, but it can also be the most difficult. As those with lived experience know, mental health issues can come from anywhere during pregnancy. The impact can be serious on expectant mothers and those who have given birth.
Mothers who are pregnant or who have recently given birth can develop feelings of sadness and depression. Mothers can feel guilty and confused. Many mothers hope to feel the glow of pregnancy; they expect to look back fondly on that period of their life. Sadly, as Natalie Don said, that could not be further from the truth for many women and for the partners and families who support them.
In Scotland, perinatal mental health problems affect up to one in five new and expectant mothers. As we have heard, that covers a range of conditions, including mood disorders, depression, anxiety and psychosis. We know that, if they are left untreated, perinatal mental health issues can have long-lasting effects on women, which can impact their relationships with their baby and other family members. The impact can extend to a child’s cognitive and emotional development. In the very worst and most tragic cases, mental illness can lead to maternal suicide.
The Scottish Conservatives welcome the committee’s report and urge the Government to take forward its recommendations to address what the committee rightly identifies as fundamental gaps. The report makes 55 recommendations on subjects that include access to mother and baby units and workforce recruitment and retention. It covers birth trauma, baby loss units, stigma and, of course, the impact of inequalities. It is impossible to address all the recommendations today, but the report is fundamentally about looking at how the Government can work across settings to improve patient pathways.
Many women who suffer mental health problems following childbirth are scared to come forward. They fear that they will be judged or that their baby will be taken away. Removing stigma and ensuring that services are inclusive are vital steps that can have a huge preventative impact. It is crucial to educate professionals on the right questions to ask, so that they avoid inappropriate treatments and potential misunderstandings in the system. I therefore encourage the Scottish Government to bring forward its delayed raising awareness strategy as soon as possible.
I am concerned that the report highlights again systemic and endemic issues in recruitment and retention. When we talk of problems in our NHS, that is the dead end that—sadly—we repeatedly come to. Ministers must act now to break the roadblock and to boost training about and understanding of mental health in midwifery.
In its briefing, the Royal College of Midwives Scotland agrees with the committee that an
“appropriately trained and supported workforce”
is vital to delivering the care that women need. As the committee notes in its recommendations, it is not simply a matter of training and supporting existing staff; we also need to ensure that there are more staff—and, by that logic, fewer vacancies—in the system.
The RCM supports the recommendation that perinatal mental health training should be incorporated into training for all midwifery students. Staff also need to be empowered to engage in continuing professional development and to be able to do so with no negative impact on the delivery of patient care.
The pandemic has had a profound impact on all our lives, and it has pushed a lot of mental health services and support to an online environment. As Gillian Martin rightly identified, Covid has led to negative experiences. We know that the reduction in face-to-face contact has negatively impacted the mental health of expecting and new mothers. Not everyone is able to access online resources, and a lack of infrastructure and capacity can prevent some mothers from connecting digitally.
The committee heard evidence that some individuals have been unable to access GP appointments. That is why the Scottish Government must take urgent action to ensure that alternative routes are available for referrals into perinatal mental health services. I welcome the fact that the minister says that he is in listening mode, but on this, as on so much else, I hope that he can get into action mode quickly.
I understand that the issues are complex, but one statistic stands out: under the SNP, women are waiting more than the maximum of six weeks from referral to access services. Mothers who are seeking support can often encounter a postcode lottery, with inconsistencies in the accessibility of mother and baby units across different NHS board areas, as we heard.
The 2019 report “Delivering Effective Services”, which Ms Mochan mentioned in her speech, highlighted some of the issues that had to be tackled. In the three years since the report was published—two of which have been during the pandemic—we have increased the number of specialist perinatal services in Scotland from four to 10. Progress has been made during the pandemic, and we will continue to make progress as we move forward.
I welcome progress; it is the speed of the progress that I question. I accept that the minister announced today that there will be a mother and baby unit for Grampian; however, demands for that have been on the record for some time. Therefore, it is the pace of progress, rather than the desire for progress, that is being questioned.
Before I close, I will touch on the very sad and upsetting issue of baby loss. Miscarriage, stillbirth or the death of an infant scars the lives of many families. My colleague Jeremy Balfour, who is an MSP for the Lothian region, has previously spoken openly and movingly in the chamber about the issue. He talked about the importance of support, particularly from those who understand the pain that is involved. The committee’s report rightly calls out the important work that is carried out by the third sector, including by charities such as Sands—the Stillbirth and Neonatal Death Society—which provide quick, tailored access to support. I strongly urge the SNP Government to ensure that third sector organisations are afforded greater financial security as we move forward, so that they can tackle the long-term funding issues that they face.
