PARLIAMENTARY DEBATE
Perinatal Mental Illness - 19 July 2018 (Commons/Westminster Hall)

I beg to move,

That this House has considered perinatal mental illness.

It is a pleasure to serve under your chairmanship, Mr Davies. I and my colleague on the Select Committee on Health and Social Care, the hon. Member for South West Bedfordshire (Andrew Selous), are delighted to have secured this important debate, and I thank the Backbench Business Committee for granting it.

Nothing can prepare someone for the challenge of becoming a new parent—the sleepless nights, the new responsibility and the feeling that they suddenly have to put their old life on hold. As I have found since becoming a parent, a few months before my 40th birthday, raising a newborn child can be hugely rewarding. There is little that compares with the joy of seeing a child grow and develop. For most of us, it is a deeply fulfilling experience. Still, becoming a parent can have a dramatic impact on many people, in terms of both the stresses they experience and the impact it has on their relationships and their emotional wellbeing.

I will talk about how the Government can act to improve the lives of thousands of mothers in England who do not receive adequate support for perinatal mental health problems. The perinatal period is the time during pregnancy and the run-up to a birth, and the time immediately following the birth of a new baby. As a general practitioner as well as a parent, I have worked to provide mothers and newborn babies with the support and care they need in the perinatal period. It is a crucial time not only for the mother, but for the development of her child. It is also a time when great pressure is placed on mothers to care for their baby and simultaneously to be happy, excited and on top of life.

According to the mental health charity Mind, about one in five women experience mental health problems during pregnancy or in the year after they have given birth. Those mental health problems can come in many different forms—from eating disorders, to post-traumatic stress disorder, to anxiety and depression. If left untreated, the mental illnesses that these women experience can affect their whole lives, their ability to cope with being a parent and their relationships within and outside their families. The illnesses can affect attachment and bonding with the baby. At their extreme, perinatal mental health problems can lead to suicide and to long-term health problems for a child.

I understand that one fifth of parents stated that they were not asked about their mental or physical health during the six-week post-natal check-up. Does my hon. Friend think that might be because GPs are massively overburdened and simply do not have the time to deal with this essential issue?

I thank my hon. Friend for raising that point. I will refer to it later in my speech. I think the pressure on GP services that she has identified is one reason, but there are some other reasons to do with training and perhaps resources.

I thank the hon. Gentleman for bringing forward this important debate. To support his case, I will describe the case of Libby Binks, a very brave constituent who came to my surgery. She described how she went through the six-week check without any consideration being given to her wellbeing, despite the fact that she was clearly in distress and had post-natal depression. A health visitor came in at a later stage and filled in a questionnaire with her, which clearly showed she had post-natal depression, but nothing whatever happened until her child’s first birthday. Does the hon. Gentleman agree that we need to make more of that six-week check in particular, to ensure that the mother’s wellbeing, as well as the child’s, is taken into consideration?

I thank the hon. Gentleman for relating the experience of his constituent, which is, sadly, shared by too many other women. Of course, there are many dedicated health professionals who do identify mental health problems, but too many women say that they slipped through the net.

I will talk about why perinatal mental health problems are so important for a child. The first 1,001 days of a child’s life, from conception to the age of two, are absolutely crucial to their social, emotional and cognitive development. Put simply, those 1,001 days are when a brain is built and shaped. During that time, 1 million new neuronal connections are made every second in that child’s brain. When the environment the child experiences, whether inside or outside the womb, is happy, relaxed and stimulating, he or she learns and develops those connections in the brain. The baby grows and adapts in a positive environment.

However, many of the symptoms of mental health problems do not provide that ideal environment. Stress raises the level of cortisol, which can cross the placenta and affect a foetus. When someone is severely depressed, perhaps they do not smile, so a baby does not see the warmth, the love and the reciprocation that they need from their mother. When someone is anxious or has an obsessive compulsive disorder, a baby sees, learns and repeats actions from the environment they are experiencing from birth. They learn to behave like their mother.

A mum’s mental health problem can have such a significant effect on a baby that academics describe it as an adverse childhood experience. Adverse childhood experiences, or ACEs, are stressful events that occur in childhood.

My hon. Friend is making a powerful speech. I was interested to hear the evidence put forward by the National Childbirth Trust to the all-party parliamentary group for the prevention of adverse childhood experiences that depression among 16-year-olds is usually linked to their mother’s pregnancy. I realise that the research is more complex, but given the worrying rise in the number of children and young people with mental health problems, is he as concerned as I am that one quarter of women are unable to access specialist perinatal services in the UK?

I thank my hon. Friend for making several points, including that a child whose mum experiences mental health problems is more likely to develop mental health problems themselves. Despite significant Government investment in specialist perinatal mental health services, significant inequalities remain throughout the country and there are still areas where, as he said, one quarter of women with significant mental health problems are not able to access specialist facilities. I hope we will get the chance to talk more later about access to specialist services.

