500 new NHS roles needed to close perinatal mental health gap
Anna Freud estimates hundreds of additional psychological practitioners are required to support around 115,000 women facing ‘fragmented’ care each year.
NHS perinatal mental health care needs major workforce investment
More than 500 new professionals are needed within the NHS in England to close the current gap in perinatal mental health care, according to data calculated by Anna Freud, a mental health charity transforming care for children, young people and families.
The Integrate report estimates that the needs of tens of thousands of people experiencing mild to moderate perinatal mental health difficulties each year are not being sufficiently met. It calls for better integration of services, including the recruitment of more psychological practitioners within universal services - such as maternity and health visiting - to improve support.
This follows the launch of a national inquiry into maternal and neonatal services last year. With final recommendations expected this spring, Anna Freud is urging the government to ensure that, alongside physical outcomes, mental health is equally prioritised and increased integration is recommended to improve equitable access to support.
One in four women and birthing people in England experience perinatal mental health difficulties.1 Of these, around 40% experience the most complex and high-risk difficulties, such as psychosis or severe depression. The majority (60%) experience difficulties classed as mild to moderate, such as less severe forms of anxiety, depression and post-traumatic stress disorder.2 However, mild to moderate cases – often called ‘common’ - can have a serious impact on both the parent and baby and, if left untreated, can persist or escalate.3,4,5
The NHS has developed excellent specialist perinatal mental health services across the UK for the most complex and high-risk difficulties. However, new data modelled by experts at Anna Freud indicates that, while these specialist services are reaching around 57,000 women and birthing people in England, around 115,000 women and birthing people are not receiving the care they need.6 As there is no dedicated service for these families, the support available to them is patchy or absent.
However, Anna Freud argues that more integration – where professionals work together across disciplines and organisational boundaries to provide coordinated care - would close this gap through earlier intervention, improved outcomes for parents and babies, and more efficient use of resources.7,8 For example, previous research indicates that addressing unmet maternal mental health needs could save the NHS around £490 million over ten years.9
What an integrated ‘gold-standard’ model would include:
One service for everyone with perinatal mental health difficulties, including mild, moderate and severe cases. This would include a single point of access and regular mental health training for universal staff, helping ensure no-one falls through the gaps.
The introduction of around 500 new psychological practitioners trained to provide early, accessible support for mild to moderate difficulties, embedded within universal services (e.g., maternity, health visiting and family hubs).10
While integration of services can benefit all women and birthing people in the perinatal period, Integrate suggests it can have the most impact for those at increased risk.11 This includes those with low incomes, living in areas of deprivation or from racially minoritised groups who are more likely to experience common perinatal mental health difficulties and also face the most significant barriers to accessing services.12,11,13
The report comes as prevalence of perinatal mental health difficulties rises, underscoring the urgent need for system change. For example, cases of postnatal depression have increased from 10% in 2014 to 16% in 2018, jumping to 24% in 2020.14
Dr Camilla Rosan, Consultant Perinatal Clinical Psychologist and Clinical Research Lead at Anna Freud, said:
“Specialist perinatal mental health services have transformed care for those experiencing the most severe difficulties. However, a vast group of women and birthing people with common mental health problems are left with fragmented services that can be incredibly confusing to navigate. This patchwork approach has left tens of thousands without effective support.
“Evidence presented in this report shows that improved integration of universal and mental health services can ease pressure on specialist services and help to identify issues earlier and more effectively, ultimately improving the wellbeing of the whole family. Central to this is the recruitment of more mental health specialists into universal services, such as maternity, health visiting and family hubs. Our calculations indicate hundreds are needed to plug the current gap in support.
“While we know the NHS is under immense pressure, this investment is really important as so-called ‘mild to moderate’ difficulties are anything but mild in terms of impact. They can shape the earliest bond between parent and baby, strain relationships, and undermine confidence and recovery at a time that should be filled with connection and hope. If untreated, problems can escalate, adding pressure to families and specialist services down the line.