Despite the heroic efforts of NHS staff, it is clear that the SNP must act urgently to overhaul perinatal mental health services in Scotland, particularly for those who have complex needs. The minister might be listening, but I hope that he will now act to remove the barriers that the committee has identified, which will help us to meet the needs of vulnerable women and their families.15:13
I thank Gillian Martin and others for their contributions so far, but my biggest thanks must go to the women who shared personal stories with committee members during our inquiry. They were very clear about why good access to mental healthcare matters.
As has been noted, perinatal mental health issues affect up to one in five Scottish women. Those issues range from anxiety and depression to mood disorders and psychosis. Some women are facing mental health challenges for the first time, while others have experienced them before. The women we listened to made it clear that their families come in different shapes and sizes, which is why the committee report highlighted the need to put mums and families at the heart of care and support.
Given that our convener has already touched on the plethora of challenges and the important recommendations of the inquiry, I will use my time to reflect on the things that stood out to me personally. I will say more on the holistic, family-centred approach that I have already mentioned and touch on Covid-19, inequality and the need to listen to and respect women’s voices.
The Covid-19 crisis intensified perinatal mental health issues and increased demands for services. Studies from across the world show that clearly. We know that the pandemic posed additional challenges for women, particularly those from minority ethnic and socially disadvantaged groups, and placed additional strain on services and their staff. Unsurprisingly, it exacerbated the challenges and the future development of perinatal mental health services must take account of the social detriments of maternal and infant mental ill health, reduce stigma and ensure equality of outcomes for all mums and their babies.
It is also vital that we take a more holistic approach that involves whole families and focuses on improving overall family wellbeing. That approach would also benefit our public services. The inquiry evidence repeatedly highlighted the importance and the benefits of a preventative and community-based approach that avoids mothers reaching the point of crisis.
Like any effective system that prevents mental ill health and promotes good mental health, perinatal mental health support must work at three levels: it must be universal for the whole population, selected for high-risk groups and indicated for people with signs or symptoms of mental health problems. Key to that is increasing the circulation of the information that is available to women and their families. Although there is high prevalence of perinatal mental health problems, rates of detection and appropriate interventions are still low.
I was quite shocked that postnatal depression and depression during pregnancy are thought to go undetected in as many as one in two women and that women with pre-existing mental health issues are not being identified at that first point of contact. The provision of better information can help stop women falling through the cracks.
It is also important that, when women bravely ask for help, or raise concerns about their wellbeing or that of their child—this is difficult to say—they are too often dismissed or disbelieved at that critical stage. Women must be respected and listened to. We must get to a place in which we accept no excuses for not doing that.
Third sector services are often excellent, but women told us that support sometimes comes too late and too far down the line. Health professionals can lack awareness of those services, and an integrated approach to investing in third sector expertise is key.
On that note, I really welcome the Scottish Government’s significant funding of £16 million in perinatal and infant mental health since March 2019, and the funding for all NHS boards towards specialist community perinatal mental health services. More than £4 million has been invested in that in 2021-22, which is especially welcome.
Detection and prevention are key to supporting women during that critical stage of their lives. We need to equality proof the delivery of perinatal services. Quick and easy access to perinatal mental health support must be available to every woman in need. We must stand with them and we must keep on listening.15:17
It is a pleasure to follow Stephanie Callaghan, particularly given that she highlighted families of different shapes and sizes. To her list, I add mothers from refugee and migrant families, who have particular needs that are yet to be met in Scotland. I urge the Government to look at that issue.
I, too, welcome the recommendations contained in the committee’s report. They are timely and important and we must see their roll-out accelerated.
The recruitment crisis in the NHS, which is often talked about in Parliament, often overshadows the great work done by individual NHS staff—not just medical staff but staff across the board. The work that is done in perinatal mental health by the many people surrounding the nurses and midwives is so important.
However, it is important that we address the question of recruitment. We have heard about the staff shortages and the vacancies that exist. The effect of those goes to the heart of one of the committee’s recommendations on the perinatal mental health training that midwives and those who support them require. One challenge is that, although midwives can be rostered to go on that important training, vacancies and absences mean that crucial clinical care would not be given if they were to do so. What goes in those circumstances? Their lifelong training. That is unfortunate but quite right, given that they are required to stay on the ward to ensure that the women on it are dealt with and handled safely.
One of the things that we need to look at is the support surrounding our NHS staff to ensure that such training can happen. It is all very well having the funding to provide the training and the places where such training can take place, but if staff cannot attend, we have lost an opportunity.
I thank the Royal College of Midwives for the briefing that it has provided to me and others in the chamber. On training, it says:
“We ... echo the concern acknowledged by the Committee that education and training is too often failing to take place because of staff shortages, with the immediate demands of clinical care on short-staffed units understandably prioritised.”
