Post-natal Depression (Services)
The final item of business is a members' business debate on motion S1M-3504, in the name of Bill Butler, on the provision of dedicated mother and baby services for women with post-natal depression.
Motion debated,
That the Parliament expresses its deep concern regarding the lack of proper facilities within the NHS in Scotland that would allow women with post-natal depression (PND) to continue to care for their children whilst undergoing treatment; recognises that the lack of dedicated mother and baby services for women with PND is completely unacceptable; notes the recent Scottish Intercollegiate Guidelines Network report which detailed the shocking lack of appropriate services for women with PND, and considers that the Scottish Executive should ensure that NHS boards throughout Scotland take the swiftest possible action to remedy the alarming poverty of provision of mother and baby units devoted to women suffering from PND.
I express my gratitude to the Parliamentary Bureau for choosing for debate the provision of services for women with post-natal depression. The issue is serious and worthy of serious consideration. I also take the opportunity to record my thanks to the members from many parties who appended their signatures in support of the motion.
The total lack of provision of dedicated mother and baby services for women with post-natal depression is a gap in health service provision of which, I must confess, I was ignorant until two months ago, when my constituent, Lyn McLeod, from Yoker, arrived at my surgery in the Blairdrum neighbourhood centre with her baby daughter, Heather. What she told me shocked me and made me determined to pursue the matter.
Lyn was admitted to Gartnavel royal hospital on 15 July this year and remained there until she was discharged on 2 October. When Lyn was admitted, Heather was aged three and a half months. Because no specialist mother and baby units are available in the Greater Glasgow NHS Board area or, for that matter, anywhere in the Scottish national health service, my constituent was able to see her baby only at visiting times. In effect, Lyn was separated from Heather at a critical time in the development of the relationship between mother and child. Indeed, had Lyn not had a relative who was able to take care of her daughter during that period, Heather would have needed to be fostered for the duration.
Since first meeting Lyn and Heather at my surgery, I have made it my business to highlight the alarming poverty of provision of suitable mother and baby units. I am grateful to the Evening Times and the Sunday Mail for publicising that unacceptable deficiency in the national health service. I also make it clear that my constituent is—understandably—even more determined than I am that the lack of service be exposed and steps be taken as quickly as is humanly possible to remedy the situation. She is resolved—as am I—to do everything possible to prevent any other mother and baby from suffering such a traumatic experience.
It is a matter of record that no appropriate provision of dedicated units is available in the NHS for mothers with PND. A reply from the minister to my written question S1W-30982 makes that clear. In spite of an acknowledged difficulty in establishing a causal link to childbirth, it is generally accepted that the incidence of the medical condition stands at 10 per cent. That means that in Glasgow, for example, between 340 and 560 mothers suffer moderate to severe post-natal depression each year. Those figures, which are taken from a perinatal health services briefing document, are in complete accord with figures that are contained in an informative briefing that I received only today from the director of the Church of Scotland's social work arm, Mr Ian Manson.
In spite of the obvious need and the principles that are clearly laid out in the Executive's "A Framework for maternity services in Scotland", the minister knows that a serious service gap still needs to be bridged. The framework states that national health service boards
"should have local strategies in place … to develop and implement services for women suffering from postnatal depression".
It goes on to outline the Executive's view that NHS boards should consider reviewing services for women with PND
"with a view to developing regional mother and baby units".
Those are fine words and worthy objectives, but women such as my constituent Lyn McLeod need health boards to act.
I acknowledge that, in its initial response, Greater Glasgow Primary Care NHS Trust informed me that a business plan to provide an interim six-bed unit will be tabled at the Greater Glasgow NHS Board's December meeting. I welcome that as a reasonable first step. However, we need a country-wide or region-wide strategy that will enable permanent mother and baby units to be provided.
Along with other members, I will listen with great interest to the minister's response to the debate. From the minister's response to my written question, I know that he acknowledges that there is an unmet need and is sympathetic to the speediest possible resolution of the problem. I ask the minister to use his position to take whatever action he thinks would be appropriate to galvanise health boards into purposeful action, which should concentrate their minds wonderfully. Mothers across Scotland demand and deserve no less.
We have to be finished by 17:55. There is no possibility of an extension. The first three speeches will be of four minutes' length; thereafter, we will have three-minute speeches.
I would like to be the first to congratulate Bill Butler, not only on securing the debate, but on his passionate contribution to it. Post-natal depression is an extremely important issue, particularly for those of us who have small children and who recall some of the concerns that were associated with the birth of those children.