Other adverse childhood experiences include domestic violence; parental separation or divorce; being a victim of physical, sexual or emotional abuse; physical or emotional neglect; or growing up in a household where there are adults experiencing alcohol and drug problems. Mental health problems in a mother can have as significant an impact on a child as some of those other problems. The term ACEs was originally developed in the US, but other studies have reported similar findings in England and Wales. Those ACEs have, as my hon. Friend has said, been found to have lifelong impacts on health and behaviour. They are relevant to all sectors and involve all of society.

An ACE survey of adults in Wales found that, compared with people who had experienced no ACEs, those with four or more were more likely to have been in prison; develop heart disease; frequently visit their GP; develop type 2 diabetes; have committed violence in the last 12 months; and have health-harming behaviours, such as high-risk drinking, smoking or drug use

Children’s exposure to adverse and stressful experiences can have a long-lasting impact on their ability to think and to interact with others, and on their learning. Health and societal inequalities that develop during early years stick with children for life. That is why I chair the APPG for the prevention of adverse childhood experiences. It is also why the identification and treatment of maternal mental health problems is not only important for the individual mother but crucial for all of us in society.

National Childbirth Trust research shows that as many as half of new mothers’ mental health problems are not picked up by a health professional. That is not to say that health professionals are not asking—they often are. There are many fantastic nurses, GPs, midwives, health visitors and others who provide care during pregnancy and during the post-natal period. However, those services, as my hon. Friend the Member for West Ham (Lyn Brown) has said, are overstretched. We all know how hard-pressed GP services are. The Government have acknowledged the problem and have promised to recruit an extra 5,000 GPs by 2020. However, they are failing miserably and are struggling to even maintain GP numbers. NHS Digital reports a decrease in full-time equivalent GPs from March 2017 to March 2018.

Perhaps a little less well known is the dramatic fall in the number of health visitors. Since 2015, there has been a loss of more than 2,000—almost a 20% drop—so each health visitor has to work harder. I commend health visitors for the work they do but, overall, women are experiencing a drop in services.

Staff numbers are part of the problem, but there are many other reasons why the problems of almost half of women with perinatal mental health problems are not identified. Stigma, and the societal pressure to be seen to be coping, makes it hard for some women to disclose that they have a mental health problem. Also, as the hon. Member for Thirsk and Malton (Kevin Hollinrake) has said, health services do not always ask women about their mental health in the most sensitive way. That is sometimes because they are pushed for time and sometimes because they have not been trained to sensitively and gently probe behind the “I’m okay” response that people are primed to give.

As a result, the hidden half of new mums with mental health problems struggle on alone, often afraid to reach out for help. The overwhelming majority of women who experienced a mental health problem said that it had an impact on their ability to cope or look after their children, and also on their family relationships. The mother of a woman suffering from post-natal depression told me:

“As a parent, watching a child go through that and feeling unable to make it better is a horrible experience. Health professionals need to make sure that husbands, partners and the family know about the likelihood of such depression…and know where to get support and help.”

Perinatal mental illness has an immediate effect not only on mothers; it can have lasting consequences for relationships in the wider family. With the added pressure to be a perfect mother, and the expectations from many that come along with that, it is no wonder that so many women feel unable to cope. One constituent described this to me:

“I remember comparing myself to the younger mums who would turn up to the mother and baby groups looking fresh and without a care in the world, making motherhood look like a walk in the park. Although my son was thriving, I felt like I was failing, because I wasn’t like the young mums or the ones in those perfect baby ads. I didn’t want to share my feelings because I felt I’d been a failure in comparison to them. I believe the pressures of our professions and the guilt of parenthood traps us into a dark place.”

It is often the most vulnerable who receive the least support, with evidence suggesting that those in areas of higher deprivation are less likely to be asked about their mental health. In dealing with this issue, the Minister has the chance to fulfil two parts of her ministerial brief, because investing in perinatal mental health will help to improve mental health and reduce health inequalities.

I have described the problem, but what are the solutions? Identification is key. Regardless of what services may or may not be out there—from specialist mother and baby units, to secondary care perinatal mental health teams, to cognitive behavioural therapy and the prescription of medication—half of women with the problem are not even identified. That is where I believe we need to start.

The disinvestment in health visiting is significant; there can be no solution to the problem while health visiting is not properly resourced. Will the Minister say what she intends to do within her Department to ensure that local authorities are adequately funded and supported so that there is investment in crucial services for children aged 0 to 19, rather than the cuts that we have seen in the past three years?