One midwife commented:
“Due to shortness of staff, I am unable to give good or even adequate care to pregnant ladies and mums and babies. … Staff dread coming to work as it’s an accident waiting to happen, we scrape through by the skin on our teeth.”
That is a very sad quote to share, but those are the same people who will go on to make sure that all the ladies under their care are safe and looked after. I do not in any way want to spread concern among people who have to use our midwifery services, but there is a strain and a stress within the profession and it is for the Government to look to rectify that.
In the short time that I have left, I want to ask the minister about the 2019 report that has been referenced. There were 28 recommendations in that report. Will the Government publish information on how many of those recommendations it has met and, more important, when the remaining ones are likely to be met?
With my final few seconds, I once again extend my thanks to the people who work in the midwifery service. I know from personal experience at the birth of one of my children about the stress and strain that they face. They do an admirable—no, a brilliant—job.15:21
I am pleased to take part in the debate and I commend the work of the committee in considering perinatal mental health in Scotland. I thank the Royal College of Midwives and Support in Mind Scotland for their helpful briefings and I thank my former colleagues Fiona Gibb and Andrea Lawrie for their help ahead of the debate.
We have heard speeches outlining the challenges faced by women who are affected by maternal mental health difficulties and the improvements that are required to ensure that women get the support they need to ensure strong mental wellbeing.
Covid-19 impacted us all. It was frightening, traumatic and life changing, but for women before, during and after pregnancy it has been particularly difficult. I received correspondence from constituents who were worried about the mental wellbeing of their partner, sister or daughter who had just given birth or who was struggling with the choices that they faced as they awaited the birth of their new baby.
Women were faced with a plethora of additional decisions such as weighing up the side effects of the Covid-19 vaccine against the risk of Covid-19-related illness and adverse pregnancy outcomes. Black, Asian and minority ethnic women were at disproportionate risk of adverse outcomes from the impact of Covid-19, which were compounded during pregnancy.
There were modifications to services such as home birth, no birth partner could be present and women had to attend scans or receive difficult news alone, all of which profoundly impacted maternal mental health. The removal of that choice and the prospect of giving birth alone are thought to link with anecdotal incidents of free birth, where women did not engage with health services, which significantly impacted maternal health as a whole. Women in rural areas, who were already more likely to experience mental health problems than those in urban areas, faced particular challenges in accessing services.
As we move forward from the pandemic, I welcome the opportunity for best start support to gain traction in driving forward the transformation of maternity care in Scotland. I note that the committee welcomed the Scottish perinatal mental health care pathways but highlighted concerns about access to specialist community services and the need for wider access to mother and baby units. I am pleased to see that the Scottish Government’s consultation on mother and baby units is now open.
I want to clarify something that Mr Hoy said in his speech about a new mother and baby unit in Aberdeen. What he suggested is not what I said in my speech. I said that it was a specialist perinatal mental health community service, which opens today.
I follow Ms Nicoll’s view very firmly and encourage as many folk as possible to take part in our consultation on mother and baby units, which is looking at capacity in Scotland as we move forward.
I welcome that clarification. Like the minister, I am absolutely delighted to hear that, literally as we hold the debate, the NHS Grampian community perinatal mental health team has gone live.
Delivery of high-quality care relies on excellent pre and post-registration education and training. I commend all our educators, particularly midwifery and mental health lecturers, across Scotland for the crucial role that they play in ensuring that midwifery students and midwives who are already in practice are provided with the highest quality education possible. I am pleased that work is under way to offer perinatal mental health training to midwives and health visitors, and I note the committee’s call on the Scottish Government
“to commission further research to identify ... barriers”
to perinatal mental health staff “completing training” and to use the findings to address barriers and increase the uptake of training opportunities.
In the week following mothers’ day, I commend the commitment of everyone who is working to improve maternal mental health services in Scotland and their work to support women, families, new fathers, people who experience baby loss and those who are living with problem drug use. I will certainly invite myself along to meet the new community perinatal mental health team in Grampian soon.15:26
I, too, thank the people who gave evidence to the committee and everyone who is working to improve perinatal mental healthcare in Scotland.
During evidence sessions, the committee heard about the importance of proactively identifying people who are experiencing or at risk of developing perinatal mental health problems. Health professionals who are in contact with people during their pregnancy journey must receive the training that they need to proactively identify such issues. The importance of upskilling the primary care workforce, in particular, was highlighted as a critical first step in building and embedding specialist services locally, as training for health visitors, GPs, midwives and maternity staff can assist with the early identification of perinatal mental health problems.