For many, PND is hard to diagnose. The Scottish intercollegiate guidelines network's guideline 60 states:
"Postnatal depression is regarded as any non-psychotic depressive illness of mild to moderate severity occurring during the first postnatal year. … It is important to distinguish postnatal depression from ‘baby blues', the brief episode of misery and tearfulness that affects at least half of all women following delivery, especially those having their first baby … Puerperal psychosis … is a mood disorder accompanied by features such as loss of contact with reality, hallucinations, severe thought disturbance, and abnormal behaviour."
In other words, we are talking about a serious illness. The fact that more than 2.4 per cent of mothers suffer from PND means that more than 1,000 mothers in Scotland have it.
There is a health care network for new mothers but, unfortunately, it is not always possible to detect PND as a specific condition. Across Scotland, there is wide divergence in diagnosis and in how the issue is dealt with. Many people are involved in that process, such as midwives, health visitors, clinical psychologists, obstetricians and psychiatrists. It is important that all those people play their part, not only in identifying PND, but in treating it.
The point of the debate is to call for specific mother and baby units. Bill Butler is not asking for the earth; he is asking for a small number of units across Scotland, amounting to approximately 30 to 45 dedicated beds for the whole country. That would not be too much of a burden on the health service, but it would be a major benefit to those mothers who go through a traumatic, distressing illness.
For those who think that PND may be a passing phase, I must say that, unfortunately for many sufferers, that is not the case. It can lead to other psychiatric illnesses and to a deepening of other underlying pathologies.
Some people have family support to get them through PND; others do not. It makes it much more difficult for mothers to bond with their children if they are trying to deal with the illness at the same time.
I believe that Bill Butler's proposal is extremely worth while, and I hope that the Minister for Health and Community Care will address it positively.
Clinical depression is a particularly horrible condition that is often belittled and misunderstood. It is awful for the person who is depressed and equally awful for everybody round about them. A family member who coped with a depressed spouse over a number of years described it as pouring oneself into a black hole, and giving and giving without getting anything back in return. If we translate that into a mother-child relationship and consider the importance for both mother and child of forming the sort of bond that enables a child to grow and develop properly, the significance of specialised help becomes glaringly obvious.
Training people how to diagnose PND is an important first step. The condition can be masked by all the normal after-affects of childbirth, such as the adjustments of caring for a new baby, hormonal disturbances and the baby blues. It is important that health visitors and midwives are aware of the symptoms and that they know what to look for. Even more important, when they recognise and diagnose PND, the services must be in place for the mother and baby. The most important part of Bill Butler's motion calls for specialised services to enable mothers to be treated for PND in a way that allows them to have their child with them. If that is done, the service can treat the mother, support the mother-child bond and support the family.
Bill Butler has highlighted an important gap in service provision. If we think of the importance of parenting to the next generation and to the future good of society, the services that he calls for are fundamental, and should be in place—yet they are not. I heartily endorse Bill Butler's motion and congratulate him on securing the debate.
The Health and Community Care Committee's consideration of the Mental Health (Scotland) Bill gave us a great opportunity to focus on the lack of provision of many services for people with mental illness. Debate arose about the lack of medium-secure units, about problems with placing adolescents in adult psychiatric wards, about the need for units and support services to treat eating disorders, and about the subject of this debate—the lack of services for mothers with PND and their babies.
I am grateful to my colleague on the Health and Community Care Committee, Bill Butler, for raising the topic and for giving the Parliament another opportunity to discuss mental health. If we are to get rid of the stigma that surrounds mental health, that can only be helped by all of us openly discussing the issues. I am particularly delighted that a man has raised the issue of PND. That proves—if proof were needed—that men can equally, adequately and passionately address women's problems.
PND is not just a women's problem. If it remains untreated, it can have a prolonged, damaging effect on the relationship between mother and baby and a detrimental effect on the child's psychological, social and educational development, as well as on the rest of the family. Mothers often delay seeking help because of the stigma or shame that they feel. They may also experience intense feelings of guilt, failure and inadequacy when they are presented with a bundle of joy and congratulations all round.
I was shocked to hear that between 10 and 15 per cent of mothers have PND, as I know that that statistic is likely to be a gross underestimate.
