Meeting date: Thursday, May 17, 2018
Meeting of the Parliament 17 May 2018
Agenda: General Question Time, First Minister’s Question Time, Everyone’s Business Campaign, Veterans (Health and Wellbeing), Land and Buildings Transaction Tax (Relief from Additional Amount) (Scotland) Bill: Stage 3, Point of Order, Decision Time
- General Question Time
- First Minister’s Question Time
- Everyone’s Business Campaign
- Veterans (Health and Wellbeing)
- Land and Buildings Transaction Tax (Relief from Additional Amount) (Scotland) Bill: Stage 3
- Point of Order
- Decision Time
Everyone’s Business Campaign
The next item of business is a members’ business debate on motion S5M-10464, in the name of Clare Haughey, on the everyone’s business campaign. The debate will be concluded without any question being put.
That the Parliament welcomes the introduction to Scotland of the campaign, Everyone’s Business; notes that this campaign calls for all women who experience perinatal mental health problems to receive the care that they and their families need; understands that more than 1 in 10 women develop a mental illness during pregnancy or within the first year after having a child, and these illnesses include antenatal depression, postnatal depression, anxiety, perinatal obsessive compulsive disorder, postpartum psychosis and post-traumatic stress disorder; believes that such mental illness often goes unrecognised, undiagnosed and untreated and that this can have a devastating impact on the women and their families; understands that the availability of specialist provision is varied, meaning that specific care may not be readily available across the whole of the UK; welcomes the Scottish Government’s Mental Health Strategy 2017-2027, which includes a commitment to fund the introduction of a managed clinical network that will aim to bring together health professionals in order to improve recognition and treatment in Rutherglen and across Scotland, and notes the campaign’s aim, which is to ensure that all women who experience such problems receive appropriate care, wherever and whenever they need it.12:48
I thank the members who signed my motion, which welcomes the everyone’s business campaign to Scotland. The campaign is incredibly personal to me; I have been a mental health nurse for more than 30 years, and for the past 15 years I have specialised in perinatal mental healthcare. I refer members to my entry in the register of interests: I am a registered mental health nurse and hold an honorary contract with NHS Greater Glasgow and Clyde.
I am delighted to welcome a number of people to the gallery this afternoon. We are joined by change agents and some of Scotland’s most talented mental health professionals, from lead nurses to consultant perinatal psychiatrists and consultant clinical psychologists. I sincerely hope that they will enjoy their visit to Parliament. Among them is an individual without whom perinatal mental health services in Scotland would not be where they are today, and for that we all owe him a huge debt of gratitude. Dr Roch Cantwell’s passion has ensured that many mothers, their infants and their families have received the specialist care that they have needed and deserved.
I pay tribute to the everyone’s business campaign co-ordinator for Scotland, Joanne Smith, for her work and drive in ensuring that the campaign has been raised in Parliament.
Our debate this afternoon could not be more timely. We are in the middle of this year’s mental health awareness week, at a time where mental health is at the forefront of the public’s thoughts. Although most people will be aware of the shocking statistic that suicide is the biggest killer of men aged under 45, it is probably less known that it is also the leading cause of direct maternal deaths within a year of childbirth.
Perinatal mental health problems are, sadly, all too common, with estimates that range between 10 per cent and 20 per cent for the number of women developing an illness in the first postnatal year, and it being estimated that one in seven of those women hides or underplays its severity.
Across the United Kingdom, mental illness in pregnant and postnatal women often goes unrecognised, undiagnosed, and untreated, with many mothers suffering in silence. The everyone’s business campaign is therefore calling for all women across the UK who experience perinatal mental health problems to receive the crucial care that they and their families need, wherever and whenever they need it.
The campaign is built on three main themes:
“Accountability for perinatal mental health care should be clearly set at a national level and complied with.
Community specialist perinatal mental health teams meeting national quality standards should be available for women in every area of the UK.
Training in perinatal mental health care should be delivered to all professionals involved in the care of women during pregnancy and the first year after birth.”
The campaign recently published a UK-wide map that categorises the levels of specialist perinatal mental health community teams in different areas. The map includes so-called red areas, where no specialist team exists; pink areas, where some extremely basic provision exists; amber areas, where basic provision exists but falls short of national standards and need to be expanded; and green areas, where women and families can access treatment that meets nationally agreed standards.
Although there might not be comprehensive community care across the country, as is reflected on that map, that is not to say that there are no services available at all. There are dedicated professionals across many services throughout Scotland who are ensuring that mothers, their children and their families can access help. All health boards in Scotland bar two have direct access to one of the two mother and baby units in Scotland, and the two exceptions can access that care, when required.