However, training is only one part of the puzzle. Healthcare staff having the capacity to do welfare checks is a major issue. The committee was told that preventative measures should be in place during birth, but that that would require having sufficient staff on duty who were trained in how to detect early warning signs.
Although someone should go to see parents straight after the birth to check how they are doing, that does not always happen at the moment. Six-week check-ups by GPs have not been happening during the pandemic, due to the incredible pressure that has been placed on practices. When checks happen, they tend to focus on the baby’s welfare alone.
Some people report that, when they were pregnant, there was a lot of concern for their wellbeing, but that, as soon as they gave birth, the focus shifted entirely to their baby. We must ensure that parents are supported throughout the process and that help is not suddenly withdrawn after the birth. Part of that is about ensuring that staff, including GPs, midwives and health visitors, have the time and training to proactively check for mental health issues.
The committee heard about the need for training for all healthcare professionals on how to offer bereavement care after pregnancy loss and baby death. Midwives are experienced in offering bereavement care, but families might come into contact with a variety of health professionals when undergoing pregnancy loss, not all of whom will have the same level of experience and knowledge as midwives. As the committee report makes clear,
“an appropriately trained and supported workforce is crucial to ensure individuals get the support they need.”
It was highlighted in evidence sessions that significant inequalities impact individuals’ experience of perinatal mental healthcare. The charity Sands mentioned the need for translators who are appropriately trained in bereavement care. The committee heard about scenarios in which, in the absence of trained translators, children and family members of non-English-speaking mothers were relied on to tell the mother that her baby had died. That is clearly unacceptable.
Much work is to be done to ensure that services are inclusive and accessible to all. In its briefing for today’s debate, Support in Mind Scotland pointed out that, although Scotland is considered to be one of the most LGBTI-inclusive countries in Europe, perinatal mental healthcare and services in Scotland currently exclude people with some gender identities who give birth. For example, trans men and non-binary people who are pregnant or postnatal can experience perinatal mental health issues and require tailored support for their needs but are likely to face barriers to accessing that.
As the committee’s report notes, it is vital that the development of perinatal mental health services is future proofed. Good quality data will be essential in identifying inequalities. During the evidence sessions, it became clear that we do not have sufficiently disaggregated data about who is accessing our specialist services, and so do not know how inclusive and accessible those services are. For example, ethnicity is not being adequately recorded in the antenatal period, so we are unable to identify disparities in care. That is extremely concerning, given that we know from an MBRRACE-UK report that black women are almost four times more likely to die in childbirth or during the postnatal period. Data collection must be improved if we are to address inequalities and ensure that care is truly person centred.
I conclude by again thanking those who gave evidence to the committee.15:30
As a member of the Health, Social Care and Sport Committee, and as a registered nurse, I welcome the opportunity to speak in this important debate. I thank everyone involved in giving evidence to our inquiry, which covered the many areas that have been spoken about today by colleagues from all parties.
My iPad seems to have frozen.
As our committee report states, women are at substantially increased risk of severe mental illness and psychiatric in-patient admission during the perinatal period. In most cases, it is mothers who are most affected, although Gillian Martin highlighted the specific example of a dad who was severely impacted by the birth of their child and the loss of the mum. Those mental health problems can affect all family members, and the effects of Covid-19 featured in much of the evidence that we took in our inquiry.
The committee’s inquiry into experiences before, during and after the birth of a child highlighted a number of issues that new mothers face with the support that they receive. We heard evidence from some women affected by baby loss who reported giving birth close to women giving birth to healthy babies. I am sure that that is completely traumatising.
A constituent contacted me about that issue. They gave birth to a stillborn baby in Dumfries and could hear other babies crying in the next room. Following lots of work with NHS Dumfries and Galloway, the Dumfries and Galloway branch of the charity Sands became involved in supporting the process. The health board changed its arrangements so that any woman experiencing baby loss in Dumfries and Galloway is supported in a different space. However, that is not the case across the whole of Scotland. I note the importance of the committee’s recommendation for accelerated action to establish specialist baby loss units and for new protocols to ensure that families are consistently treated with respect in a destigmatised and trauma-informed way.
Language accessibility was another issue that stood out to me during the inquiry. Gillian Mackay touched on that. Clea Harmer, the chief executive of Sands, described scenarios in which, in the absence of a professional translator who understood bereavement, children of mothers for whom English is not the first language were relied on as translators. That included one eight-year-old child who had to help her mother. That evidence particularly stood out to me.