As Kenny Gibson said, the requirement for 30 to 45 beds for mothers with their babies does not seem a tall order in the grand scheme of things in the NHS. However, I stand by the principle of the least restrictive alternative, as outlined in the Mental Health (Scotland) Bill, because hospitalisation may not be the most appropriate option for all. Day care or community psychiatric nurse support may be appropriate or adequate in some cases.
There is no shortage of drugs for depression, but serious consideration must be given to the fact that the drugs affect not only the mother but, through breast feeding, her baby. There is also concern about side effects and mothers sleeping through a baby crying. I am sure that we have all heard of people who started on anti-depressants following the birth of a child and who, decades later, are still on those drugs. The support of CPNs and health visitors is crucial in cases of PND.
The SIGN guidelines are welcome, but only if they are implemented. Even within health board areas, the implementation of screening is patchy.
I commend NHS Argyll and Clyde on holding a PND event on 5 September in Erskine. I understand that the Deputy Minister for Health and Community Care, Mary Mulligan, was there. The commitment by that health board to addressing PND in an area of considerable remoteness that includes 26 islands undoubtedly is commendable. I look forward to the minister's response to the debate.
I, too, thank Bill Butler for bringing this serious problem to our notice. It is right and proper that we should all demand services that allow women with PND to have their children with them when they are treated in hospital.
Those of us who are mothers know what it is like to have the baby blues—feelings of sadness and despair. Indeed, when I read Bill Butler's motion, I was reminded of the number of times that my mother said to me, "Mrs So-and-so's got the baby blues." In those days, either a neighbour or a friend took the baby for a day, or perhaps a couple of days, so there was a community response to the problem. Unfortunately, that is not so much the case now.
Mothers and fathers never forget the incredible fear of the unknown, particularly with the first child. We all remember the first time that we were left alone with our firstborn—there was no one around and it was an incredible shock that the little person relied solely on us. The immense responsibility hits people between the eyes. How difficult it must be for someone to admit to themselves and to others that they have no feelings for the tiny child, or that they cannot accept that the child has changed their life in such a dramatic way: they have little freedom, their career is on hold, and they spend time looking after another human being who, it appears, does not respond to their absolute commitment to them in the early months. How do they face up to those feelings?
Medicine recognises that there is such a condition as PND, but it can be difficult even now for medicine to link the signs of depression to childbirth. Indeed, my experience of working in a psychiatric unit is that even in the early 1990s, women were being admitted with diagnoses of depression, eating disorders or excessive stress, none of which was linked to childbirth. In some instances, as Bill Butler said, their children were looked after by foster carers. Some doctors were of the opinion that there was no such thing as PND, and that someone would suffer from depression only with their first child—they would never suffer from it again.
Maternity services should be geared towards assessing women's circumstances holistically. Professionals need training and support. Believe me, if someone is in low spirits or is depressed, they can—and will try to—hide those feelings, especially if they believe that they are depressed because they have little or no love for a child. One of the most important pieces of advice that was ever given to me by consultant psychiatrist Dr Raymond Antibi was, "Beware the smiling depression." We see a mother who is outwardly happy, a baby who is well looked after—clean and fed—and nothing more. Then we start to see things deteriorate.
Appropriate multi-agency services, with experienced professionals, must be in place. As Mary Scanlon said, women may not always need medical services in the first instance; they may just need to see a friendly, understanding face.
A review of maternity services is being undertaken. How many of us have asked Bill Butler's question about what services exist in our area for PND sufferers? If members have not asked that question, they should.
I thank Bill Butler again. We can make a difference. The minister has acknowledged the need; let us meet it.
I, too, congratulate Bill Butler on securing the debate, which is on an issue that holds great significance for many mothers and families throughout Scotland and, obviously, for Bill Butler's constituent.
As members have said, it is regrettable that we allow the serious issue of post-natal depression to fall victim to trivialisation all too often. In allowing PND to be perceived as simply the baby blues or dismissing it as an overly emotional or illogical reaction to the demands of motherhood, we assist in fostering a society that marginalises many mums who suffer from the condition and we compound the fears of stigmatisation and shame. The SIGN report draws attention to that. I will not read from the report because we do not have time for that, but it talks about the stigma and shame felt by sufferers, who might be reluctant to confess their feelings.
As feelings of embarrassment and failure are symptoms that are often synonymous with post-natal depression, it is essential that any debate on the issue recognises the potentially protracted and detrimental effects that such a depressive illness, if untreated, can have on the mental well-being of not only mothers, but families, and the consequential damage to family relationships.
