Prioritising maternal mental health through research

Societal expectations around motherhood and fears around the consequences of a diagnosis can make it difficult for women to talk about perinatal mental illness, or seek support and treatment. Until recent years this silence has also been reflected in the level of services available for these women and the lack of training for healthcare professionals.

Through a programme of research over the last five years, King’s has helped voice the experiences of those with perinatal mental illness, producing essential evidence to successfully call for more funding and to develop resources for women and for healthcare professionals to support them.

This has enabled an increase in funding and training to allow 30,000 more women to be treated from 2016-21 in perinatal mental health services.

Mental health through the generations

Sadly, perinatal mental health conditions often come with long-term adverse consequences for both mother and child. King’s researchers were one of the first groups to highlight the inter-relationships between mental disorders in mothers and a range of risk factors and disorders including social disadvantage, smoking, domestic violence, obesity and gestational diabetes.

Our research has shown the relationship between perinatal mental disorders and adverse outcomes for the child, including stillbirth, sudden infant death syndrome, low birth weight, delayed development, parenting difficulties, and loss of custody of the baby.

To raise awareness amongst policy and healthcare services, King’s researchers analysed data from the South London Child Development Study and showed that children of mothers who have perinatal depression had more emotional, behavioural and cognitive problems. King’s researchers assessed the economic cost of these childhood difficulties as a means to make a case for more funding and estimated the minimum economic cost by early adolescence to be £8,190 per child.

These stark findings highlighted the importance of identification and treatment of women with perinatal mental health problems to break this intergenerational cycle of mental ill health.

Uncovering the numbers, the conditions and the experience

Before 2014 most perinatal mental health research focused on depression and psychosis experienced after birth. Using gold-standard diagnostic interviews our researchers revealed that pregnant women experience a wider range of mental health conditions, including eating disorders and obsessive-compulsive disorder (OCD).

Our research also examined the effectiveness of mental health screening questions in pregnant women and found that anxiety scales were not fit-for-purpose for perinatal mental health.

Using national suicide enquiry data we showed the distinct characteristics of perinatal suicides. The relatively short duration of mental disorder before suicide highlighted the absolute importance of timely support. This research also showed a substantial number of those who committed suicide were not receiving treatments for mental disorders.

£365 million in ringfenced new funding

Supported by their research which defined the urgent need for increased service provision, King’s researchers engaged with policy makers to catalyse a transformation of services for women with perinatal mental disorders in the UK and beyond.

Professor Louise Howard chaired a panel to develop NICE guidelines for clinical management and service guidance for mental health before and after birth. She also wrote a chapter for the Chief Medical Officer public health reports and compiled a highly influential The Lancet series of three reviews on perinatal mental health.

King’s research was a key contribution to a report in 2014 commissioned by the Maternal Mental Health Alliance (MMHA), a consortium of more than 80 charities, as part of their awareness-raising campaign Everyone’s Business.

MMHA also commissioned the Centre for Mental Health to conduct an independent review to make the health economic case for further investment. This cited King’s research extensively and influenced the UK government’s decision to allocate NHS England £365 million over five years in new funding for perinatal mental health services.

This has led to service developments allowing perinatal mental health services to treat 30,000 more women during the period 2016-21.

Internationally our research has informed the World Psychiatry Association (WPA) position statement on Perinatal Mental Health. King’s research into perinatal suicide was used in producing guidance for US maternity professionals, and the influence of our research on outcomes for the fetus and child has been used in guidelines produced in Australia and New Zealand.

Resources, training and raising awareness

King’s research laid the foundation for the development of the KCL self-help guide for antenatal depression which became available through the Increased Access to Psychological Therapies services. The workbook was requested by 134 services nationally, potentially impacting more than 5,000 women per year. One practitioner’s feedback by email was “Fantastic...really helpful for the women.”

Alongside this, King’s research has been the basis of specialist training of thousands of clinicians, including via the Royal College of Psychiatrists and Health Education England, and it has informed pregnancy planning tools available via the website of the pregnancy charity, Tommy’s, reaching more than 8000 women per month.

Alongside informing the development of these resources, King’s research has been influential in raising awareness around maternal mental health through widespread coverage in the UK media of research, allowing its messages and implications to be communicated directly to women themselves.

This combination of public engagement and policy work all grounded in King’s research has enabled many more women to access the services they need and ensured those who provide care have the right kind of training to most effectively identify, deliver treatment and support.