I am very proud to have worked, prior to my election, in the perinatal mental health service in Greater Glasgow and Clyde, which is categorised as being at the highest level on the everyone’s business map.
The Maternal Mental Health Alliance’s report acknowledges, as do I, that we can do more across Scotland. In 2017, the Scottish Government, with the first-ever Minister for Mental Health in the UK, sought to address the disparities by launching the new Scottish managed clinical network for perinatal mental health, in order to identify gaps in provision of such care and to promote improvements in local services.
The new network is an excellent start towards ensuring that every woman and her family who require help with perinatal mental health problems receive prompt and effective care from professionals who are skilled to meet their needs.
Although we are not fully there yet, as an RMN with over 30 years’ experience, I cannot overstate how far our mental health services have come in that time. When I started nursing, mental health hospitals were on the periphery of our society—they were, quite literally, on the outskirts of towns and cities—and there were few community services available. Now, community mental health services are the norm, there is liaison psychiatry in our acute hospitals, and crisis and home treatment teams can be found in most areas of the country.
As clinical nurse manager of the perinatal mental health service, I was part of the team who helped to set up the mother and baby unit in Glasgow in 2004—the first of its kind in Scotland. All that and the continuous work to end stigma have ensured that our services, our treatment, and the prevention of mental illness are constantly improving.
I have, over the years, cared for so many women suffering from a range of illnesses, including depression and anxiety, after having a baby. Many of them had lost all confidence in themselves and their ability to be a good parent, but after some treatment and support, they got back to health.
I often reflect on the words of one particular mum, who gave me a card after her care and treatment came to a close. She wrote:
“I have spent weeks looking for a gift that shows my appreciation for all that you have done for me. Nothing I could find seemed good enough so I am trying to find the words in this card to repay you. You have given me back my life. You have knitted my family back together again and I can now get on with being the mum I want to be to my children.”
I believe that those words show exactly why the services are so important. As a perinatal nurse, I feel very privileged to have worked with mums, their infants, and their families at a very special time in their lives—the time when their baby has been born. It is a very special area of mental healthcare and one that I am very passionate about. I am sure that other health and social care professionals who work in the field feel likewise. That shows why perinatal mental healthcare is so important.
Perinatal mental health is everyone’s business: until all the mums who experience perinatal mental health problems receive the care that they and their families need, wherever and whenever they need it, we still have some work left to do.12:55
I thank Clare Haughey for bringing the debate to the chamber today, especially during mental health awareness week. I offer my support to the everyone’s business campaign and welcome the visitors in the gallery.
Despite more than one in 10 women developing a mental health problem during pregnancy or within the first year of having a baby, the topic is not spoken about nearly enough. We all know people who have struggled after the birth of a child. After having my son 24 years ago I, as many young mothers do, found myself feeling alone, isolated and not sure that I was doing the right things. I continually questioned my actions, and felt that everyone else seemed to know better than I did. No matter how much I beat myself up or questioned myself, I did not want to say to anyone that I was not coping. However, having spoken to friends and family, and looking back, it seems that that is how a lot of people feel, so I am pleased to see that the subject is now being discussed more openly.
That is exactly why I also welcome the introduction of the Maternal Mental Health Alliance’s campaign here in Scotland. It seeks to improve access to specialist perinatal mental health services, so that women can receive the care that they and their families need, wherever and whenever they need it.
We know that services are falling short of the required standards. Only last month, data from 2017 that was analysed by the MMHA showed that women could get no such specialist care in seven out of the 14 health boards, and the MMHA has warned that women are facing a postcode lottery in accessing lifesaving care. We know what the costs are when adequate support is not provided. Suicide remains the leading cause of death among women in the perinatal period, and the impact of undiagnosed or untreated illness can be devastating for families. Although I welcome the commitment to introduce a managed clinical network, I want to see expanded and improved antenatal and postnatal mental health services, so that we get it right for every mother.
When we know that seven in 10 women will hide or underplay the severity of their perinatal mental health problem, it is also important that, on top of improving service provision, we break down barriers to talking about mental health. Last month, I was lucky enough to visit Quarriers, in the heart of Glasgow’s east end, to see the perinatal mental health support that it provides in its purpose-built family resource centre. Based in the community, the facility creates a comfortable space in which mothers can talk openly about problems that they are having, and know that they are not alone. I was encouraged to hear from the staff in the centre that the resource is well utilised. It is also great to see such services being delivered within the heart of the community. I would like to see that being replicated across the city and throughout Scotland. That would show that perinatal mental health is something that we can all speak about without stigma or feelings of self-doubt.