It is, however, welcome that the Scottish Government continues to prioritise improvements to care through the implementation of the best start programme and in partnership with senior leaders and clinicians. That includes the development of specialist community perinatal mental health services, including language services, across all health boards. That will be really important as we receive refugees from Ukraine and will build on work that has been done with Syrian refugees. I ask the minister to give an update on the work to support language services.
The Scottish Government is undertaking a huge amount of work to improve perinatal mental health services. In September 2021, the Scottish Government published its maternity and neonatal (perinatal) adverse event review process. The Scottish Government has invested more than £60 million in perinatal mental health, including an investment of almost £2 million in the third sector.
We know how important the third sector is in supporting women throughout their pregnancy and post pregnancy. The funding includes money for community specialist mental health services in every health board in Scotland and for in-patient services for women with the highest level of need. In addition, there is a commitment to investment in the third sector across 33 different organisations, including Sands, which operates across Dumfries and Galloway and the Scottish Borders to provide support for women and families.
Although that work is welcome, much can be done, including at health board level. I am conscious of the time, so I will stop there. I welcome the debate and the work of all my committee colleagues.
We move to the closing speeches.15:35
In closing for Scottish Labour, I again welcome the report by the Scottish Parliament’s Health, Social Care and Sport Committee. I thank Gillian Martin for opening the debate on behalf of the committee and for sharing the details of the process that we went through in completing this very important report.
I am glad that the report recognises that, quite simply, the Scottish Government has not done enough to support women who experience perinatal mental health problems. In fact, the Government has fallen well short of expectations, with women in some parts of Scotland being unable to access mother and baby units. As has been mentioned, that is completely unacceptable. If the Scottish Government is serious about giving perinatal mental health the focus and consideration that it deserves, it must start by ensuring that effective measures, preventive and otherwise, are in place to support women who face difficulty.
I am sure that all members welcome Kevin Stewart’s listening mode, but I would very much like to see him in action mode, as that is what will be needed to meet the challenges ahead.
We are in action mode, driven by the programme board. I highlighted some of that to Mr Hoy earlier. I ask Ms Mochan and others in the chamber to encourage folk to respond to the on-going consultation on mother and baby unit capacity. We can all do our bit to ensure that we move forward as one to get this right for women, babies and families right across Scotland.
The minister is right that we should all encourage people to participate. I assure him that I will look out for all the actions that he takes—he should not worry about that. Because of mismanagement and lack of investment in services by the Government, the issue has become a serious one on which we need action.
Will the member take an intervention?
I want to make progress, please.
Scottish Labour’s view is that the mental health and wellbeing of our population should be of paramount importance. If the Scottish Government shares that view, it must act and take on board all the recommendations of the committee’s report to improve services, and it must do so with purpose. As Dr Gulhane said, this is a mainstream issue that must be addressed with urgency. Improving services includes investing in more mental health professionals in the community so that perinatal mental health services are accessible and close to home for those who need them. Alex Cole-Hamilton addressed that issue very well.
As I have highlighted previously in the Parliament, those in the most deprived areas are more likely to be impacted by poor mental health and wellbeing. According to the Scottish Government’s “Perinatal and Infant Mental Health—Equality Impact Assessment Record”,
“This is true for perinatal mental illness too, with higher levels of deprivation correlating with higher prevalence of poor perinatal mental health”.
That highlights clearly that the accessibility of services close to home is pivotal for everyone, but in particular it amplifies that that should be the case in areas of most need, to ensure that no woman is disadvantaged or misses out on services due to their postcode or income.
I must reiterate the attention that the committee’s report places on the importance of ensuring consistent NHS recruitment and retention of midwives, which has been mentioned many times, and on the need for them to have the necessary training to meet the needs of women who suffer from perinatal mental health problems.
The area is one in which too many midwives, nurses and other health professionals feel overworked, underpaid, undervalued and undertrained, because of the stress that is put on them in the workplace and, I believe, because of the Government’s lack of action at many points. I say to the Government that, without action, the numbers leaving the profession will increase, and that we must do more. I look forward to a response from the Government on such action.15:40
This short inquiry was of great personal significance to me, and it was a pleasure to take part in it. In particular, I am grateful that our inquiry accounted for the impact of baby loss, which is often a taboo subject—one that is not spoken about until it affects us personally, or those who are closest to us. When it happens, it is absolutely devastating, and the world falls apart. I speak for the friends around me who have all experienced that pain.
I thank all the women who took part in the evidence sessions, as well as the fathers; Gillian Martin specifically outlined the plight of one father who had such difficulties in accessing services for his child. The experiences that they shared with us regularly brought us to tears. I felt their pain, frustration, exasperation and sheer sense of loss as they fought to access services for themselves and for their families, partners and wee babies. I was pleased that the minister acknowledged that the inquiry raised awareness—which is much needed—of perinatal mental health.