However, there is another, relatively low-cost opportunity to identify the hidden half. About six weeks after giving birth, new mothers see their GP for a six-week baby check, with many practices also offering a maternal health check. Official National Institute for Health and Care Excellence guidance encourages doctors to do that and inquire about a mother’s emotional wellbeing, providing an opportunity for them to spot the development of any mental health problems. That check could be the last time a mother sees a health professional for a routine appointment in which there is the opportunity to focus on the mother, rather than her baby.

While some women get an excellent six-week check, showing its potential, other women miss out. A fifth of women questioned in a recent NCT survey said that they were not asked about their emotional or mental wellbeing at that appointment. Some women’s checks are all about their baby. Why do all women not get the check that they need? Despite the six-week baby check being part of the GP contract, for which they receive funding, doctors do not receive any funding for the check on the mum. It is a credit to many practices that they offer the checks without funding, but making the time for a full appointment can be challenging, meaning that there is little opportunity to encourage a mother to talk about how she feels, which takes time. A rushed appointment can make many, like the constituent of the hon. Member for Thirsk and Malton, feeling dismissed, or like it was a tick-box exercise.

One woman I heard from recently said her appointment made her

“feel like she was a burden”.

Another of my constituents spoke movingly of her experience:

“I knew there was something very wrong almost as soon as my son was born. Nothing I was ‘supposed’ to be feeling was happening. All I wanted to do was cry. I was feeding him and taking good care of him, but I felt empty inside, and so sad. I can’t remember anyone asking me how I was. I only saw my health visitor once, and that wasn’t in private so there was no opportunity to confide in her.

I told my GP I had postnatal depression and that I needed some help. He told me ‘you have a good family, you should be grateful—you need to pull yourself together.’ I don’t think I have the words to explain how damaging that was. I felt too ashamed to see him again so I changed to another medical centre. My first appointment was with a GP who listened to me. I found the courage to confide in her and she offered me support straight away. I remember very little of my child’s first year of life and I’m sure that is because of the trauma and deep depression I experienced.”

That could have been prevented if my constituent had been seen early on in the post-natal period, and if that first GP had delivered open, supportive questioning that reassured her, rather than made her feel ashamed.

Another constituent told me:

“I sat down with my GP, who had a check-list printed out and placed on his desk. He ran through the questions at a rapid rate, didn’t listen to my answers at all and placed ticks in the boxes after he asked the questions—not based on my reply. Hopefully a separate check for mothers can be achieved, as mothers just want someone to talk to who will not judge them for their feelings.”

About 30% of women diagnosed with post-natal depression still have depression beyond the first year of childbirth. If problems are not identified and treated early, they can worsen and develop into a much more severe mental illness. That underlines the need for an early check. If depression was recognised and treated appropriately within the perinatal period, it could prevent some effects that are much harder to treat in the long run.

I am sorry to intervene again. I intended to make a speech, but I am needed elsewhere, so I will ask a question. I have a lot of time for the Minister and I am wondering how we can help her to make the necessary case to the Treasury. Is it not true that if we look after the parent and the child as early and as well as possible, that will save massive amounts of money in the long term? This is an invest-to-save opportunity, and it would be welcome if the Government took it.

I thank my hon. Friend for her intervention. I have avoided, as much as I can, talking about money in the debate—not all of this is about money, but there are many opportunities to make a massive difference. If we can draw a direct link between a mum’s experiencing mental health problems and the damage that that may do to her child—it increases the child’s chance of developing health problems and even of being involved in crime later in life—there are certainly opportunities to invest to save.

We must not forget, either, that perinatal mental illness has serious consequences for the mother. Suicide is the leading cause of direct maternal deaths occurring within a year after the end of pregnancy in the UK. It is at least possible that if an effective six-week check were in place, some of those deaths would be prevented. Of course, this is, as many hon. Members have said, a complex issue. Diagnosis and treatment are complex, but in addition some health services undoubtedly do not give women the care that they need. Women feel that they are still being dismissed, stigmatised and ignored. However, we should not blame the individual GPs and health professionals who carry out the checks; we should look to change the guidance, the system and the structure in place.

From its research, the NCT has made three recommendations. The first is to fund the six-week maternal post-natal check so that GP surgeries have the time and resources to give every new mother a full appointment for the maternal check. At the moment, although the check focusing on the baby is contracted for and there is funding available for it, there is no requirement for a six-week check on mothers. Checks on mothers, if they are done, are often compressed into the baby’s check, so conversations about mental health may be rushed or sidelined completely.

A constituent got in touch after I said that I was going to speak in this debate. Her response was surprising. She said:

“After the birth of my first child, I suffered terribly with post-natal anxiety—something I didn’t even know was a thing. I don’t remember anyone ever picking up on how I was feeling and no one ever really asked.

Then after the birth of my second child I believe I was depressed. When he was born I didn’t feel anything which then made me feel guilty”—

a common theme—

“and I struggled to bond with him over the first year.”