On that point, it is positive to have heard that NHS Greater Glasgow and Clyde has met the national guidelines on service provision that were set out by the Royal College of Psychiatrists. With the health board being clearly focused on delivering for service users, that gives us a greater chance of succeeding in assisting every mother. All stakeholders, locally and nationally, need to play their parts; the NHS is right at the heart of the strategy, going forward. I hope that NHS Greater Glasgow and Clyde continues to meet the guidelines. We have a duty to ensure that the guidelines are monitored regularly.
In finishing, I repeat my support for the campaign. The subject needs to be brought more to the public’s attention, so I hope that the many personal speeches that we will hear from across the chamber today will help to achieve that. We must create a society in which mothers feel able to share their experiences, rather than feeling that they have to hide away, which is why I hope that more resources will be put towards services that reach out to the mothers who find themselves affected.12:59
I congratulate Clare Haughey on bringing the important topic of perinatal mental health to the chamber, and I acknowledge her significant experience and expertise on the topic. I also thank the Aberlour Child Care Trust, the everyone’s business campaign and the Scottish Parliament information centre for the briefing materials that they provided prior to the debate.
Perinatal mental health issues are estimated to affect up to one in 10 women during pregnancy. I support the call of the everyone’s business campaign for all women who experience perinatal mental health problems to receive the care that they and their families need, wherever and whenever they need it. I believe that the establishment of a national managed clinical network on perinatal mental health—the first MCN covering mental health—is a good sign of the Scottish Government’s determination to give mental health parity with physical health. Clinical networks operate in other parts of the health service and have a proven track record on driving up standards of care.
Good perinatal maternal mental health is vital in improving outcomes for mothers and their young children. Poor maternal mental health can impact significantly on child development outcomes. If untreated, it can impact on a child’s emotional, cognitive and even physical development, and although that is not inevitable, the consequences can be serious and potentially lifelong.
That is why the Government-funded MCN on perinatal mental health is so important. The MCN brings together specialists on perinatal mental health with nursing, maternity and infant mental health practitioners, who are assessing provision across all levels of service delivery, currently and in the longer term, to ensure that all women, their infants and their families have equity in access to the perinatal mental health services that they need throughout Scotland.
With all that we know about the importance of early development to a child’s life, intervention and support at the earliest possible stage can have a really positive impact, and can prevent or mitigate issues later on. I whole-heartedly agree that there is a way to go both in raising awareness of perimental—
I am sorry, Presiding Officer. I am struggling to say “perinatal mental health”. It is not an easy phrase.
Will Ruth Maguire take an intervention?
Are you going to teach her how to say it?
No—but I thank my colleague for taking my intervention. She is aware of my campaign to increase paternity leave to up to four weeks in organisations in the public sector. Might that help women who are struggling in the early days?
I thank Fulton MacGregor for that intervention, which gave me a chance to put my teeth back in.
I absolutely agree that children having both their parents around in the early days is good for mum, good for dad, good for baby and good for everybody, so I whole-heartedly support Fulton MacGregor’s campaign.
The most effective work will be done through partnerships including the local authority, the health and third sectors and—of course—perinatal mental health services. Those services straddle adult and child mental health services, which means that the investment protects two generations at once, by supporting child development outcomes and improving maternal mental health. It is work that will ultimately prevent unnecessary suffering for women and families, and it improves children’s early experiences and removes future pressures.
There is an obvious human cost of undiagnosed or untreated illness, and if those mental health problems were identified and treated quickly and effectively, serious and sometimes life-changing human and economic costs could be avoided.
All of us in the chamber agree that we want Scotland to be the best place to grow up. Addressing perinatal mental health issues effectively and as early as possible is just one of the things that we can do to help make that aspiration a reality. Let us pledge to do all that we can to make perinatal mental health everyone’s business.13:03
I start by congratulating Clare Haughey on bringing forward this important debate, particularly as we are in mental health awareness week. I thank the charity behind the everyone’s business campaign and all the campaigners, all the clinicians and, indeed, all the charities that are involved in mental health for their efforts, not just this week but throughout the year.
It is important to recognise that the campaign is about supporting the individual and that perinatal mental health issues impact on the individual for the rest of their life. They also impact on their family life, their social life and their working life, and on their children. It is about health outcomes for the mother, but it is also about health and life outcomes for the child. That is why the campaign is so important. People need access to specialist and wraparound services. However, to make that happen, we need a change of culture—a change in how we think about mental health. I will tell members what I mean by that.