Scottish Conservative members welcome the committee’s report in full, and we urge the SNP Government to take forward its recommendations in full. The report’s recommendations cross a wide range of themes, including the accessibility of services, mother and baby units, workforce recruitment and retention, birth trauma, baby loss units and inequalities.
In particular, the report paints a deeply worrying picture of Scotland’s perinatal mental health services and their perilous state after 15 years of SNP control.
Does the member agree that it is often the third sector that provides support for people who have lost a child or who have had a child but are having some kind of mental health issues afterwards and that, unless we get proper funding for those third sector organisations, we are going to leave families behind?
That is very much the evidence that we heard loud and clear. The nimbleness of the third sector provides such a lifeline to those people.
As the committee took evidence, it became clear that accessing primary care services, community services, third sector services and specialist services involves barriers for individuals who are in dire need of support. What does that mean? It means that, often, support is available only for acute cases and interventions.
The BMA told us that the bar for referral is set high. How can that be right, given that suicide is the leading cause of maternal deaths in the period of six weeks to a year after the end of pregnancy?
I welcome the minister’s pledge that steps are being taken to ensure that the service landscape is more accessible, yet services are limited not just in their accessibility but in their consistency and structure. Alex Cole-Hamilton spoke of the postcode lottery of services that our families face across the country.
Let us please not sit here today and use the pandemic as a justification. Although it may have deepened the crisis, it has also acted as a monumental volcanic fissure, exposing the sheer scale of the problem: the underinvestment, the lack of planning and the lack of focus. Those issues long predated March 2020.
In particular, the report highlights the stresses that are placed on the midwifery profession by years of inadequate workforce planning under the SNP Government, under which workforce planning always appears to take a back seat.
As things stand, there is a current and long-standing shortfall of midwives in Scotland. As Carol Mochan mentioned, this is what a midwife said in response to a recent survey by the Royal College of Midwives:
“I cannot remember the last time we had safe staffing within our unit. On a daily basis, we are struggling to provide a decent standard of care to our women and their families.”
Staff shortages are having an impact not just on recruitment and retention, but on training, including training on perinatal mental health, which is too often failing to take place because of staff shortages.
As I mentioned in my introduction, I welcome the fact that baby loss fell within the scope of the committee’s inquiry. We need to ensure that every health board has specialist baby loss units, which should be sympathetically located. Those units must have a means of entry and exit that is separate from maternity wards, so as not to cause additional stress, and in no circumstance should women have to walk the length of the maternity ward to access support.
I turn to the pandemic. Covid has, without question, placed severe restrictions on pregnant women. Women have been forced to attend scans without support; forced to receive sometimes devastating news; left on their own to come to terms with a loss that is beyond understanding; and left to go through labour with no support. Further, the removal of support groups and postnatal classes has undoubtedly reinforced feelings of isolation and abandonment. Natalie Don shared the very real experiences that she went through during pregnancy, and I congratulate her on her good news.
Given those sobering truths, as we learn to live with Covid, I strongly believe that the SNP Government must undertake an urgent review of perinatal mental health provision during the pandemic. If we are to learn lessons for the future, we can begin only by reflecting on the past. As Craig Hoy highlighted, the Minister for Mental Wellbeing and Social Care said that he was “in listening mode”. Is it not about time that he got into action mode? I would also like, as Emma Harper stated, to see some “accelerated action”, so let us implement the committee’s recommendations in full.15:46
It is vital to promote and raise awareness of perinatal and infant mental health. Without access to the appropriate support, treatment and guidance, challenges around mental health can have a significant and long-lasting impact on young families across Scotland. I therefore thank the Health, Social Care and Sport Committee for dedicating time to investigating this important area of healthcare. I also echo the thanks that the Minister for Mental Wellbeing and Social Care expressed to those who provided evidence to the committee, especially those who have shared deeply personal experiences.
Finally, I thank members in the chamber for their thoughtful and considered contributions. I will take the opportunity to respond to some of those contributions, but I recognise that many issues have been raised. The Government provided an extensive written response to the committee’s report yesterday and, with regard to those issues to which I am unable to respond in my closing speech, I undertake to write to members to ensure that their questions are responded to.
The Government has confirmed that it has submitted its written conclusions to the committee, but I do not yet see that that response has been published. Does the Government know when it will be publicly available?
I am afraid that that is up to the committee; I presume that it will publish the response as soon as it possibly can.
I want to bring some clarity to the issue of mother and baby units. Those units are a highly specialised service that is provided on a regional basis because of the very small numbers involved and the very specialist workforce that is required. We are currently consulting on options to increase mother and baby unit capacity, and that consultation will help to inform an options appraisal to assess the most appropriate way of increasing the number of beds in Scotland.