She then said:

“I believe I met you”—

meaning me, because I was working as a GP in the constituency at the time—

“at my six-week check with him and I remember you asking how I was feeling. After telling you I think I may have needed to”

get some extra help

“for more therapy, you agreed it was a good idea and told me to come back”

for follow-up. She continued:

“I think women need to know where they can go for help and what signs to look out for. I was too scared to tell anyone that I didn’t feel any bond with my son because I think there’s still such a stigma around mental ill health.

I do think the idea of a separate appointment for the mother would be a good idea and more signposting to support groups, how to self-refer, confidential information and advice.”

That experience with my patient, who is now my constituent, demonstrates the value of making time to identify and explore perinatal mental health issues. It might be argued that GPs should be doing that anyway, even if it is not contracted for. I would respond by saying that some are and some are not. GPs do many things that are not in their contract. But the only way of getting true national coverage and the time needed to do a proper job is to resource it.

The hon. Gentleman will be aware that £365 million has been set aside for perinatal mental health services. He is not too far away from North Yorkshire himself, and North Yorkshire has just secured £23 million of that to help with perinatal mental health services for new and expectant mothers.

I do give credit to the Government for making investments in this area of provision. We started from quite a low baseline. There has been significant investment. Too many women are still missing out on these specialist services; the coverage throughout the country is patchy, but I acknowledge that things are improving. However, if we are not identifying half the women with perinatal mental health problems, that is a significant problem in itself.

The investment required to identify problems through the six-week check is estimated by the NCT to be about £20 million a year. That is a very small amount in the grand scheme of the NHS’s budget, but it could make a huge difference to many new mothers. Secondly, in addition to the funding for the six-week check, the NCT recommends improved guidance for GPs on best practice on mental health, specifying a separate appointment for the maternal six-week check and the best methods of encouraging disclosure of maternal mental health problems.

A separate check involving supportive, open and encouraging questioning would provide an opportunity for women to come forward with any problem that they may be having. It might also help to eliminate some of the feelings of stigma or shame; 60% of women said that they felt embarrassed, ashamed or worried about being judged. Just because it is in a GP’s contract does not mean that a doctor has to do the work; with the right training in place, it can just as effectively be undertaken by a practice nurse or other suitably qualified healthcare professional. What is important is that it forms part of the ongoing relationship that a new mother has with her GP practice.

The third NCT recommendation covers NHS investment in and facilitation of GP education. It is important that GPs are trained to recognise the symptoms of post-natal depression and differentiate them from “the baby blues”, which resolve on their own; and it is crucial that mothers are reassured and valued, not dismissed.

These three relatively straightforward measures—a contractual obligation, guidance, and training—could make a huge difference to many women’s and children’s lives. They could eliminate some of the preventable problems encountered by women suffering from perinatal mental illness. The average cost to society of one case of perinatal depression is estimated at £74,000. With an already overstretched NHS under immense pressure, these measures could alleviate some of the stresses placed, later, on mental health services; they will inevitably have to deal with the consequences of undiagnosed and untreated perinatal mental health problems.

With this debate, we are already raising awareness and challenging some of the stigma surrounding perinatal mental health, but we also have a unique opportunity to do something practical to address the problem. Negotiations for the new GP contract begin in September, and by holding this debate today, we want to gain wider support for these important recommendations to be included in the new contract.

There are many other areas of perinatal mental health that I hope we get the chance to explore in this debate. We have already discussed the availability of specialist perinatal mental health services. I hope that we also talk about the variable access to psychological therapies, which are excellent in some parts of the country; in other parts of the country, women struggle to access those services, too. I am very grateful to the other hon. Members who have come today to speak and contribute.

I consider myself to be a fortunate father, one whose experience of parenting has so far been very positive. Many parents are not so lucky. When I hear the heartbreaking stories of women whose post-natal depression has blighted their and their family’s experience of parenthood, I am reminded of just how fortunate I have been. I am also acutely aware of how damaging it will be to wider society over the longer term if we do not improve the way in which we handle this issue. We need to bring the hidden half of these women out of hiding. Post-natal mental illness is not just a problem for new mums. If we fail to tackle it, we risk failing the next generation of children, too.

It is an enormous pleasure to follow my colleague on the Health and Social Care Committee, the hon. Member for Stockton South (Dr Williams). I commend him for a tour de force of a speech, which was extremely comprehensive. I will not speak for as long as he did and I will try not to cover the points that he did, because this is a large area and there is a lot to say about it.

It might be a little surprising to some that two men are opening this debate on perinatal mental illness, but I strongly disagree with anyone who thinks that we should not be, because the strapline of the Maternal Mental Health Alliance is that this is “Everyone’s Business”. That is exactly what it is. We need men advocating and agitating, if this issue is to be taken seriously and dealt with properly.

