Stories from new mothers: accessing maternal mental health services

As part of our wider programme of work on maternal mental health, we worked with four local Healthwatch to speak to new mothers about their experience of maternal mental health care. During the interviews, they talked about facing difficulties accessing mental health services. 

Why access to mental health support matters

Access to the right mental health support can make a real difference to women experiencing poor perinatal mental health.

Pregnancy, childbirth, and the postnatal period have the potential to cause and exacerbate mental health issues. According to the NHS, around one in four women experience mental health problems during pregnancy and 24 months after giving birth. Support is needed to tackle these issues. 

Impact of not getting the right support

Untreated maternal mental health problems can significantly impact the mother's or birthing parent's wellbeing and affect the ability to provide adequate care for children. According to the MBRRACE-UK 2018-2020 report, maternal suicide remains the leading cause of direct death between six weeks and one year after pregnancy. 

"They say people don't cry out for help - I did. And no one listened. And I got into a really dark place. I couldn't look at my children and smile." Mother interviewed by Healthwatch Wirral

Services exist, but mothers don't, or can't, use them.

The four local Healthwatch we worked with mapped local maternal mental health support services:

• Bristol, North Somerset and South Gloucestershire recorded 17 services;
• Cambridgeshire and Peterborough recorded 10;
• Wirral 14;
• and Brighton and Hove nine.

The majority of services were free. They incorporated NHS services (specialist and generalist), charity services and those provided by local community authorities. Sometimes these overlapped and were run by multiple sectors. A few services recorded were private. 

We were surprised to see so many services; the mothers interviewed mentioned very few. This suggests that mothers can't easily access many of these services or don't know that they exist.

"I said what was going on and what had happened, but that was it. They didn't give me any leaflets or advise me what else I could do." Mother interviewed by Healthwatch Bristol

Some mothers only found help and support from support groups or private care after conducting their research.

When healthcare professionals failed to inform new mothers about existing support, women had to advocate for their needs and research the required support. 

One mother found the help she needed through a charity that had a group on Facebook.  

"When I met up with [the charity worker], and I told her everything, she was like, "This will be perfect for you." And I think she was the first outside person who kind of reassured me and gave me the tools to kind of think about the thoughts that I was having in a different way […] And if it wasn't for [the charity], I don't know what I would have done, I really don't." Mother interviewed by Healthwatch Wirral

When healthcare professionals offered information about mental health services, it did not always happen helpfully for the interviewees. 

One mother said she could not remember if the professional she saw had told her about available mental health support services. She felt the appointments were rushed, which made it challenging to absorb any information effectively.

Inadequate support

New mothers said that some support they were offered eg. discussions about mental health with health visitors, midwives and GPs, felt like a mere formality. Even if they got a referral  to support services, the support was not timely or didn't meet the mother's needs. 

For instance, healthcare professionals didn't often recognise mothers' mental health difficulties. This is in line with our previous reports on maternal mental health.

"It wasn't someone sitting down and going, you know. "How are you sleeping? Is there anything we can help with? Any concerns with your own -" It was just kind of read a list off a piece of paper. And then it was like, 'tick, tick, tick. Okay. See you later." Mother interviewed by Healthwatch Wirral

Even after seeking support, some mothers we heard from had to reach a crisis point before accessing the help they needed. 

"I didn't get the intervention quick enough; I think if I'd have had support during my pregnancy, and they would have kind of realised. Okay. Things aren't quite right. It might not have got to the stage where I had to be admitted." Mother interviewed by Healthwatch Cambridgeshire and Peterborough 

When mothers could access mental health support, it wasn't always helpful. They weren't able to choose the type of support they needed:

"I saw a mental health worker who was lovely and referred me for some CBT, which has never worked for me. I don't work well with CBT. So, I went to one session." Mother interviewed by Healthwatch Brighton and Hove

Eye Movement Desensitization and Reprocessing (EMDR) therapy was also offered to one interviewee. However, inadequate staffing affected its impact. 

"[I had] EMDR Therapy once a week. Although it kept getting cancelled, so, it wasn't every week at all because they were so short-staffed. And she, the therapist, was the only one that could do the EMDR therapy. So I didn't have as many sessions as I would have liked." Mother interviewed by Healthwatch Cambridgeshire and Peterborough

These options are also offered on a limited basis – for example, six weeks. Mothers highlight this is not sufficient. They needed support provided in the longer term or to access it later in their postpartum journey.  

"I think I would have [taken counselling if it was offered six months after giving birth]. Definitely think I would have done, but that wasn't something that was offered or available and, kind of, I think I just get on with things." Mother interviewed by Healthwatch Brighton and Hove

Policy context

NHS's Long term plan

In 2019, the NHS Long Term plan acknowledged that the 'consequences of not accessing high-quality perinatal mental health care is estimated to cost the NHS and social care £1.2 billion per year.' It also made a series of commitments to increasing access to perinatal mental health care. 

 These commitments included: 

• An additional 24,000 women with moderate to severe perinatal mental health difficulties to benefit from care
• An additional 30,000 women receiving specialist help for less severe difficulties 
• Ensuring specialist perinatal mental health support is available up to 24 months after birth (up from the previous 12 months)

To support these commitments, funding allocation for perinatal mental health services was set to rise steadily in the coming years, demonstrating a clear national commitment to respond to new mothers' needs.

While additional funding has been provided, and spending has been increasing over the last four years, delays in distributing the funding have led to a slow roll-out. More importantly, research by the Maternal Mental Health Alliance has found that many areas are reporting an underspend of their budget in this area, primarily due to workforce challenges. 

Key challenges

• Workforce shortages. Insufficient availability of staff with the appropriate skillset means that in many areas, PMH services cannot spend their full budget.
• Regional discrepancies. Access rates vary significantly across regions, ranging from 3.7% of women accessing care in one ICS to 15% in another.
• COVID-19 impacts.  Research by the Maternal Mental Health Alliance indicates that the pandemic has increased the need for maternal mental health support, especially among women of colour and families experiencing poverty.
• Resource issues. There is also an urgent need to update and renovate the physical estate of many mental health services, ensuring that specialist PMH teams have sufficient resources to deliver on the targets. 

Three-year delivery plan for maternity and neonatal services

In March 2023, NHS England published a three-year delivery plan for maternity and neonatal services, which brings together concrete actions drawing on recent reviews of maternity services, including the Ockenden review and reviews of failures in maternity care in East Kent and Morecambe Bay.

This plan again emphasised the need to roll out more specialist perinatal mental health services and improve the availability of specialist care. It sets out responsibilities for integrated care boards to commission community perinatal mental health services in line with national specifications.

The Maternal Mental Health Alliance acknowledges that access to PMH services has improved in recent years, with every local health system now having access to a specialist community perinatal mental health team, almost all PMH services seeing increasing numbers of women, and around half of the services offering care for up to 24 months after birth and extending care to fathers and partners. 

Yet the stories shared with us, alongside our wider research programme on maternal mental health, highlight the many struggles of new mothers and their families to access quality care and the urgent need to deliver on the commitments of the Long-Term Plan.