We often mention the statistic that one in three of us will have a mental health issue at some point in our lives. I prefer to think about that as every one of us being on a spectrum of mental health throughout our lives. Thinking about it in that way can help us to change the culture—to change where the resource goes, where the workforce goes and how we not only address the stigma but back up the commitment to tackle mental health problems with the services that people need. Those services include perinatal mental health services.
We also need to address antenatal depression, postnatal depression, anxiety and post-traumatic stress disorders—women need support in all those areas. However, we should consider providing that support in different places. We should consider perinatal mental health not only straight after a child is born but when the woman goes back into the workplace. We must think about what happens in the workplace and how we can provide access to better mental health services there. If the woman is going back to the university or college sector, how do we give her better support and better access to mental health services there?
Crisis services are a specific challenge—we heard about that during First Minister’s questions. We ask people to wait days on end to see a general practitioner, and then sometimes weeks, if not months, to see a counsellor or psychologist. For many people, that delay can literally become a life-or-death matter. Someone who breaks their leg will be seen by an accident and emergency department within four hours, even though they will not lose their life. However, if someone who has a serious mental health crisis is not seen quickly, that can mean the end of their life. We need to change the culture in relation to crisis centres. It is really important to back them with resource.
We also need to think about how we provide care in the community. First, we need to consider how we deliver direct services, whether that is in an acute setting or a primary care setting and whether it is through access to a counsellor in the workplace, in a college or on a university campus, or access to an emergency service in a crisis centre. However, it is also important that, in the community, we have genuinely local crisis teams that identify individuals who need wraparound support.
Yesterday, I read about the case of someone who tried to access a local crisis team in their community. They had a history of mental health issues but were turned away. Four hours later, the police picked that person up from a well-known suicide site at a bridge in the west of Scotland. That is a stark example of the need for better thinking in relation to our crisis teams. Alongside that, we must consider the workforce and how we can get more clinical psychologists and counsellors into all those places to support perinatal women, as well as all women and, indeed, all our citizens, throughout their lives.
I welcome the everyone’s business campaign and thank Clare Haughey for bringing the debate to the chamber. I hope that members can work collectively to give mental health the priority that it needs and back that up with services, resources and the workforce.13:08
I echo members’ thanks to Clare Haughey and the everyone’s business campaign for securing parliamentary time for us to debate this important issue.
“Welcome to the best club in the world. Your life is going to change, but only in good ways.” Those are some of the words that society utters whenever someone is expecting a child. With such a weight of societal expectation around pregnancy and parenthood, it is not surprising that it is difficult for mothers to come forward and admit that they are not necessarily coping or enjoying the experience in the way that they thought that they might. However, for all too many mothers, that is the reality. It is a hidden issue in our mental health landscape and I am glad that we are airing it today.
As with many other mental health issues, perinatal mental ill health is a spectrum. It can be severe or mild; it can involve anxiety or depression; it can involve obsessive-compulsive disorder; and it can lead to post-traumatic stress disorder and real psychosis in some extreme cases.
Perinatal mental ill health happens during or after pregnancy. I will take a moment to recognise a group that is not often a mentioned in such debates: those who miscarry. My sister, Rosie, who is in the gallery this afternoon, is one such person. She miscarried in 2016 and then suffered mental health issues directly afterwards. She has allowed me to share her words with the chamber this afternoon. She said:
“It hurts so much. Along with the feelings of guilt and failure at not successfully bringing my baby into the world, there was a chemical change that I didn’t understand or expect.”
Rosie is among many mothers or would-be mothers who suffer in that way, and we need to do far, far more for them.
There is a tension, because the stigma of not wanting to put up their hand and say that they are not coping gets in the way of identification. That is why the six-week check, which every new mother undergoes, is all important. However, it means nothing if our doctors, midwives and health visitors are not adequately trained to understand the early-warning signs that show that someone is just not coping or might need a little bit of extra support. We urgently need to rectify that and make sure that, as a matter of course, people are adequately trained in perinatal mental health issues.
Once we identify those women, we do them a profound disservice if we cannot back that up with adequate service provision in the communities and hospitals in their locale. We know that less than half of mothers are served by adequate perinatal mental health facilities or services either in their communities or in their local hospitals.
I am intensely proud to have been involved with Aberlour when it started its perinatal befriending service in Forth Valley. All told, it has helped 160 mothers in that area since it started three years ago, but there is no guarantee that the service will be able to be sustained when the funding goes. We need to mainstream such services right across the country so that there is no postcode lottery.