I make it absolutely clear: if it is needed, access to a mother and baby unit is available to women wherever they live in Scotland. That right is enshrined in the Mental Health (Scotland) Act 2015, and our mother and baby unit family fund supports family members with the costs of visits to mother and baby units.
On community perinatal mental health, we have been working in particular with the Grampian, Highland, Orkney, Shetland and Western Isles health boards to provide funding and create services that support the needs of women across those areas. Indeed, today we heard the news that the NHS Grampian community perinatal mental health team has officially launched that service today.
With regard to an update on action towards delivering effective services, we established the programme board in 2019 to implement the recommendations and to improve services. Every year, the board has produced a delivery plan that sets out detailed information about how we are going to implement the delivering effective service recommendations and go beyond that to develop comprehensive perinatal and infant mental health services across Scotland.
I agree that the third sector is a valued and vital part of the system, which is why we provide £1 million per annum to support it, across a range of organisations. That includes £578,000 for baby loss charities over the past four years, with £178,000 going to Sands to develop the national bereavement care pathways.
On midwifery recruitment, we are working with health boards and taking forward a nationally co-ordinated UK and international recruitment campaign for midwives. We are supporting the settlement process.
On retention, NHS Education for Scotland has been commissioned to develop a national midwifery career framework.
On training, perinatal mental health is a fundamental part of the core curriculum for undergraduate midwives. I can confirm that the number of people accessing postgraduate education has remained high throughout the pandemic and that NHS Education for Scotland has been expanding training placements on commissioned programmes, as well as ensuring that perinatal and infant mental health training is provided.
Bereavement care is the responsibility of absolutely everyone who works in maternity services—all the health professionals. Midwives, consultants and all other members of that workforce are trained in bereavement care.
Will the minister take an intervention?
Will I get the time back, Presiding Officer?
You will, yes.
I will take the intervention.
I am grateful.
Does the minister agree that, if a mother has to give birth to a child that is going to be born asleep, that should happen in a separate area, and that we should strive to reach that goal as soon as we can in every hospital and maternity service in Scotland?
I am not sure whether the member is aware that a great deal of work on that is going on at the moment. We have put out a survey in every maternity service in the country, to establish what is provided and where the gaps might be, and we will work hard to close gaps in provision. I absolutely agree that compassionate, sensitive care is vital at that difficult time.
Gillian Mackay mentioned ethnicity data, which has been a key issue throughout the pandemic. I inform the member that Public Health Scotland has started to collect data on ethnicity in the context of pregnancy.
Presiding Officer, I have so much more that I want to say, but I guess—
I can give you up to seven minutes, minister.
Okay. I will pack a lot more into my final minute.
Our work on perinatal mental health and wellbeing remains action focused and ambitious. The findings and recommendations of the committee’s inquiry will further support and inform our continuing programme of work.
Good maternity care is crucial to good perinatal mental health. We continue to make improvements to maternity and neonatal care in Scotland through the introduction of continuity of carer in maternity services and through the new model of neonatal care, as part of the implementation of the best start programme.
Since 2017, we have provided funding of more than £16 million to support implementation of best start, which remains a firm commitment of the programme of government. We have used the Covid pause to reflect on and reset the programme and to consider the direction and structures for the final phase of delivery. Part of that consideration is about how the remobilisation of best start and, specifically, introduction of continuity of carer, could be prioritised to focus on people who would benefit most.
I will conclude there. All that work, combined with the work that has already been mentioned in the debate, provides a solid foundation from which we can continue to deliver positive mental health outcomes for parents and children across Scotland.
I call Paul O’Kane to wind up the debate on behalf of the Health, Social Care and Sport Committee.15:53
I am pleased to close the debate on behalf of my colleagues in the Health, Social Care and Sport Committee and, as deputy convener of the committee, I thank the team of clerks and support staff who assist the committee in our work, and who supported the inquiry and the preparation of the report that we debate today.
I join colleagues in thanking everyone who submitted evidence. I thank all the organisations that shared their views or supported people to share their views, many of which have been mentioned in the debate.
In particular, I want to thank—as the convener, Gillian Martin, has done—the women and their families who gave oral evidence to the committee. It was a difficult thing to do to give that evidence, but the evidence was compelling, and it was important in the production of the report. I was reflecting this morning with the convener about the deeply personal nature of what was shared and how, while common themes emerged, each experience is different, with different supports needed at different times. We have heard a lot about that this afternoon. Access to appropriate services, including primary care services, community services, third sector services, specialist mental health services and specialist perinatal mental health services, is often a major barrier for individuals who need support.