There is little doubt that ensuring that appropriate support systems that incorporate a wide range of medical, social and voluntary services are in place is central to the treatment and possible prevention of the disorder. Mothers must be assured during the ante-natal and post-natal stages that support exists and can be readily accessed.
The need to establish specialist units in the NHS that provide an option for mothers and babies to be admitted together must be addressed. Other members have raised that and I hope that the minister will comment on the matter when he responds to the debate. I draw attention to a further recommendation in the SIGN report, which stresses the importance of psychosocial interventions as treatment options for mothers and in support for families.
During my extensive contact with breastfeeding mothers, I have come across peer support groups and I have been made aware of research that shows that they play a valuable role in assisting all women during the post-natal period. I congratulate the Executive on its announcement today that it will provide £60,000 to Ayrshire and Arran NHS Board for the establishment of such a peer support group service in Cumnock. I hope that more money will be provided for other areas. I commend local health care co-operatives for their work throughout Scotland in helping to establish peer support groups, particularly for PND.
I urge the Executive to ensure continued funding for such ventures. I congratulate Bill Butler again and I agree with his motion.
I thank Bill Butler for his sensitivity in raising the subject. Principle 7 of the Executive's "A Framework for maternity services in Scotland" notes:
"Trusts should make sure that all professionals receive training and support in … identification, screening … and support of women who have or are at risk of developing postnatal depression and other mental illness in a non-stigmatising way".
Obviously, that is not fully happening yet, despite the best intentions of the Parliament and the Executive a year or so ago when the framework was published.
I have had three children and I have not been so unfortunate as to experience post-natal depression, but, like many, I have seen people who have been through it. I have known a few whose families have started to be wrecked through those terrible months, which in some cases extended into many years. One or two women never really recovered from that period.
It is certain that almost all women suffer exhaustion in one way or another for some period after a birth. Cases of post-natal depression as a distinct entity are increasing. We do not know whether the case numbers are truly increasing or whether the increase is a result of better diagnostic techniques.
I leave one thought with the minister, which is for him to examine the link between the statistical increase in post-natal depression and the rapidity with which women are ejected from maternity hospitals nowadays. I remember a debate a couple of years ago in which many MSPs congratulated health boards on the turnaround of mothers after birth, which was down to a day or so. I remember that it was the male MSPs who applauded that fact whereas a good number of the female MSPs got to their feet and said that mothers deserved a bit more of a rest than that. Some of us thought that mothers were not budget airlines to be turned around as fast as possible and that women should be cared for a bit longer in hospital, although I should note that many of the women had requested that they leave hospital as soon as possible.
Even if women are desperate to get out, many horrible things can happen immediately after a birth. Surely it is better to have new mothers in a safe environment with the care and support of nurses. I leave this thought with the minister: are there statistics on the long-term effects—post-natal depression and other complaints such as breast engorgement—on women who leave maternity hospital very soon after giving birth?
I am pleased that Bill Butler secured the debate. He is to be commended for raising such a serious issue.
I am not sure that anecdote is the best way forward in respect of policy and decision making. Dorothy-Grace Elder made an interesting contribution but, in the great history of maternity services, I am not sure how long women being admitted to hospital to give birth has been a feature. I caution the minister not to waste money on too substantial a body of research into the links to which she refers, but we might want to look at that matter.
I am very much aware of Bill Butler's constituent's campaigning work. I am pleased to say that her work has made its way out to Strathkelvin and Bearsden. That shows the vitality of the campaigning work that Lyn McLeod and others have undertaken on this serious issue. The absence of specialist mother and baby units cannot be supported. I trust that the minister will concede that argument either tonight or in due course.
If we are relying on anecdote, I say that my wife, who is the mother of three children, wanted to get out of hospital as quickly as possible so that she could return home to her family and her own bed. No woman wants to be in hospital. Having had one premature baby and one seriously ill baby, I know that neither my wife nor I could have borne the prospect of not being in contact with them during those very trying times—holding and touching the baby, while knowing there was nothing that one could do as a parent for a seriously ill child. The converse side of that is that there is no greater offence against sensibility than for a mother to be unable to have contact with her child.
Trish Godman rightly highlighted how the traditional lines of support by the extended family or friends have altered as a result of changes in social circumstances. Even the impact of distance has meant that people cannot be there for other people any more.
