Perinatal mental health provision badly lacking

http://www.theguardian.com/society/2015/oct/14/perinatal-mental-health-provision-badly-lacking

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My thoughts are with the family of Charlotte Bevan and her daughter Zaani Tiana (‘Chain of failings’ led to death of Charlotte Bevan and her newborn baby, coroner rules, 9 October). As described in the inquest report, the failings started when Charlotte was pregnant and there was no appropriate care plan in place. This is not uncommon, as perinatal mental health (PMH) is a very neglected area in the maternity services in the UK.

The majority of units do not have a dedicated consultant obstetrician and/or a specialist midwife in PMH. As a result, pregnant women with mental health conditions are often not identified early, counselled adequately (regarding the use of medication) and directed to the appropriate services in a timely manner. This is often complicated by the fact that the electronic patient record systems used by the maternity and psychiatry services are different and therefore information-sharing is often a real challenge. This also leads to poor communication with GPs, health visitors and other community care teams. Pregnant women often run from pillar to post for advice and support but fail to get them in time. Moreover, due to lack of training, maternity staff often do not feel comfortable in providing adequate evidence-based information.

Due to lack of pre-pregnancy counselling, pregnant women might stop their medication due to the fear of harming the unborn child or concern regarding breastfeeding. Things need to change urgently within maternity services to prevent such loss of precious lives.Raja GangopadhyayConsultant obstetrician in PMH, West Hertfordshire Hospitals NHS Trust

• Regarding your piece on Charlotte Bevan, it is encouraging that it ends with reports of promises from the NHS agencies involved to ensure mothers and babies have access to the services and professionals they need during pregnancy and following birth. You might be concerned to know that when I raised the lack of an appropriate PMH service in the local area with my MP, he and I were told by the mental health trust that mental health training on the issue would be provided for GPs, midwives and health visitors. Clearly, funding is not available in this area to provide an appropriate PMH service staffed by properly trained clinicians like psychiatrists, psychotherapists and psychologists. A bit of mental health training for hard-pressed primary care workers follows the pattern in times of austerity of trying to imply that a service is being provided when clearly it is not. Every trust should be funded to provide a PMH service. Babies of mothers who are depressed or who suffer from a psychotic illness, and who are not treated by appropriately trained and experienced staff, may be at risk – in terms of their safety, their emotional wellbeing and their future prospects. Early intervention of a proper kind saves large amounts of money in the long run. It also may prevent the sort of suffering endured by Charlotte Bevan and her family.Liv DarlingLondon