The silent mental health epidemic we need to talk about

The truth is society has a very narrow way of defining perinatal mental health. Concerns are often dismissed as “baby blues”, failing to recognise the broad spectrum of mental health experiences, which can encompass antenatal, postnatal, and perinatal low mood, depression, anxiety, OCD, psychosis, as well as birth trauma and post-traumatic stress disorder (PTSD), which together affect about 25,000 women each year in the UK.

Research shows more than one in five women will face a mental health challenge during pregnancy and after birth. However, we still don’t have a clear picture of the extent of the suffering, with 70% of women either hiding or underplaying the severity of their mental health challenges.

The consequences for women, birthing parents, and their families can be devastating, with mental health-related causes accounting for a third (34%) of deaths occurring between six weeks and a year after the end of pregnancy, and maternal suicide the leading cause of direct deaths occurring during the same period.

We cannot begin to make progress on perinatal mental health without first addressing the pervasive and systemic inequalities that exist in the UK today. We know that a complex set of social factors determines our health outcomes and life expectancy, often impacting those who are at the greatest disadvantage. These disparities are stark in the UK’s maternity system where Black and Asian women, women living in the most deprived areas, and their babies, are significantly more likely to die during or after childbirth. Mental health plays a big part in these inequalities. 12% of the women who died during or up to a year after pregnancy in 2020–22 were experiencing multiple disadvantages, and of these, all had a current or past mental health diagnosis, which shows that early detection, intervention, and ongoing support are critical.

There has been progress. Last week the Care Quality Commission released its 2024 Maternity Survey, which showed more women were asked about their mental health during antenatal check-ups, with 89% saying they received mental health support as part of their antenatal care, up from 85% in 2022. We’ve also welcomed the introduction of Maternal Mental Health Services across England, delivering critical care for women and birthing parents.

But there’s still a huge shortfall in funding and resources, with the failure to address women’s mental health costing the UK £8.1 billion per year, and the annual cost to the NHS estimated at £1.2 billion. Parents are faced with a postcode lottery with no guarantee that services will be universally, or even adequately, available. In many cases, postnatal care pathways are so patchy or non-existent that women, and babies, end up in A&E due to a sheer lack of anywhere else to go.

Despite the immense scale and complexity of this issue, and the urgent need for more funding, there are clear priority areas where improvements to support and services could quickly make a huge difference. Here are four to get the discussion started:

Dedicated GP check-ups

Postnatal GP check-ups are a crucial contact point for new mothers and birthing parents and a chance to access early intervention on mental health issues. While women are entitled to receive a six-week appointment with their doctor, it’s often combined with a baby check-up, and women report feeling rushed, with some ending up with less than three minutes to discuss their own health.

More funding is needed to ensure every woman receives a full appointment for their maternal six-week check, and a follow-up appointment at 12 and 20 weeks after birth. These appointments provide a vital safety net, and without them, women often face long delays for postnatal mental health support. However, just offering appointments isn’t enough – we need to make sure that women are able to find, access, and get to these appointments.

Services in the community

An ecosystem of community-based services is needed at scale across the UK’s maternity system. Delivered by a well-trained and resourced workforce, this would create a 24/7 safety net for new parents at home, in the community, and online, with a focus on areas of greatest deprivation and need. Our experience shows just how powerful peer-to-peer support can be for those going through the isolating experience of perinatal mental ill health because access to someone with similar experiences can remove barriers to seeking or engaging with help. NCT’s Parents in Mind services demonstrate the impact of creating safe spaces for sharing and support. After receiving peer support from local parent volunteers, 94% of parents felt understood, and 88% felt better informed about where to get help. It’s vital that these kinds of services are made available to all women, parents, and families.

Having a secure home

Living in temporary or poor-quality accommodation can significantly impact new parents and their babies, as unstable housing environments can contribute to heightened stress, increased parental anxiety and depression. In England, a record number of babies, children, and families are homeless, with 145,800 children living in temporary accommodation in England. When pregnant women and new parents are living in temporary accommodation or being regularly relocated to new areas, continuity of support is seriously compromised. That’s why it is so important and that’s where the suite of services that support new and expectant families need to work more closely together.

Improved training for healthcare professionals

The professionals who staff maternity services are critical too, and they need more funding and resources, and better-quality training to adequately address the growing mental health needs among new mothers and birthing parents. They also need to be supported and valued in their work. The Royal College of Midwives has called for funding and training for 350 additional specialist perinatal mental health midwives to help meet the gap in services.

Training should include greater awareness of the mental health conditions that can arise during the perinatal period and the impact these issues can have on women, birthing parents, and their babies. Training that is trauma-informed and culturally appropriate is crucial to ensuring professionals have the knowledge and skills.

It’s important to say, fathers, co-parents, and non-birthing parents also experience poor mental health, and it’s often closely linked to maternal mental health. This is another area that needs far greater attention and support. The same is true for the mental health of LGBTQIA+ parents whose experiences remain “under-recorded, under-researched, and under-heard".

We can all acknowledge the complexity that surrounds mental health. There are no simple solutions – but the evidence and the lived experiences of women and birthing parents are screaming at us to act. Every new and expectant parent deserves to have their mental health and wellbeing looked after, through inclusive, person-centred and trauma-informed care, and to have access to early and regular support where and when they need it.

It’s too important to keep this issue behind closed doors - let’s get this discussion out into the open and start creating change today.

If you’d like to donate to NCT’s Winter Appeal, and support more new parents to feel confident, connected and safe this winter, you can do so here.

Angela McConville, Chief Executive at NCT