How the UK model of postpartum depression care could guide Canada’s treatment plan

Years ago, British mother and baby psychiatrist Alain Dubois reviewed the records of new mothers who died by suicide after their postpartum depression and anxiety went untreated.

“The women who [only] received poor care but received shocking rejection and disinterest in their so-called care from the healthcare system,” he said.

“I saw a woman who survived by chance because she went to live with her grandparents – where there were specialists – from her own house, where there was no one at all. literally saved my life.”

A similar problem persists in Manitoba and across Canada.

Delsie Martin, who has a six-month-old son and a two-year-old daughter, says she had had recurring thoughts of death when she visited the Neepawa health center in August.

Delsie Martin says she sought help at Neepawa Medical Center after having lingering thoughts of death. Martin, who has a six-month-old son and a two-year-old daughter, is being treated for postpartum depression. (Submitted by Delsie Martin)

She says a doctor at the hospital discharged her without any treatment or referral to other services.

In 2014, the UK government made maternal mental health a priority and worked to ensure that those at high risk of harming themselves or their babies still had good access to care from qualified professionals.

The results are staggering, he says.

Dubois, who heads the UK’s Maternal Mental Health Alliance (MMHA), says a similar model could be applied in Canada to prevent people like Martin from falling through the cracks.

Martin told CBC News in an interview last week that his doctor told him, “You have no reason to be depressed.”

The mother says she told the doctor she was taking medication for postpartum depression, which she also suffered from after her first child.

Martin says the doctor urged her not to have any more children and dismissed her concerns about finances.

British model

Perinatal mental health care doesn’t have to be like that, says Gregoire.

In 2015, a year after the UK changed its focus on mental health, the UK government committed £75 million (approximately C$125.3 million, according to the earliest exchange rates available from the Bank of Canada since 2017) in the perinatal mental health care budget.

Next year he announced an additional £290million (C$484.6 million) as part of its five-year plan.

In 2019, all regional clinic-led organizations received annual funding for specialized perinatal mental health services in their base budgets.

The government plans to increase funding each year until 2024 to ensure that more women can access services and support for their partners.

The UK’s Maternal Mental Health Alliance says that by taking a “proactive and rounded approach to perinatal mental health (PMH), the significant human and economic costs of undiagnosed or untreated PMH problems can be minimised”. (Alliance for Maternal Mental Health UK)

The spending is due to advocacy by the MMHA, which was set up in 2011 when women with lived experience came together with clinical providers to call for change in the UK.

the covenant “Everyone’s Business Campaign” works to ensure that all women in the UK who suffer from a perinatal mental health condition receive the care and support they and their families need, where and when they need it.

Over the past eight years, some of those goals have started to come true, says Gregoire.

“We have seen a real transformation in their experience of care and support for their mental wellbeing.”

The alliance works to improve access in Northern Ireland, Wales and Scotland, as well as to ensure that people with mild to moderate perinatal mental health conditions have better access.

The British alliance has also moved to provide support to other countries working to bring about change across the Global Alliance for Maternal Mental Health.

Apply this model in Canada

A Quebec-based psychiatrist and professor is calling on provinces and territories, which mostly determine their own health care models, to work together to ensure a model similar to the UK’s is implemented in Canada.

Tuong-Vi Nguyen, assistant professor in the departments of psychiatry and gynecology and obstetrics at McGill University, says the whole family suffers when the biological parent suffers from postpartum depression.

“The risk is not just about the productivity of the mother or how quickly she returns to work after giving birth, but it’s really about the health of the whole family,” said Nguyen, who is also a psychiatrist from the reproduction.

Partners of mothers with postpartum mental health issues are 25 to 50 percent more likely to develop their own mental health issues, Nguyen says. Mothers with anxiety and depression during pregnancy also have children who, as adults, are more likely to develop diabetes and hypertension, she says.

A file photo shows a woman speaking with a therapist.
According to Tuong-Vi Nguyen, a professor at McGill University, many new parents need mental health support, but they have very few options in Canada. (BlurryMe/Shutterstock)

Before the pandemic, about one in seven women suffered from postpartum depression or anxiety, according to organizations such as the American Psychological Association.

Researchers involved in a 2021 international study involving nearly 7,000 pregnant and postpartum women say that this number has risen to one in three.

At the same time, there are not enough mental health care providers to meet everyone’s needs.

“Five years ago, I had a hard time convincing people to start psychotherapy. Now, even when someone is ready, the waiting list is much longer,” Nguyen said.

Manitoba also has the lowest rate of psychologists in the country: about 20 per 100,000 people compared to a national average of about 50 per 100,000, according to data reported this summer by the Manitoba Psychological Society.

The need is there, but the political will to address perinatal mental health is not there, says Nguyen.

According to Natalie Mohamed, Media Relations Advisor for Health Canada and the Public Health Agency of Canada.

She added that in 2017, Canada committed $5 billion over 10 years in targeted funding for provinces and territories to improve access to mental health and addictions services, and also created a portal online called Wellness Together Canada which offers free access 24/7.

However, neither initiative specifically prioritizes perinatal mental health.

A provincial spokesperson reported their 2021 report, A Path to Mental Health and Community Well-Being: A Roadmap for Manitoba, which the province spent $17 million to support in the first year of the plan.

The spokesperson says the roadmap identifies five strategic focus areas and represents the Manitoba government’s plan to “create an integrated, responsive and accessible system” that meets the needs of Manitobans. However, it does not mention perinatal mental health.

Nguyen wants to see Canada develop a national perinatal mental health strategy and ensure there is funding to implement it.

The costs of not caring

The health system spends astronomical sums when maternal mental health is not taken into account.

The London School of Economics and Political Science found in a 2014 report that perinatal depression, anxiety and psychosis result in a total long-term cost to society of approximately £8.1 billion (C$13.6 billion) for each year-old birth cohort in UK

Another report published in 2022 found that addressing these unmet maternal mental health needs and changing the way pregnant and postnatal women are treated could have a net economic benefit of £490 million (C$805.9 million) for mothers. country’s health services over 10 years.

Nguyen, who helped develop a similar calculator for Canadaclaims that the costs of this country are comparable.

The calculator, which derives from pre-pandemic data, found that in Canada, the costs associated with perinatal mental health issues amount to $6.7 billion annually. In Manitoba, these costs amount to approximately $309 million.

“We’ve known the human cost of perinatal mental disorders for some time…It’s too bad we need to talk about dollars and economic costs to get people to act,” Nguyen said.

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