The worst comes when we talk about in-patient provision. In this country, on any given day we have only 12 beds available to mothers and their babies to come in for perinatal mental health support. If those beds are full, mothers are directed to adult services and cannot take their babies with them. We are compounding the mental turmoil of the chemical changes that are going on in their brains with the separation anxiety created by having to remove their child from the situation. That has to be the nexus of where we take the agenda, because it is an absolutely critical point.
I thank Clare Haughey once again for the opportunity to have this debate, and I thank the campaign. It is very easy for us to let these women drift back into the shadows and try to muddle through and carry on regardless, but they are looking to the chamber for answers. It is time that we woke up to that.13:12
I, too, thank Clare Haughey, for securing the debate and the Maternal Mental Health Alliance for its campaign on perinatal mental healthcare and treatment. I thank all organisations that work in this important area and I thank my colleagues, whose contributions have been passionate and sensitive.
Like all members, I was glad to see a managed clinical network for perinatal mental health established, but it is clear that there is much more to be done.
Women are more likely to experience severe mental health problems following childbirth than they are at any other time in their life. Although we know that up to one in five women might experience some kind of mental health problem during pregnancy or in the first year of their child’s life, the mental health difficulties of too many women go undiagnosed and untreated.
Prioritising maternal mental health is a preventative approach to mental health; we know that the mental health of mothers, and new parents generally, is such an important factor in children’s development, wellbeing and their own mental health in later life.
In his review of national health service targets, Harry Burns advocated a “life course approach” to planning health services, which means acting more in early life to support people in the long term. It is about teacher training and training the early years workforce we are trying to attract.
Investment in maternal mental health is an investment in infant mental health. However, the support that we offer families at that crucial time is lacking, and the Royal College of Midwives has said that we are lagging behind England and Wales in making improvements.
It is concerning that only one health board in Scotland has a specialised perinatal community team that reaches the Royal College of Psychiatrists perinatal quality standards under the type 1 criteria. To be clear, in the view of the Royal College of Psychiatrists, failing to meet those standards is a threat to patient safety and rights and might even breach the law. As colleagues, including Annie Wells, have noted, although it is clear that very good work is going on in parts of Scotland, seven health boards offer no specialist community perinatal mental healthcare at all.
The Mental Welfare Commission has found that some women who would have benefited from specialist in-patient care in a mother and baby unit considered that the units were too far away from home—the travel and disruption to their wider family life was too challenging at a time when they were in severe distress. Therefore, we must think seriously about how to improve provision for women who are not close to Livingston or Glasgow. I know that the managed clinical network has been looking at that issue, and I would be grateful if the minister would address that point when she closes the debate.
Bliss has also stressed the need for better mental health support for parents whose babies are cared for in neonatal units. That is an incredibly anxious time for parents and they need access to psychological support.
The links between financial stress and mental health problems cannot be overstated. I very much welcome the new neonatal care fund to ease financial pressures for parents whose babies are in hospital.
We must also ensure that the basics are in place for all new families. Starting a family or having another child means huge change for most families’ financial circumstances. For those on low incomes, the prospect of long periods on statutory maternity pay, navigating the benefit system and paying for childcare can be frankly terrifying.
Parliament has shown the will to tackle child poverty. We have put targets to reduce child poverty back in place, and I am pleased that the Government has listened to the Green Party’s calls to roll out the healthier, wealthier children programme, which is an income maximisation approach that works.
In my Lothian region, family-friendly advice projects and healthy start projects are helping to boost the incomes of young families in Edinburgh and beyond. There have been other positive steps, too, such as the new best start grant. However, there is no room for complacency, because child poverty is predicted to rise, which will have an impact on maternal mental health. The Institute for Fiscal Studies predicts that nearly 30 per cent of children in Scotland will live in poverty by 2021. Such financial stress for parents can have a serious impact on their mental health.
I look forward to working with colleagues to improve perinatal mental health, and I look forward to the minister’s response to the challenges that we face in delivering that improvement.
A few members still want to speak, so I am minded to accept a motion without notice, under rule 8.14.3, to extend the debate by up to 30 minutes. I ask Clare Haughey to move such a motion.
That, under Rule 8.14.3, the debate be extended by up to 30 minutes.—[Clare Haughey.]
Motion agreed to.13:17
I, too, thank Clare Haughey for bringing this important subject to the chamber and for an informative and moving opening speech. I also thank her because this issue is rarely discussed. It should be, as it affects a lot of women—one in 10, as we have heard.
Pregnancy is traditionally portrayed as a happy, joyful time in a woman’s life. People say things such as, “You look radiant”, “You’re blooming,” and all the rest of it. For many women that is true: they revel in this amazing chapter of their life, feeling fulfilled, happy and well—if a little exhausted towards the end. However, for others, as we have heard, it is just not like that that.