Bill Butler is to be commended on raising the need for sensitivity on the serious effects of post-natal depression. A number of members highlighted that in their contributions to the debate. I would be delighted to see the minister galvanised by Bill Butler's call. I look forward to seeing its galvanising effects on the minister, if not tonight then at some time in the near future.
I would like to add my congratulations to Bill Butler on securing this important debate.
The World Health Organisation estimates that by 2020 depression will be the second biggest cause of death and disability worldwide. If nothing else, that statistic should concentrate our minds and help us to refocus our health priorities to deliver much more comprehensive mental health services.
Research has shown that only one in four cases of post-natal depression is diagnosed and treated by doctors. That lack of effective diagnosis and treatment presents a huge danger to the potential mental health of women suffering from post-natal depression. If not tackled professionally and quickly, it can turn into a chronic and long-term illness. There is also strong evidence of a link between untreated post-natal depression and poor health outcomes of the children concerned.
The SIGN 60 guidelines state that there is a need to ensure routine screening for any signs of depression. For that to happen, those who come into contact with new mums must be properly trained to spot the signs of PND. The mental health charity Mind believes that many women go untreated because of a lack of training and because health professionals do not have sufficient time to spend with patients. Health professionals need to be vigilant for signs of PND, as it is very difficult for many mothers to admit to post-natal depression. As Trish Godman said, everyone, including the professionals, expect them to be on cloud nine with a new baby, so many women hide their true feelings. For that reason, I believe that it would be worth while and cost-effective for the Executive to focus its attack on that stigma through its "See Me" campaign.
The SIGN guidelines also recommend that psychosocial interventions should be considered when deciding on treatment options for post-natal depression. Services such as infant massage, cognitive behavioural techniques, couple interventions, social support and counselling should be available. They have been shown to help women suffering from post-natal depression. Given that many women are rightly wary of drug therapies at that time, there is an urgent need for alternatives to be made available. Unfortunately, I believe that, like other SIGN guidelines for mental illnesses, few health boards will implement them, citing a lack of resources. The Executive needs to take responsibility for the implementation of SIGN guidelines, rather than allow them to gather dust on a shelf as happens now. I would appreciate a response from the minister on that point.
Like other members, I add my congratulations to Bill Butler on securing today's debate on an important subject.
Bill Butler and others have highlighted the lack of facilities across Scotland, especially mother and baby units for mothers who unfortunately require in-patient services. In reality, up to 80 per cent of women suffer a mild, transient emotional reaction after giving birth. As Kenny Gibson, Elaine Smith and Trish Godman have mentioned, that is commonly known as the baby blues. That reaction is considered normal and I am sure that we will all recall experiences from within our own circle of family and friends of how women have reacted to giving birth.
I want to tell a story that lightens the debate a bit and on which my husband has dined out for almost 18 years. Before the birth of my son, my husband and I agreed that, all being well, we would be out within 24 hours of the birth. I had given strict instructions to my husband not to bring any flowers or fancy presents, as I would not be there very long. My son was born in the morning and my husband came back to visit later in the afternoon to find me with a long face and in tears. He thought that something was wrong with the baby, so he asked, "What's wrong?" I responded by saying, "What's wrong? Just look about this room and you'll see what's wrong." He looked but could not see what was wrong, so I told him: "Everyone has flowers except for me." Members can imagine how the conversation went on from there.
My experience is trivial and fairly normal, unlike the experiences of the one in 10 mothers who suffers post-natal depression. Those women and their families require care and support, but unfortunately, as has been said, provision of care varies across the country. I know from speaking to Bill Butler that care is patchy in the Greater Glasgow NHS Board area. Indeed, some parts of Glasgow are simply not covered.
However, some local health teams are doing good work in an area of health care that is sometimes neglected. In Cumbernauld, for example, health visitors and community midwives work together as a team to offer support, help and advice to mothers. They can detect the early signs of post-natal depression by using their observation skills. Through the local health centre, they have formed a group called "Life after Birth", which is also supported by the community psychiatric nurse. The group meets regularly, usually over a 10-week period. It offers women professional help and guidance and an opportunity to talk, have time for themselves and find support from other mothers. The group works—in the most recent course, only three of the 14 women involved required additional support. Thankfully, because of the staff's team approach, the necessary on-going support is in place.
Such schemes, which involve early observation and—when required—intervention, work and are helping to keep women out of hospital and with their babies. However, that approach should not be unusual; it should be the practice in every community in Scotland. I urge the minister to ensure that such an approach is taken throughout the country.