The Health and Social Care Committee and the Education Committee, in a report earlier this year in response to the Government’s Green Paper on transforming children and young people’s mental health, included a contribution from our excellent Children’s Commissioner for England, Anne Longfield. In evidence to both Select Committees, she said:

“I would like to see a comprehensive starting point that looks at children from birth and pre-birth onwards, and recognises that problems develop along the way; and the earlier and the nearer to home they can be treated, the better it is going to be for the child.”

I think that is a really important point. While there is a lot to be commended in the Government’s Green Paper, we know that in early intervention the earliest years are key.

The Prime Minister and the Chancellor have allocated an extra £20 billion to the Department of Health and Social Care. That gives us an enormous opportunity. Quite properly, the Government are not rushing decisions on how that money will be spent. We will be thoughtful and considered, to ensure that we make wise choices. For my money, prevention and early intervention would be a good use of that money. I am sure that the Minister will push hard in the Department, to ensure that this area is prioritised.

The hon. Member for Stockton South, who spoke so well, talked a lot about the GP checks. I want to press the Minister on how this is supposed to be working at the moment, so that we can learn from it and get it right when the GP contract is renewed in September. My understanding is that Ministers have made it clear that all GP surgeries must offer a six-week post-natal check, to assess how a woman has experienced her transition to motherhood, which includes a check on her mental health. Further, I understand that GPs who opt out from doing so receive a reduction in funding. Until fairly recently, Ministers had been informed that only four practices in England had opted out. Given that information from the Department of Health and Social Care, and given that we are paying for that service and it is supposed to be happening, how is it that 22% of the women in the National Childbirth Trust survey said that they were not asked about their emotional or mental wellbeing at their appointment? Are we, as taxpayers, paying for a service that many GP practices are not providing? I ask the Minister to address the oversight and accountability of GPs in this area.

I realise that we need more GPs. The good news is that 3,157 medical students qualified as doctors and went into general practice this year. That is the highest number ever. We are increasing by a quarter the number of medical students we are training in this country and not before time, because other countries have been training more than we do. Globally, we need 2 million more doctors. I want to see a lot more British doctors—bright British children able to come into this fantastic profession. Of course, we are grateful for the doctors we have from all over the world, but we need to train more of our own and that is exactly what we will do.

The reality, which I understand, is that a lot of GPs, because of the pressures of the job, are working part-time, not full-time. I learnt recently that the average GP works four days a week, rather than five. We also know that a number of them are leaving general practice in their mid-50s, which is a crying shame. We cannot afford for them leave in their mid-50s. We cannot force people to work as GPs, but in their 50s they have so much experience and they are so needed. There is an issue of making the role of the GP less stressful and more enjoyable. In general, the Government need to think more about ensuring that public servants across the board have greater job satisfaction, so that they enjoy and look forward to going to work each day. If we have more GPs and they are less stressed, they should be able to do this work better.

I do not think I received a briefing from the Royal College of General Practitioners for this debate—perhaps I missed it. I am grateful for the briefings we had from a number of Royal Colleges and different organisations, all of which have been extremely helpful, but it would be good to have the full involvement of the Royal College of General Practitioners in addressing the incredibly important issue of perinatal mental health. Hon. Members are absolutely right to raise the training issue.

Earlier this week, I chaired the all-party parliamentary group for supporting couple relationships and reducing inter-parental conflict. We were looking at the issue of loneliness. New parents are one of the groups in society who often feel quite alone, if they do not have all the support networks that we would ideally like them to have. Someone at that meeting said that raising mental health touched on GPs’ anxiety that they would open a Pandora’s box of issues that would take them some time to deal with. GPs generally work to 10-minute appointments. We need to ensure that they have the time, in a relaxed environment, to go into these issues properly. It cannot be done in a rush or on a tick-box basis.

I want to pay attention to the important role that fathers and the partners of women with newborn children have in this area, because it needs to be properly recognised. Unsurprisingly, mothers report that fathers are their main source of emotional support. Yet fathers can sometimes feel left out and not as fully involved as they could and should be in dealing with perinatal mental illness, while the mother of the child wants the father to be involved. We have not always done as well in that area as we should.

I understand that there is evidence that a father’s involvement in pregnancy increases the likelihood that a woman will receive pre-natal care in her first trimester by 40%. The Royal College of Midwives also reports evidence that teaching massage and relaxation techniques to fathers to assist during labour is an effective way of increasing couple satisfaction and decreasing post-natal depressive symptoms, as well as providing psycho-social support for women. We also know that the mother’s relationship with her partner is a key determinant of antenatal maternal stress. This suggests the importance of assessing and addressing a range of attitudes and behaviours on the part of expectant fathers—not just domestic abuse but their own mental health, substance abuse, hostility, infidelity, rejection of the pregnancy and so on. Those issues must be dealt with, because they will have a huge impact on the wellbeing of the mother.

