Substandard mental health care for pregnant women and new mothers is creating long-term costs of more than £8bn every year, according to a pioneering study of the effects of maternal depression, anxiety and other illnesses.
The report, produced by the London School of Economics and the Centre for Mental Health charity, represents the first time academics have sought to quantify not just the direct economic impact on affected mothers, but the effect over decades on their children’s prospects, both in terms of development in the womb and during the crucial early years.
The report was commissioned by the Maternal Mental Health Alliance (MMHA), which groups together dozens of campaigning and professional bodies connected to the issue. The organisation said the NHS would only need to spend a relatively small sum, £337m a year, to bring maternal mental health care up to recommended levels around the country.
With up to 20% of women experiencing mental health problems in pregnancy or the first 12 months after birth, known together as the perinatal period, the study calculated a total cost to the nation averaging £9,900 for each of the 813,000 births in the UK in 2012.
Almost three-quarters of this comes from the future impact on children, the academics said, basing this on research into the effect on foetuses of a mother’s psychological distress, and of impaired care in the first year of life, seen as key to development. Of the £8.1bn total, around a fifth is calculated as being borne by the public sector, with £1.2bn falling on the NHS and social services alone.
In an introduction to the report, Alain Gregoire, chair of the MMHA, called the £8.1bn total a shocking statistic which should prompt urgent action from politicians and healthcare commissioners.
He said: “It is in their power to do something about this issue; if perinatal mental health problems were identified and treated quickly and effectively, many of these serious and long-term human and economic costs could be avoided.”
The report finds significant gaps in the detection of mental health problems in the period before and after birth, saying that only an estimated 40% are diagnosed, with just 3% of women experiencing a full recovery.
The authors note: “It is hard to argue this represents an adequate response to the scale and importance of the problem.”
The study factors in anxiety and depression and psychosis in pregnancy and early motherhood, noting that what is traditionally termed postnatal depression can often begin before a child is born. The calculations involved a range of costs connected to mothers, including bills for health and social care, lost earnings and the economic effect of suicide.
For the children, it covered areas such as stress-induced preterm birth, infant death, emotional and behavioural problems, special educational needs and the effect of leaving school with no or poor qualifications.
Because of limited data, the academics did not include some other maternal conditions, including eating disorders and obsessive compulsive disorder, meaning they believe even the £8.1bn figure could be an underestimate.
The report also found alarming variations in mental health care for pregnant women and new mothers, in part because of a lack of strategic focus.
Of 211 clinical commissioning groups in England, the regional organisations that partly replaced primary care trusts last year, just 3% have a formal strategy for perinatal mental health services, with a significant majority having no plans to implement one.
Even when women are treated, services can be patchy. While talking therapies are seen as especially useful for milder cases of perinatal depression since many anti-depressants cannot be used while pregnant or breastfeeding, there is currently capacity to treat just 15% of women in England who need such services. In some areas, women can be treated in special mother and baby mental health units, rather than being separated from their children on standard psychiatric wards. Yet even here, the report says, twice as many of these facilities are needed.
The MMHA, which is launching a campaign on the issue this week called Everyone’s Business, also carried out a parallel audit of perinatal mental health services around the country with the Royal College of Psychiatrists (RCP). This ranked the clinical commissioning groups in England and their equivalents in Scotland, Wales and Northern Ireland on a six-point scale, ranging from no provision at all to those which fully met RCP standards.
It found no specialist service at all in 40% of areas in England and Scotland, rising to 70% on Wales and 80% in Northern Ireland. Fewer than 15% of the UK had comprehensive provision.
The geographical variations were stark, even within the same areas, the study found. In London, seven of the 32 areas had highest-level services, but nine provided none.
Labour’s shadow minister for public health, Luciana Berger, called for swift action. She said: “Too many new and expectant mums are being badly let down. The government has a duty to reduce these avoidable costs. They must do more to ensure that perinatal mental illness is identified as early as possible and that all women have access to the help and support they need.”
Junior health minister Dan Poulter said the government had ensured all new midwives will have mental health training, and 1,700 more midwives and 2,000 health visitors had been recruited since 2010.
An NHS England spokeswoman said the health service welcomed the report: “It is vital that during pregnancy and following childbirth, women at risk of developing conditions ranging from mild anxiety to severe depression and psychosis are identified early so they get the tailored care they need. While more needs to be done, significant progress has already been made, in particular through the health visiting programme, which is working to increase the number of health visitors and transform services to improve support in areas such as perinatal mental health.”
