Mothers and Babies: Reducing Risk Though Audits and Confidential Enquiries across the UK (MBRRACE-UK) have published a Rapid report: Learning from SARS-CoV-2-related and associated maternal deaths in the UK. It makes for sobering reading, reporting that four women in the UK died by suicide during March – May 2020.
The women involved appear to have been bounced between different mental health services, with no recognition of repeated referral. Visits from health visitors had stopped for the women, and they had received only a single post-natal midwife visit, due to COVID-19 guidelines.
In Scotland, on 14th April, the Scottish Government advised that mental health services should not be withdrawn (15 mins into video), however it would seem that many women and families have seen changes to their support systems, as reported by the Babies in Lockdown report.
“Some parents struggled enormously and described feeling abandoned or falling through the cracks, while others thrived. Some services were badly affected, others stepped up and did more than ever.”Babies in Lockdown: listening to parents to build back better (2020). Best Beginnings, Home-Start UK, and the Parent-Infant Foundation UK.
Vignettes provided by the MBRRACE-UK research team are telling and frankly heart-breaking:
A postnatal woman with known mental health problems contacted her GP during the early days of lockdown requesting an increase in antidepressant. She had contacted the crisis team and was said to be “not suicidal”. She was rereferred to the perinatal mental health team. The next day she rang the crisis team. She had several further telephone consultations with perinatal mental health and crisis teams but was not seen face to face. She died by suicide the following day.
MBRRACE-UK reports that:
[This woman] should have had a face-to-face assessment the same day yet both crisis and perinatal mental health teams seem to have viewed it as the other’s responsibility. Earlier face to face, or at the very least video consultation may have enabled the diagnosis of psychosis and prevented this woman’s death.
A second vignette starkly illustrates the barriers experienced by one woman:
A woman revealed a history of mental health problems and early life trauma during her pregnancy. Repeated referrals were either not accepted or cancelled due to COVID-19 restrictions. A letter to the woman from the perinatal mental health service arrived two months after the cancellation (one month after she gave birth) explaining that she would not be seen due to COVID-19 restrictions as they only saw people with acute mental illness, and providing leaflets on primary care psychological services, third sector and self-help resources. She died by suicide two weeks later.
MBRRACE-UK have produced new recommendations for the care of women with perinatal mental health problems, in addition to the existing recommendations.
Participation Officer and Everyone’s Business champion Clare Thompson comments:
Support for women and families should not be patchy, or a postcode lottery. It shouldn’t be a matter of luck that a child is left without a mother. The Everyone’s Business campaign calls for all women throughout the UK who experience a perinatal mental illness to receive the specialist care and support they and their families need, wherever and whenever they need it.
If you need urgent help for your mental health, please speak to a friend or family member, call Breathing Space on 0800 83 85 87, or speak to your GP, midwife or health visitor.