As I have said, poor paternal mental health has an impact on maternal mental health. Research suggests that a father’s mood and anxiety disorder can exacerbate the effects of a mother’s poor mental health and escalate the risk of a child developing emotional and behavioural problems, while fathers with better mental health can provide a buffer against the negative impacts. Fathers and partners are very important, and I am grateful to the Centre for Social Justice for pulling together some of that research.

Again, I am grateful to the Centre for Social Justice for drawing my attention to Greenwich Mind, which is a practical example of a service that provides answers to some of the issues that I have described. It works in partnership with Tavistock Relationships and other local providers to run post-natal support groups and parenting workshops in local children’s centres for parents with or at risk of depression. Those activities specifically focus on the co-parenting relationship, not least in terms of how it is affected by adjusting to parenthood. Evaluations show that relationship quality and mental health improved as a result. That is an example of a good service that we need to see more of.

We must remember the wise words of the hon. Member for Stockton South about the impact that maternal mental health has on children’s development. The health and mental wellbeing of our children is key. I also serve as a vice chair of the all-party parliamentary group on adverse childhood experiences. We are a bit behind the curve in this area in England. The research in America is overwhelming. As an English Member of Parliament, it concerns me that the understanding of it is better in Scotland than in England; the same could be said for Wales and Northern Ireland. I look forward to the time when England is at the same level of understanding.

I will not repeat what the hon. Gentleman said about the earliest years of a child’s development, but those issues really matter. The wellbeing of the mother—indeed, of both parents—in those early months is critical for how our children develop and for giving them the best chance to flourish.

It is a pleasure to follow the hon. Member for South West Bedfordshire (Andrew Selous), and I thank the hon. Member for Stockton South (Dr Williams) for setting the scene so well. He obviously has a passion and a knowledge of the subject—not just as a father, but from his previous job. I have a knowledge of it through people who work for me and who I have social involvement with, including the lady who writes all my speeches—she is a very busy girl—who always wanted to be a mother and had two miscarriages. I am very conscious of her story, and I will tell that today.

The wife of my hon. Friend the Member for Belfast East (Gavin Robinson), Lindsay Robinson, who set up a charitable group in Northern Ireland, has also given me permission to tell her story, which I will do in the way she told it to me. It is important to record those stories. We have come together on a Thursday afternoon to tell the story of why perinatal illness is very real, and to think about how we can help, which is the real reason for being here. I always say that we try to provide solutions so we can do things better. For the record, I should say that I have already apologised to the Minister and the shadow Minister, and to you, Mr Davies, for having to leave early, because I am committed to a later debate.

The work of the NCT is vital and a great support to parents all over the world. In Northern Ireland, we have three active branches that offer local mums, dads and families vital information, resources, connection points, community and friendship when they need it most. I thank the charity for the time and energy it has put into the research for the #HiddenHalf campaign, which has focused our attention on the issue of maternal mental health. It is clear from its work, and that of all those in the maternal mental health arena, that too many women go undiagnosed and unsupported. This debate must be a way to address those issues verbally, and we look forward to the Minister’s response about how she will help us.

NCT’s #HiddenHalf statistic that the problems of almost 50% of women who were surveyed, and who struggled, were not identified by a healthcare professional and that they did not receive any help or treatment is shocking. We must work together to change that. All the hon. Members who have spoken so far have reiterated that point.

My parliamentary aide, Naomi Armstrong-Cotter, who is also a local councillor, has spoken out in a personal way about her experience of miscarriage, of successful pregnancies afterwards, and of the fact that a leaflet handed to someone is not enough to give them the tools to deal with the emptiness of that loss. Our local paper, the Newtownards Chronicle, gave her an opportunity to tell that story; coincidentally, that appeared last week. Her plea was for greater support during and after pregnancy; for a network whereby someone did not have to search for help, but it was ready and waiting; and for follow-ups to be given more effectively. She is now blessed by God with two children, and I have no doubt that her family’s support kept her life together when she was having great difficulty trying to adjust to what was happening to her.

My party fully supports the #HiddenHalf campaign and I attended an excellent event in Parliament two weeks ago to raise awareness of its work on the issue, where I heard stories from mums whose lives have been marked by the illness and by not receiving the timely help that was necessary to make a difference. The event was hosted by my hon. Friend the Member for Belfast East, who understands only too well the devastating impact that maternal mental illness can have on women and the wider family unit. He was the other half who lived with the difficulties that his wife Lindsay was having. She struggled and suffered for two years before getting help. She has given me express permission to use her experience in this place to highlight the failings and the need for a brighter future.

