When it comes to perinatal health*, women receive significantly less information about their mental health and wellbeing compared to their physical health. Yet perinatal mental ill health affects around 1 in 5 women. This can impact significantly on the whole family and child development outcomes if left untreated. At its most devastating, maternal ill health can be life threatening; suicide is a leading cause of death for women in the perinatal period.

Investment in services… and a public health role

The Scottish Government is acting on the evidence and is investing £52 million into improving access to mental health services for expectant and new mothers. The case for a public health response is also clear. At this year’s Maternal Mental Health Scotland conference, where Minister for Mental Health Clare Haughey confirmed the investment, I delivered a session to explore what this response might look like – recognising the impact we can have at this stage on health outcomes for mothers, their babies, partners and family members.

Relationships

The perinatal period is an intense time. Here relationships begin, change, end, develop, deepen and are challenged. And all of this takes place against a backdrop of additional changes: hormonal changes, physical changes, adjustment to new roles, new and increased worries about money, work and family life…to name just a few.

People not only agreed that there was a real role for public health in perinatal mental health but had amazing ideas about what this could look like and the impact this could have. Questions flew around the room… why do we not provide more information about mental health in the perinatal period? How can we justify posters and leaflets on an array of physical health information and virtually none on mental health? Surely it’s a women’s right to know all the information, not just some? Why do we not ask women about mental health routinely during pregnancy? Why do we not ask dads and partners how they are doing?

Fear… and the power of connections

There were also expressions of fear and uncertainty at increasing mental health conversations at a wider level. Fear that a busy clinical setting does not allow enough time to respond effectively. Fear that there is no service to refer on to. Fear that it could make things worse. Fear of not saying the right thing. I was very fortunate to have representation from the Maternal Mental Health Scotland Change Agents who we worked with on the refreshed Ready Steady Baby who passionately emphasised how recognition, validation and authenticity in the perinatal period can be hugely therapeutic. Within the room came a very tentative suggestion that what we were really describing were ‘soft skills’… followed by a resounding YES! I was struck by the desire and need for a group of professionals to unashamedly talk about the power of soft skills to make connections and build relationships.

Permission

In the same way that we now have permission to acknowledge it’s OK not to be OK (check out the ‘See Me’ campaign here), I heard a collective permission that it’s OK to be nice and not needing to have all the answers. Permission to acknowledge that there might not be a service to refer on to but that by being kind, inquisitive, sensitive, approachable, non-judgemental we can build quality relationships. Relationships allow people to feel safe enough to say how they’re truly feeling: what scares them, what they don’t know or what they don’t have answers to.

Before the event I was thinking about relationships in terms of the interplay between perinatal, parental and infant mental health and how we must consider how all contribute to and influence one another. However, what I quickly discovered was that people really wanted to talk about the relationships clinical and support staff have with women and their families. I heard something very special about the powerful outcomes of these relationships. They help someone feel safe. They help someone feel supported. They help strengthen bonding. They simply help!

Mental and physical health equality

From a public health perspective we need to work with our partners to learn, share and advocate for relationships as a key protective factor for maternal, paternal and family mental health in the perinatal period. Healthcare providers should be able to prioritise relationships and have the permission to use their ‘soft skills’, and the support to develop them. By doing so we will improve the outcomes for both mother and child (and generations to come) and achieve parity between mental health and physical health.

* The health relating to women from conception through the first year following the birth of a child 

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