As the motion states,
“more than 1 in 10 women develop a mental illness during pregnancy or within the first year after having a child”,
which is exactly when they need their health and energy most. Because of societal pressure, they often pretend that everything is alright, as they do not want to seem weird or different, as Alex Cole-Hamilton articulated. The everyone’s business campaign is so important because it raises awareness of the issues. It says that it is okay to not be okay and that sufferers are not alone.
The fact that the illness often goes undiagnosed and untreated has a devastating effect on women and their family and friends. There is patchy provision of specialist care throughout the United Kingdom and, like Clare Haughey and others, I am glad that that is recognised in the Scottish Government’s mental health strategy, which will fund a £173,000 managed clinical network on perinatal mental health. The network will train midwives, health visitors and primary care and mental health professionals so that women know that there will be help when they most need it, no matter where in Scotland they live. There should not be a postcode lottery in an issue as important as this—it is everyone’s business.
The Scottish intercollegiate guidelines network’s SIGN 127 campaign—SIGN 127 is a guideline on managing perinatal mood disorders—presents a vision of what a world-class service for perinatal mental health would look like. The Scottish Government has committed to implement the SIGN 127 guideline and has also prioritised perinatal mental health in its plan “The Best Start: A Five-Year Forward Plan for Maternity and Neonatal Care in Scotland”.
The gaps in specialist perinatal mental health services in Scotland must be closed, and I believe that the Government has taken the first steps to address that. An example of great practice is that of the Aberlour children’s charity, which believes in early intervention. Aberlour points out in its briefing, for which I thank it, that not all children are born equal. Since 2014, Aberlour has been providing perinatal support services across Forth Valley, and it will expand its provision this year to support mums and their families in East Lothian. Aberlour also runs a befriending support service to provide intensive, community-based, one-to-one support throughout pregnancy and during the first year of a child’s life. By matching each mum with a befriender, the service aims to improve mental health and wellbeing, increase confidence in parenting, reduce social isolation and support access to wider community supports and resources. Aberlour also believes that acknowledging the importance of the father, partner or any other existing supportive relationships in the lives of expectant or new mums is essential, which fits entirely with Fulton MacGregor’s campaign on parental leave.
Nothing is more important than our health and the health of our next generation. It is incumbent on each and every one of us to recognise the signs of perinatal and postnatal illness and to offer support to those who are suffering. We do not live in the dark ages, so let us not be kept in the dark about this most serious of issues.
I call Michelle Ballantyne, to be followed by Mary Fee.
On a point of order, Presiding Officer. I am terribly sorry, but I neglected to refer members to my entry in the register of interests, which shows that I was an employee of Aberlour for eight years prior to coming here. I am now rectifying that neglect.
Thank you very much for putting that on the record, Mr Cole-Hamilton. I am sure that everyone in the chamber will forgive you.13:21
I, too, thank Clare Haughey for bringing forward this debate on what is a really important subject.
Why is perinatal health everyone’s business? The latest statistics suggest that everyone will know someone with experience of perinatal mental health problems, be it a mother, sister, aunt, cousin or friend. Our future is vested in the wellbeing of children and, therefore, in the wellbeing of their mothers. There is a saying that it takes a village to raise a child, and that sentiment is particularly important with perinatal health. Is it, therefore, really acceptable that seven out of 14 health boards in Scotland offer no specialist care?
At present, without specialist perinatal services, it falls to GPs to detect signs of maternal mental health problems. However, how can we expect a doctor to identify and treat the often well-hidden symptoms of mental health issues, which are frequently those of an individual whom they have never met before? I know from personal experience how important a well-established relationship with one’s GP can be in identifying when something is not right. After a routine visit to my own GP following the birth of my fifth child, she asked me, as I was preparing to leave, how I was feeling. My initial, quick response of “Fine” was soon followed by a flood of tears when her concern cut through my collected exterior. My GP’s knowledge of me caught my postnatal depression early and allowed a quick and effective intervention that saved me and my family from what might have been a very difficult time.
Of course, we know that the go-to solution for mental ill health these days is often antidepressants. New mothers, whether it is their first child or fifth, are dealing with both physical and emotional change and some will require a pharmacological intervention, but that should not be the first step. There needs to be prioritised investment in appropriate specialist services. If perinatal mental health problems were identified and treated quickly and effectively, then the serious human and economic costs for the whole country could be avoided. Not getting that right impacts on not only maternal mental health but children’s future outcomes, pressure on our health services and mothers’ ability to return to work.