From her experience, Lindsay spearheads the campaign in Northern Ireland for mums, dads and their families to get the support they need and deserve via her movement, “Have you seen that girl?” At the event that I and others attended, the impact of the NCT NI volunteers was clear. She also plays a role in the Maternal Mental Health Alliance’s Everyone’s Business campaign, of which NCT is also a part. Many charities and bodies have come together to offer support.

From the point of view of the two ladies whom I have referred to—my permanent parliamentary assistant and speechwriter and the wife of my hon. Friend the Member for Belfast East—the Church has also helped. It is important to have a faith and to have access to that at an important time.

Having met Lindsay—I spoke to her this morning, just before she left here—I understand that 80% of Northern Ireland still does not have access to specialist perinatal mental health services and that funded community-based peer support is limited. I understand that the Minister is not responsible for Northern Ireland, but from a Northern Ireland perspective, unfortunately, I would be surprised if we were not behind the rest of the UK, which is not good. We need to be up alongside and equal to other countries across the United Kingdom, as the hon. Member for South West Bedfordshire said, but treatment and support is a postcode lottery with too many mums and families being let down when they are at their most vulnerable.

The campaign for change is based on three areas. There should be provision of a mother and baby unit. Unlike in England, Scotland and Wales, a mother and baby unit is not available in Northern Ireland, which is disappointing—nor is it on the whole island of Ireland. The Minister is not responsible for that either, but it shows hon. Members that across north and south Ireland, we have not moved to make that happen. That means that mum and baby have to be separated should in-patient treatment be required. That is a very negative thing. I want to give a perspective on where we are in Northern Ireland and also say what has happened there recently. Some headway has been made—not enough, I have to say, but some at least.

The situation is simply not good enough and can have further negative effects on the mum and the family. There are five health trusts in Northern Ireland, but such specialist services for mothers are currently only available in one: the Belfast Health and Social Care Trust. Although that trust’s services are fantastic, they cannot meet the needs of the whole population of Northern Ireland; that would be impossible for one trust. Mums and families outside the Belfast trust’s area also deserve access to specially designed care and support.

Community-based peer support is also important. I am informed that currently great support is provided in the community and in the voluntary sector, often by mums themselves. How often do mums all come together to support each other? My wife had great support when we had our children; that was not only family support but support from other mothers who had had children at the same time. Again, however, in Northern Ireland we are without proper funding to successfully grow that kind of work.

I make a plea. I am aware of the NCT’s Parents in Mind programme, which is running very successfully here in England—on the mainland—and doing tremendous work. MPs from the mainland will know that and welcome it. NCT Northern Ireland volunteers are keen to source funding to bring that programme, or a similar one, to parents in Northern Ireland. We look forward to the day when that happens. For many parents, peer support is a lifeline, offered by those mothers who have faced a similar battle and who are keen to receive training so that they can provide help to others.

I am also aware from my party colleagues in Northern Ireland that Lindsay Robinson and Tom McEneaney, working with the Maternal Mental Health Alliance, led a team of campaigners to meet the all-party working group on mental health at Stormont; although Stormont and the Northern Ireland Assembly are still not functioning as they should, meetings still take place. The campaigners presented the information and asked all the Northern Ireland parties to sign a consensus statement, pledging their commitment to action all of the issues that I have mentioned as soon as possible. I am delighted that my party—the Democratic Unionist party, for which I am the health spokesman—has signed up to that, and I am assured that other parties have also signed up to it. We are keen to meet further with the team and give them our support. I hope that we are considering a strategy that will take us right through the next period, hopefully with a functioning Assembly. However, the strategy will certainly work, whether or not the Assembly is up and running.

I will close now, Mr Davies; I am always very conscious that there are other speakers to come. In closing, I again offer my full support to the NCT’s #HiddenHalf campaign and its goals here in England—on the mainland—and I thank the NCT for its continued support for the campaign in Northern Ireland. The NCT is supporting our campaign in Northern Ireland and we thank it for that, because it is very important that we have that support. As I have said often, we are better together—the United Kingdom of Great Britain and Northern Ireland—with all regions working on things that are of mutual interest to us all. I understand that the NCT is fully behind all that is happening and will become further involved in the coming months, and I look forward to that.

Also, I commend Lindsay Robinson and all those who have been campaigning in Northern Ireland for improvements to maternal mental health. We know that they are making a difference, both to the parents in their communities and also with decision makers. However, we must also take action in this House. We must do what we can to honour the bravery of those who lay their experience on the line for people to see and bring about changes that support mothers and families across the UK.

Again, I congratulate the hon. Member for Stockton South on securing this debate and other Members who have spoken or who will speak; I look forward to hearing all the contributions to the debate.

It is a pleasure to serve under your chairship, Mr Davies, and I congratulate my hon. Friend the Member for Stockton South (Dr Williams) and the hon. Member for South West Bedfordshire (Andrew Selous) on securing this debate.