I, too, thank Bill Butler for securing the debate and for arguing his points so forcefully.
I will touch on two or three points that have not yet been covered. I acknowledge the problem that Bill Butler mentioned in relation to his constituent. However, problems are also caused by the practice of putting mothers and babies in more general psychiatric wards that lack specialist facilities. People in such wards are seriously ill and if the ward does not have the infrastructure or if no one on it is trained to deal with mothers and babies, although we might be keeping the mother and baby together, we are also giving rise to a host of other problems.
As the debate has made clear, a whole range of conditions is included under the term post-natal depression. Although depression is a serious element of that, some women also suffer from mania or hyperactive behaviour in the post-birth period, which sets off an underlying psychosis. It can be difficult to pick up such a condition, because, as Trish Godman said, in the post-birth period everyone expects chaos. Moreover, as Brian Fitzpatrick and other members pointed out, first-time parents are never really quite sure what to expect. As a result, behaviour that the family circle might think odd or unusual in other circumstances goes undetected. That is particularly the case where there is no family structure, or no granny and aunts on hand who have been through childbirth and can identify that something unusual is happening.
We have to get a lot smarter at identifying things. Many people end up in hospital because the condition goes on so long that they cannot find any way back without hospitalisation. Perhaps the problem might be addressed by providing in the pre-birth period packs for families that explain post-natal depression. I know that that might be difficult, because no one wants to frighten or alarm people in describing what happens after birth. I agree with Brian Fitzpatrick that telling anecdotes is not the best way of debating the subject. However, post-natal depression was never mentioned in the pre-birth classes that my wife and I attended. For example, no one mentioned that taking the baby home was one possibility within a range of possibilities. I think that that is another key element in tackling the problem.
I, too, thank Bill Butler for securing this important subject for debate. Like others, I believe that it is vital to ensure that services for mothers who suffer from post-natal depression are brought into the 21st century. For too long, those women have either received no treatment at all or their treatment has resulted in separation from their babies. We need to ensure that mothers in all parts of Scotland, no matter whether they live in Petersburn in Airdrie or Peterhead, have the same access to support and treatment for their condition.
Furthermore, the treatment that mothers receive should allow them to remain with their children during a very important and formative phase in the development of mother-child relationships. I join Bill Butler in asking the minister to do all he can to ensure that mothers in every part of Scotland have access to a permanent mother and baby unit.
I add my congratulations to the Church of Scotland on the success of its post-natal depression project. The two drop-in centres in Edinburgh have provided much-needed support and therapy for the women who use them. The project is an excellent example of how the voluntary sector can support and supplement the NHS.
In order to support women who suffer from PND, we must first identify them and I am pleased that progress is beginning to be made in Lanarkshire. In January, Lanarkshire Primary Care NHS Trust will publish its post-natal depression guidelines. They will set out a systematic approach to identifying before the birth of their babies women who might be most at risk and they will ensure that the widely recognised Edinburgh post-natal depression scale is used to identify mothers who are affected by the condition. Women who are identified will be referred to the local education groups that are run by CPNs and health visitors.
My colleague Bill Butler has highlighted a serious issue. He has identified a need for improved treatment for those who suffer from the most acute forms of PND. The treatment would enable the bonding process between mother and child to continue. We must ensure that the many thousands of women who suffer from PND at home with little or no care are given the level of support they deserve.
As a first step, we must ensure that proper, systematic mechanisms are put in place to identify those people. We must ensure that support services are available at a local level for mother, child and other family members. We must ensure that women feel able to talk about the way they are feeling. For too long, post-natal depression has been stigmatised. Many women have felt enormous pressure to put up and shut up—to put up with the depression and keep quiet about the way they are feeling. Such experiences must end and we must work towards a better, more caring response to PND.
I congratulate Bill Butler on raising and pursuing this important topic. I have listened carefully to what he and others have said. I share his desire for improvements in the care and treatment of women who suffer from a serious condition which, unchecked, can have an adverse effect on mother and child.
It is a tragic fact that the second leading cause of maternal death in the United Kingdom is mental illness that is related to motherhood. Although there is a long way to go, mental health services in Scotland are beginning to develop a systematic approach to the prevention, detection and successful treatment of the illness. Karen Whitefield gave an account of what is happening in Lanarkshire.
More generally, we are experiencing development in the use of integrated care pathways for sufferers, based on clear standards and regular audit. That is in line with clinical advice and the health department's guidance to the service.