The committee also heard that women who have experienced miscarriage or baby loss are extremely vulnerable. Again, that has been reflected in the debate.
As a committee, we have sought to shine a light on an area of our health service that is, all too often, somewhat forgotten, underresourced and not always planned with the care and sensitivity required. As Gillian Martin said, the committee wanted to shine not just a spotlight but a floodlight on the issue. We want to end stigma and open doors for people.
In that regard, the evidence that we heard about women affected by baby loss being treated in maternity wards alongside women who have given birth to healthy babies was particularly compelling. There is a clear need for specialist provision across Scotland. That was outlined powerfully by Emma Harper in relation to her constituent in Dumfries. I note what Maree Todd said about what can be done to push forward the committee’s recommendations in that regard.
I turn to some of those recommendations and, in doing so, I highlight the strong contributions to the debate—it has been not just a powerful debate but an emotional one for many colleagues. Access to perinatal mental health services was a key part of our recommendations. There has been a large degree of consensus across the chamber about the importance of increasing awareness of services, early identification of perinatal mental health issues and ensuring that our pathways are robust and able to deliver joined-up care.
Many members mentioned mother and baby units and the importance of ensuring that such units are provided across the country. Along with colleagues, I note Kevin Stewart’s commitment to being in listening mode and taking action in that regard. The committee would welcome that and would be keen to continue that discussion as we move forward. We need to ensure that when people need services, those services are available in the communities where they live. I am sure that the committee would seek to engage with the consultation that the minister outlined in his remarks.
The committee was keen to see the Scottish Government secure current and future funding to ensure equity of access to specialist community mental health services throughout Scotland. Carol Mochan pointed to the gaps that exist in specialist community services, and said that we need to do more to ensure equity of provision. Alex Cole-Hamilton—who is not in the chamber—spoke about the postcode lottery that sometimes exists in access to those services.
We heard a lot of strong contributions from colleagues about the work of the third sector. Colleagues gave powerful examples of that work. The committee met organisations such as Fife Gingerbread, Home-Start, Aberlour, Mind Mosaic and of course Sands, the baby loss charity. It is important that we continue to ensure sustainable funding for those organisations to deliver on their vital work. I note what Maree Todd said about what funding is available, but I am keen that we continue to monitor that and audit what funding is available across all sectors to ensure that we continue to drive forward that important work.
Workforce formed a strong part of the committee’s recommendations. Colleagues rightly raised some of the issues that are currently affecting the workforce across midwifery and nursing. Sandesh Gulhane, Gillian Mackay, Carol Mochan and others spoke about the pressures on staff, the burnout that is being experienced and the need for not only retention but further recruitment. Craig Hoy made a strong point about ensuring that there is a balance between those two things and that we continue to have people who are available to support mothers when they need that support.
I am conscious of the time, but there is a lot to pack in, as the minister said—this has been a full debate.
Stephanie Callaghan spoke powerfully about the importance of listening to women and of understanding that trauma can manifest itself in many different ways. We must meet people where they are. Indeed, the committee has made strong recommendations on ensuring appropriate resources to support staff in diagnosing that trauma, on developing care pathways to prevent and treat birth trauma and on providing dedicated treatment not only before birth but after birth, ensuring that support is on-going, certainly in the early stages.
Martin Whitfield made an important point about the needs of our refugee families in Scotland. That is particularly pertinent for us all in this current period.
Sue Webber spoke powerfully about baby loss, which is very important, and it is very personal to Sue Webber—and indeed to many of us in the chamber, who have friends, family or relatives who have experienced that.
Natalie Don spoke powerfully about the impact of Covid-19 on women who were expecting children and had children during the period of the pandemic. As a mum herself, she spoke very powerfully about the need for support and continuing with support groups throughout the pandemic. There are key lessons for us all to learn about how we have reacted to the pandemic and about how services have continued to get back on track and on stream. Audrey Nicoll spoke about some of those challenges, too, in particular regarding isolation.
The committee believes that the report should act as a strong catalyst for change in this hugely important part of our health service. We are clear that we will work with Government further. We will hold it to account and we will collaborate with organisations across Scotland to ensure that we get this right for women, babies and families across the country, continuing to ensure that the light that we spoke about at the beginning of the debate can shine, and that nobody is left in the darkness.
That concludes the committee debate. I remind all members that, if they participate in a debate, they should be here for the closing speeches. That is the courteous way to proceed.
If members wish to change positions before the next item of business, they should do so now. While they are doing that, I remind them of the Covid measures that are in place. Face coverings should be worn when moving around the chamber and across the Holyrood campus.
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