Should perinatal mental health be everyone's business?

Although pregnancy and birth are a positive time for most women, between 10 and 20% of women suffer from mental health problems during this period. Mental health problems can arise in pregnancy or after birth and most commonly consist of anxiety, depression, posttraumatic stress disorder (PTSD) following a difficult birth and stress-related conditions such as adjustment disorder. Severe postnatal mental illness, such as puerperal psychosis, is less common, but is one of the leading indirect causes of maternal death (Knight, 2014). In the United Kingdom, there has been increased awareness of the importance of perinatal mental health in recent years, which has prompted a demand for change in prioritisation and health services. In this editorial, we consider some of the factors that contributed to this and the challenges we face if we are to implement change in primary care. In doing so, we do not provide an exhaustive list but focus on contributors that may be useful to consider. We also outline the argument for why perinatal mental health should be everyone's business. A significant factor in increasing awareness of perinatal mental health in the United Kingdom was the formation of the Maternal Mental Health Alliance (MMHA). This has over 60 member organisations, including many associated with primary health care such as the Royal College of General Practitioners, Institute of Health Visiting, Royal College of Midwives and NHS England. In 2014, the MMHA launched a campaign for perinatal mental health entitled 'Everyone's Business', which included a map of perinatal mental health services produced by the Royal College of Psychiatrists. This showed significant variation in services across the United Kingdom, with 40% of the United Kingdom having no specialist perinatal mental health provision (www.everyonesbusiness. org.uk). Where services do exist, they range from one specialist mental health nurse or psychiatrist to complete specialist perinatal community teams and inpatient mother and baby units. However, full specialist community perinatal services are rare. This and other factors mean that approximately half of women with perinatal mental health problems are not identified or treated, despite regular contact with maternity services (Baur et al., 2014). So why should perinatal mental health be everyone's business? The arguments for this are compelling. There is now substantial evidence that maternal mental health problems are associated with a variety of adverse outcomes for women and children. The impact on women and children varies according to the timing (pre-and/or postnatal) and type …