“Integration is complex but it is possible, and we hope services use this report to guide change. For example, we urge the ongoing national inquiry into maternity and neonatal services to prioritise mental health outcomes as much as physical, along with the vital role integration can play.”
Integrate was also supported by the Maternal Mental Health Alliance.
Nikki Wilson, CEO of the Maternal Mental Health Alliance, said:
“Research has long shown that women and birthing people throughout the UK are suffering high levels of mental health problems that have a profound impact on them, their children and their families. The NHS has made big improvements in care in the past few years, but the majority of women and birthing people, who need only relatively simple forms of care, are not getting it. This is because maternity and health visiting services have historically only focused on physical health, and despite wanting to provide for all health needs, these services have never had the time, the resources, the training or the mandate to deliver holistic physical and mental health care. Modernising care to achieve this would reduce suffering, save lives and ultimately even save money.”
Lived experience: why integration matters to families
Keji Moses: “My mental health didn’t come into the equation”
Keji Moses, 48 from Canterbury, experienced depression after her daughter, Mayah, was stillborn in 2018, and dealt with anxiety during the pregnancy. She didn’t feel like her mental health was prioritised or her care coordinated by maternity services, and believes that integration could have reduced the impact on her mental health. Following these experiences, Keji set up Mayah’s Legacy, a charity that helps women feel confident and heard when discussing their health. She said:
“During the pregnancy, my mental health didn’t come into the equation. When I saw or interacted with clinicians, they really never turned their attention to me. For example, after I was told over the phone my baby had tested positive for a rare genetic condition and a consultant would see me soon, they just hung up. I was left to find information online, which was horrible and scary. The first time someone asked me if I was okay, I was 34 weeks pregnant, and it was clear I wasn’t coping. Because of the anxiety, my blood pressure was so high, I was at risk of a stroke.
“After I lost Mayah, a bereavement nurse called me a couple of times and, even though I was really struggling mentally, that was it. Being left in a ward throughout the night where women were having babies compounded things too. I fortunately had friends and family who helped me move forwards, but if I didn’t have the right support around me, would I have come out the other side? I don’t think so. At the time, I really couldn’t see how I could get through the experience.
“Better integration could have reduced the impact on my mental health. For instance, having a psychologist available on the maternity ward could have transformed the care I received, ensuring I at least spoke to a mental health professional. I think having a single person to speak to all the way through would have helped to identify my anxiety earlier and I wouldn’t have gotten lost in the system. These holistic approaches, where the mental and physical health of both the mother and the baby are prioritised, would help parents get the right support before reaching crisis.”
Nakesha Chambers: “My care ended really abruptly”
Nakesha Chambers, 35 from Birmingham, has three children aged 14, 12 and four years old. She experienced complex perinatal mental health difficulties while pregnant with her second child and more moderate challenges after her the birth of her third in 2021, which also had a serious impact on her wellbeing. She said:
“While pregnant with my second son, I became really unwell and was hospitalised for mental health care a few months after the birth. I’d kept myself really isolated and, with my partner working seven days a week, my mental health problems got worse before my family knew what was going on. If there’d been more support focused on my mental health, for example a health visitor asking how I was feeling, things may not have escalated.
“Following the birth of my daughter, I experienced lots of sensory issues. For example, feeding was challenging which caused me to dread mealtimes, messy play and avoid some playgroup activities. I’ve since been put on the pathway for an autism diagnosis, which has helped me understand these challenges. I also found it hard to let anyone else do things for her, due to traumatic experiences from my own childhood, which meant I wasn’t really sleeping. I received good care while under perinatal services but, when I was discharged, it was really hard to access support. It’s been two years and, despite being in crisis twice, I only had one appointment with local support services.
“My experiences show that there needs to be better integration between maternity and community services, along with more mental health training. With my daughter, I felt like my care ended really abruptly, which was crushing. Being given more information about local groups and how to navigate referral processes would have made a big difference to me.”