It takes a village: The future of perinatal mental healthcare

The perinatal period is a unique experience for many women: the anticipation and promise of life with a newborn, the potential lament of a former life lost, and a whirlwind of other logistics and activities can all characterise one’s preparation for the looming postnatal period. For many women, this is the most precious and exciting period of their life, but for others it can be overwhelming, confusing, and extraordinarily difficult.

According to Perinatal Anxiety & Depression Australia (PANDA), around 15 to 22 per cent of women experience depression during pregnancy and/or following the birth of their baby. Additionally, research suggests that one in five women report symptoms of anxiety during pregnancy, while between four and 20 per cent – data collection practices vary, as do definitions and diagnoses of mental health issues, making it difficult to pinpoint exact numbers – experience symptoms of anxiety disorders after giving birth.

At Nous, we have undertaken numerous projects that have borne out these statistics in more anecdotal ways. For example, we have conducted intimate focus groups with recent mothers, in which we have heard about the lack of preventive mental healthcare these women received prior to giving birth, as well as postnatal episodes of psychosis, often rooted in traumatic experiences of labour. As some of us at Nous know all too well, even if you’ve had experiences of depression or anxiety in your life, poor perinatal mental health is, or at least can be, very different in colour and contour.

The consequences of poor perinatal mental health are not limited in their impact to the expectant or recent mother. In addition to her own wellbeing, they can have an immediate impact on breastfeeding success, mother-child bonding, and care for other children in the family. These early experiences can also set up children for longer term emotional dysregulation and other developmental issues, exacerbate family pressures, and contribute to many of the greater burdens of poor mental health, including negative impacts on employment and increased healthcare costs.

It has long been recognised that the costs of poor mental health – to individuals and to the Australian community at large – are substantial and cannot go unmanaged. The Australian Government has a broad ranging National Health Strategy implemented and many States and Territories have their own plans to tackle mental health challenges, including perinatal mental health.

Yet these can sometimes work in isolation and fail to bring together the patchwork of service providers that support women during the perinatal period, leaving women vulnerable during some of the most important moments of their lives.

What women want and need can be very specific during pregnancy and the postnatal period. As a result, they may have interactions with a number of different service providers, including general practitioners funded through Medicare, hospital services funded by State and Territory Governments, Maternal Child Health nurses funded by local councils, private hospitals or practitioners, advocacy and support services delivered by not-for-profits, and more.

There are some excellent services available, including midwifery-led maternity care programs that support continuity of care and carer across the perinatal period, carefully designed mothers group programs, and intensive, admitted health services for women and babies in need. There is also a proliferation of private services catering to mothers’ interests. Peer-led models of support – such as peer-led navigation systems and peer-led testing and support services for those more at risk of HIV and other bloodborne viruses – have proven effective in the cases of complex mental health issues, LGBTQIA+ health, serving and ex-serving military PTSD, and other areas.

But there is also evidence that these supports are not always accessible, often because they are not available in the volume or locations required. For example, upfront mental health education and awareness-raising can build resilience among women and their support networks, facilitating timely action if required, but this isn’t consistently being provided during antenatal classes, doctors’ appointments, or other points of contact during pregnancy.

When mental health issues do occur, mainstream diagnostic tools, which pick up depression, anxiety and other conditions, are not always appropriate. Similarly, maternity-specific mental health support is a rare, and the usual, stock-standard referral pathways, to a generalist counsellor or psychologist, may not always be suitable for women experiencing perinatal mental health issues.

There are also practical elements of parenting that some women and their families need extra support with, such as establishing sleep routines, managing day to day tasks after a caesarean section, or navigating complex family dynamics. These can be out of reach because of service availability or cost. Women from disadvantaged or minority backgrounds – Aboriginal and Torres Strait Islander women, culturally and linguistically diverse women, those in the LGBTQIA+ community, and others outlined in the National Women’s Health Strategy – face further, specific barriers of their own.

The opportunity is ripe to further map out women’s journey through pregnancy and early parenthood and identify the service mix that will meet their needs. Nous has done some important work in this regard. For example, our evaluations of the Queensland Women and Girls’ Health Strategy and the National Stillbirth Implementation and Action Plan have elucidated specific needs for priority populations and identified initiatives that are already serving these populations and could be successfully scaled up.

Spending time speaking and listening – in other words, genuinely consulting – with women and their families, service providers, policy makers and funders is critical to getting this work right. It is also important to think about and cater for the diverse and intersectional identities and needs of women in the perinatal period, including their age, location, socioeconomic status, cultural background, and parousity.

Availability of services must be backed in with good system navigability. Nous has spoken with many women who have found it incredibly difficult to get the help they need because care pathways are so unclear. Within the system itself, different providers are all too often unaware of what the others are doing, what roles each are playing or might potentially play, how to leverage one another’s unique strengths, and how they can come together in concert to put on a more cohesive show.

Fostering a health system that is genuinely women-centred will require strong direction and buy-in from leaders across the system. The Commonwealth Government, States and Territories, local councils, private health care providers, not-for-profits and mental health consumer advocates all have something to contribute. But someone needs to take the first step to better coordinate and coalesce their efforts.

Such system-wide integration and streamlining is not without precedent. As a society, we have seen significantly better care pathways evolve in response to domestic and family violence, as well as a more concerted effort to deal with the upstream social determinants of health. This proves that it is not an insurmountable challenge, but certainly one that takes some commitment and system stewardship.

They say that it takes a village to raise a child. It is difficult to argue with that. What they tend not to mention, however, is that you have to build the village first.

Get in touch to discuss perinatal mental healthcare and the future of women’s health.

Connect with Simone Shultz and Lauren Ware on LinkedIn.

Prepared with input from Paul Eleftheriou, Ian Thompson and Heidi Wilcoxon.

This is the second article in our series on the future of women’s health. Read the first part here.