Although I welcome the fact that the Scottish Government has made commitments to improve services, there still exists an unacceptable postcode lottery for mothers across the country. Of course, the issue often underpinning all of that is funding. Why, then, is it that increased funding received through the Barnett formula has not been ring fenced in Scotland as it has been in England and Wales? Our perinatal mental health services are now failing to keep up with those south of the border, which means that mothers and their children in Scotland are being failed. Perinatal mental health straddles both adult and child mental health services. We know that poor maternal mental health can significantly impact on child development outcomes and significantly limit children’s life chances. If the Scottish Government is serious about closing the attainment gap, perinatal mental health must be addressed.
There is a real requirement for significantly more joined-up thinking when it comes to the provision of our health services. Investment in perinatal mental health is exactly that—an investment—and it is estimated that failing to make it costs public services five times more downstream. That is nothing, however, compared with the human cost and suffering. Long-term investment and planning will be vital in combating the far-reaching human and economic consequences of poor perinatal mental health. I hope that the managed clinical network will now start delivering the resources for appropriate services.
We also need champions: individuals such as Clare Haughey or Claire Grieve, a midwife at Borders general hospital, who recently received the chairman’s award at the NHS Borders celebrating excellence awards for her outstanding work in improving perinatal health services in the Borders.
The birth of a child should be the most wonderful experience, yet so many new mothers struggle. We have come a long way, but the journey is not finished. If it takes a village to raise a child, then perinatal health really is everyone’s business.13:26
I welcome the opportunity to speak in this afternoon’s debate on the everyone’s business campaign. I, too, thank Clare Haughey for securing the debate.
Mental health problems affect everyone, directly or indirectly, and the campaign on perinatal mental health raises specific issues that must be addressed for the sake of pregnant women, new mothers, their children and their wider families. As many as 10 to 20 per cent of women face a period of mental illness either during pregnancy or in the first year after birth, and organisations involved in the care of perinatal health warn that rates of detection and appropriate intervention are still low.
The Maternal Mental Health Alliance has drawn up a map of health boards across Scotland to illustrate the level of care and service available to pregnant women and new mothers by health board. Referring to a point that was very well made by Alison Johnstone, I say that it is shocking that only one health board, NHS Greater Glasgow and Clyde, has a specialised perinatal community team and meets the perinatal quality network type 1 standards.
Even more shockingly, seven of the country’s health board areas have no provision for perinatal mental health care. Regarding the standards, the Royal College of Psychiatrists has warned:
“Failure to meet these would result in a significant threat to patient safety, rights or dignity”.
Most if not all mothers will experience that express train of emotions that hurtle towards them after they give birth. How we support women after giving birth is crucial for their long-term wellbeing.
I welcome the commitment and the action taken by the Scottish Government to introduce a managed clinical network. That action was set out in the “Mental Health Strategy 2017-2027”. I am glad that there has been positive action, which will help to improve the care of and support for pregnant women and new mothers. I look forward to further progress being made on the support that is offered to women who are affected by poor mental health. I will continue to monitor the progress of the Government’s mental health strategy and to offer any help that I can to ensure that people are not being failed when it comes to mental health.
Although today’s focus is on pregnant women and new mothers, there is a case to be made to include women suffering from fertility problems. As many as one in six couples experience some form of infertility. For many, the effects of that can cause prolonged mental health problems. I know of a constituent who was diagnosed with depression because of her difficulty in becoming pregnant. For her, a huge concern and worry was that her mental health problems would continue into a successful pregnancy, and the risk of post-natal depression was always in her mind. Thankfully for her, that was not the case. However, a focus on early intervention for women going through fertility treatment would be beneficial as they become pregnant and after the birth of their children.
I once again thank Clare Haughey for today’s debate, and I extend my support to the everybody’s business campaign to secure better maternity mental health for mothers, their children and their wider families.13:30
I commend Clare Haughey for bringing the motion—and, indeed, her knowledge and expertise in this area—to the chamber today. I also welcome the change agents, Dr Roch Cantwell and others to the public gallery. We all aspire to perinatal mental health getting the attention and sustained discussion that it deserves, and I thank all members who have spoken in the debate for their contributions and for sharing their experiences.
