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Perinatal care is a big beneficiary of the recent funding boost in mental health care.
It’s opened new beds in hospitals and services outside them, for women with mental ill health, so they can stay with their babies as they absolutely should do.
Good news, of course. But it’s not the whole story. The journey towards and into motherhood brings women into contact with other public services too.
Perinatal care is not just provided by the NHS. How well mentally ill women are treated needs every step of their ‘care pathway’ to be in place, and working well.
Our investigation into the care of one mum, one of our own, a junior doctor, suggests that all is not well on the perinatal pathway, despite the extra funding that has strengthened the NHS step.
Social care and the family courts, two other significant stretches on this pathway, are in crisis.
The number of care cases handled by the courts has risen ‘relentlessly’. This, the word of the family division’s most senior judge, Lord Munby. The social workers who manage these often complex cases are making extremely difficult decisions, under this extra pressure and in the teeth of austerity.
And mistakes are made, on the perinatal pathway, in its present state, with all the pressures it’s under. Earlier this year, a Parliamentary and Health Service Ombudsman report presented the case of ‘Ms R’, a woman whose baby was taken away without explanation.
We spoke to Ms R, who had a previous history of bipolar disorder. She told us her baby was only returned after her GP, who knew her well, had intervened. ‘It is like they didn’t believe me when I said I was okay,’ she said. ‘I work. I drive. I have never had problem with my other son. Look at me.’
Rob Behrens, the ombudsman, reports that serious failings in specialist mental health services can have ‘catastrophic consequences’ for patients. He’s right and in perinatal care these consequences can be catastrophic for children too. But they won’t stop until the Government takes the state of the entire length of the perinatal care pathway seriously.
It’s great news, as NHS England claims, that tens of thousands more women are helped by expanded perinatal services. But there are’s still ridiculously long waiting lists for talking therapies in most parts of England, treatments which women need to get well during and after pregnancy. Without them, perinatal psychiatrists are like surgeons without operating theatres.
It’s great news that ministers are pouring £365m into perinatal care in England. But how will that help when the social care stretch of the pathway is so severely weakened by austerity?
Doctors agreed at our policymaking conference, the annual representative meeting, in Brighton, last month, to make perinatal care a focus of BMA work this year.
We’re calling for no mother to be separated from their baby for want of a local bed (it happens). And for proper support for mothers whose babies are removed. It wasn’t there for our junior doctor colleague, when hers was taken away. No wonder she’s lost faith in the NHS and social services.
We’ll need the right number of beds, in the right places, well-funded mental health services inside and outside of hospitals. Talking therapies for all patients - not just those who qualify for the IAPT service. And we need someone in Government to sound out the entire perinatal care pathway, social and health care sections included.
So it’s time for ministers to step up to the job. Take a good long look at perinatal care. It’s not just about funding boosts and more NHS services. If we’re to avoid even more catastrophic consequences for parents, their daughters and sons, we need the whole public service to be working together too.
Gary Wannan is deputy chair of the BMA consultants committee and a consultant child and adolescent psychiatrist.
Read the BMA News digital feature ‘Separated at birth’