Bill Butler referred to an addition to the framework for mental health services in Scotland, which in 1999 provided a template for the best organisation of co-ordinated care to improve services and support for women who have post-natal depression.
Dorothy-Grace Elder referred to "A Framework for maternity services in Scotland", which in 2000 specified work to be undertaken by NHS Scotland to address the needs of women who have, or who are at risk from, post-natal depression.
Several speakers referred to the SIGN guidelines on the management of post-natal depression and puerperal psychosis that we commissioned and which were published in June 2002. We have also funded a thorough audit of service provision of primary and secondary care in Scotland against the background of the SIGN guidelines. The outcome will provide a national picture and inform future decisions on the planning and delivery of comprehensive services, support and best practice.
I turn to the main subject of the debate and to a key factor that has been identified as having a bearing on the effectiveness of in-patient care, namely joint admission of an ill mother with her baby. There is strong support among patients, professionals and the health department for units that are designed around joint admissions so that a mother can maintain contact and bonding with her child. That is an aspect of provision in which I want significance progress to be made throughout mental health services. The SIGN guidelines and their references to the proven benefits of providing a service for mother and baby suggest that about 30 to 45 beds are required in Scotland.
The recent Executive guidance on regional service planning will help NHS boards in their task of providing regional services. To that end, I will ask the regional planning groups to consider the benefits of providing joint admission services for post-natal depression on a regional basis in the light of the SIGN guidelines and I shall seek a response from them. Of course specialist in-patient care needs to be complemented by a range of community and other support services being made available locally in line with the published guidance, as Mary Scanlon and others have reminded us.
That is not to say that no progress is being made in addressing the needs of mothers and babies together. As Bill Butler reminded us, Greater Glasgow NHS Board has announced that it is moving ahead to draw up detailed plans for a specialist facility for mother and baby admissions. That is fully in line with the published guidance and it is an excellent example of an NHS board responding to patients' needs in a specialised area of treatment.
I was pleased last week to speak to Karen Robertson, the nurse consultant in Glasgow on perinatal mental health. I congratulate her on all the work that she has done in that area—I know that she has been a leading figure in spearheading developments in Glasgow. The NHS board there has recognised that it will take time to deliver its plans and it is therefore providing an interim arrangement for the admission of mothers and babies until the proposed specialist unit becomes available. Where Glasgow is leading, I want other areas of Scotland to follow. I believe that working on a regional basis is the way forward, which is why—as I said a minute ago—I shall ask regional planning groups specifically to pursue the matter and I shall seek a response from them.
As well as supporting the development of joint admission arrangements, the department also supports and encourages the screening of new mothers using what is known as the Edinburgh scale at six to eight weeks and again at three to six months for the earliest possible detection. Women with post-natal depression can be seriously ill and yet the illness can go undetected. Like most disorders, the earliest possible identification of need and speedy interventions offer the best prognosis for improvement. Karen Whitefield and Mary Scanlon mentioned stigma. If we address that issue, sufferers are more likely to be identified early. I hope that the campaign that we are undertaking on that will be helpful.
The mental health and well-being support group, in its second round of visits which finishes this month, has been paying particular attention to what local facilities are available in NHS board areas for the detection and treatment of sufferers from post-natal depression. In line with published guidance, the group looks specifically for the use of the Edinburgh scale and for developments in the creation of integrated care pathways for the best organisation of care. Its findings include a score rating of progress that has been made. That offers an at-a-glance picture in each case and links to the performance and accountability arrangements for the NHS in Scotland.
I do not know whether members read the reports of the mental health and well-being support group, but they might wish to refer to a particular report on post-natal depression and the score for services in their area. The reports are an important feature of the health improvement agenda in ensuring that key issues are addressed and improvements made. One of the key aims of the support group is to ensure that the good practice that is being followed in parts of Scotland is adopted everywhere. That is vital if sufferers are to receive the high quality care that they deserve and if we are to see improved clinical outcomes and therefore better future mental health.
We agree that there should be a spectrum of care and support for the mother, the baby and the wider family. We accept, and shall promote, the merits of joint admission arrangements. We congratulate Greater Glasgow NHS Board on its announced plans and on leading the way.
I give members my personal commitment that I will do everything that I can to ensure that there are improvements in services throughout Scotland for post-natal depression in general and the development of mother and baby units in particular. I again congratulate Bill Butler on raising the issue and on making such progress on it in such a short time.
Meeting closed at 17:55.