Over the past while—whether it has been through press coverage, passionate campaigning, parliamentary activity or elsewhere—we have heard about the priority and fundamental importance of perinatal mental health. On Monday, I spoke on the issue at Maternal Mental Health Scotland’s annual conference. We have momentum, which we must keep going, and the everyone’s business campaign has played a significant part in ensuring that that happens. That is in the wider context of this week being mental health awareness week and, of course, 2018 being the year of young people. Together, all of that work and all those opportunities can make a real and tangible difference to the profile of issues such as perinatal mental health. Ultimately, we want to raise that profile so that there is better support for women and a more sophisticated understanding of the issues at population level across Scotland.
Annie Wells spoke about what support is available in her area, at the Quarriers centre. Others spoke about the Aberlour project, and there is the Juno project here in Edinburgh. Annie Wells, Ruth Maguire and others spoke about the importance of partnership working. The model should not always be a medicalised one; with partnership working, we can offer support to each other in the community.
As well as focusing on the importance of good perinatal mental health in general, Clare Haughey’s motion supports the everyone’s business campaign, which calls for all women who experience perinatal mental health problems to receive the care that they and their families need, wherever and whenever they need it. The evidence for that is persuasive. We know that between 10 and 15 per cent of women who give birth will suffer from anxiety or depression during pregnancy and the first year after it. That equates to between 5,500 and 8,000 women each year. Furthermore, we know that, in two of every five households with a new baby, at least one parent will suffer from depression or anxiety. The Royal College of General Practitioners has said:
“Up to one in five women ... are affected by mental health problems”
in the perinatal period.
“Unfortunately, only 50% of these are diagnosed. Without appropriate treatment, the negative impact of mental health problems during the perinatal period is enormous and can have long-lasting consequences on not only women, but their partners and children too.”
As others have said, mental ill health is the second leading cause of maternal death after cardiovascular disease. Treating maternal mental health problems is good not only for the women who are affected but for their babies—that is the intergenerational aspect that Ruth Maguire mentioned—and it contributes to breaking the cycle of poor outcomes from early mental health adversity.
All of that is why we have prioritised perinatal mental health in our 10-year mental health strategy. Two of the strategy’s key themes are prevention and early intervention; others are about improving access to treatment and having joined-up, accessible services. We have provided funding of £173,000 a year for the perinatal mental health managed clinical network, and we have funded the network at nearly double the usual level for MCNs, allowing it to bring together not just specialists on perinatal mental health but specialists on nursing, maternity and infant mental health.
The network has the following long-term ambition, which, I have no doubt, we all support:
“That all women, their infants, and families, have equity of access to the perinatal mental health services they need across all of Scotland.”
We want a focus on prevention and early intervention that spans the whole range of the early years, starting from preconception and continuing through infancy and into the school years. Our aspirations apply equally across the piece, and I will make sure that the MCN takes into account miscarriage and fertility problems—which two members mentioned—if it is not already doing so.
The minister says that we have a shared aspiration. Can we have a timeline for when we expect every health board, not just half of the health boards, to have access to the services? What is the timeline for that?
I will come on to that.
The focus of the perinatal mental health MCN is not just on what we usually expect of MCNs—that professionals will talk and share good practice across their work. The work that the network is doing across Scotland involves all health boards and third sector organisations as well as the voices of families.
We want an approach in Scotland that is based on the most thorough understanding possible of the picture across the country. It is not just about which areas have specialist services, although it is crucial that we know that; it is about what is available across the spectrum of need, which spans universal education and awareness raising through to the specialist services that are vital when mental illness occurs. That is why continued involvement of the third sector and universal services is going to be important as we move forward, in the context of integration authorities remaining responsible for the commissioning of community and mental health services including perinatal services. They will continue to have a central role.
Our next steps and the investment will be guided by the MCN’s on-going work to build that full picture of current provision in Scotland. I was not going to mention what is going on in England. Although England has put in investment, I have heard quite a lot of criticism that it is doing it the wrong way round, whereas we are doing it the right way round. I look forward to the MCN’s conference next month, when it will tell us exactly what it has been doing and what it will do in the future, which will influence what we do going forward.
The involvement of women and families is crucial, and the work that we can all do together will ensure that everyone can access the support that they need.
Anas Sarwar rose—
I am not going to give Anas Sarwar a timeline until I know exactly what is required and where, and until I have taken the advice of experts who will tell us exactly what to do. It is important that we get this right from the beginning. We should not waste scarce resources, which has been seen to be happening in England. We must make sure that it is about all the services and that we take a cross-Government approach, as Clare Haughey said.
I thank Clare Haughey for bringing her motion to the chamber for debate, and I offer my very best wishes for the continued success of the everyone’s business campaign, which is doing such important work. It is everyone’s business, and I assure everyone in the chamber that it is certainly mine.13:39 Meeting suspended.
14:30 On resuming—