We should judge the success of our society by how we treat our new mothers—it really is that simple. I am here today to speak up for better-quality, more consistent and well-funded services for perinatal women.

I am not a new mother. In fact, my youngest teenage son is sitting just over there in the Public Gallery and Members may be able to tell from his towering 6-foot frame just how long it has been since I was recovering from giving birth to him, the second of my two gigantic children. Even so, I remember those special early days for all the many wonderful, and some horrible, reasons that all mothers will know.

We do not discuss post-natal truths enough in the UK. Women will sometimes share with their friends the gory details of their experience of giving birth, but we rarely ever see in the print media, on TV, or in films what happens after a baby is born. If the fairy tale does not end when Cinderella weds her prince, as most fairy tales do, it most certainly has ended by the time Cinderella has entered her third trimester and is waddling around the palace. Nobody wants to hear about Cinderella’s third-degree tear, the fact that her boobs leak, the possibility that she may experience incontinence, or the fact that, even though she has a wonderful, healthy baby in her arms, she just cannot stop crying. But fairy tales are out of date and so is the fact that we do not talk about perinatal experiences—both external and internal experiences—with the honesty we need.

Things are changing, however. After all, we are here today saying that what is on offer to post-partum women in the UK just is not good enough. It is outrageous that women in one quarter of the UK are still without access to specialist perinatal mental health services. How can the mental healthcare of new mothers still be a postcode lottery? It is not as if mental health changes are uncommon after a woman has given birth. In fact, 81% of women say they have experienced at least one perinatal mental health condition either during or after their pregnancy.

I know from talking to friends, family and, indeed, constituents how imperative perinatal mental health support is. We must remember that three quarters of women who say they have experienced a perinatal mental health condition had no previous history of mental health problems. For those who have experienced mental health problems before giving birth, changes to the brain’s chemistry post-birth, combined with post-partum isolation, can trigger the return of symptoms that they had previously experienced, often in their teenage years.

Speedy referrals and access to early treatment is vital for those who experience mental health issues during or after pregnancy. What is so worrying is that it takes more than four weeks for 38% of women in the UK who are referred to be seen. In fact, there are cases of women suffering post-partum who have the courage to seek help from their doctors and health visiting teams but who still have to wait beyond a year for help after referral. That is a whole year that these women are waiting for help in what is often one of the most turbulent, joyous, change-filled and complicated times in any mother’s life. Any service that keeps people waiting for more weeks that I can count on the fingers of one hand is completely unfit for purpose.

We must close the funding gaps that cause huge waits—it is reassuring to hear that the Government intend to do that—and end omissions in service provision. We must also ensure that maternity services do not remain overstretched and understaffed. We must bring back full bursaries for midwives and related healthcare qualifications, which will allow staffing gaps to be filled with the much-needed new caring talent that will have the capacity to offer continuity of care to high-risk women in pre and post-natal moments of vulnerability. The erosion of higher education bursaries, especially for nurses, midwives and other healthcare students, was yet another example of this Government knowing the cost of everything but the value of nothing.

There is another reason why we must act and act soon. A study by the department of anthropology at the University of Kent, which is in my constituency, shows that post-partum depression discourages mothers from having more than two children. The decision to have children, or the decision to have more children, is a woman’s choice alone. However, that choice must be made without the pressures and limitations that come with poor funding of post-natal care. A choice made through fear is no free choice at all.

I completely echo colleagues’ calls for there to be much greater depth in the maternal six-week check. The baby’s check by the doctor and the mother’s check by her doctor must be separate. A woman’s six-week check cannot be limited, as I so often hear it is, to a few rushed questions. I have been told of women being asked only about the contraception they plan to use, with no questions at all about their physical or mental wellbeing. I have heard from friends that their doctors simply asked them, “Are you feeling okay?” That is not a proper question. As any mother will say, the moment their new new-born is in their arms, the definition of what was previously considered “okay” is thrown of out the window. Time must be put aside for proper, in-depth questions and for real insight.

After all, as we have already heard, according to the Royal College of Midwives 42% of women with post-natal depression never even mention it to a healthcare professional, and three quarters of those women stay quiet because they feel guilty about having such thoughts. Moreover, many women are led to believe that serious mental health issues are merely a bout of the baby blues. We urgently need proper training and proper conversations to create an environment where mothers feel safe, well-informed and able to talk about any difficult experiences.

I acknowledge that even the most thorough six-week check for women would not always pick up on everything. Post-natal depression can sometimes manifest slowly. One study suggested that the majority of women experiencing symptoms did not report them until six months post-partum or later. To tackle that, I urge that the maternal mental health check by health visitors at three to four months is reinstated. Even taking more time at that early point when a woman is sat with her GP at the six-week check will save lives. A couple of weeks ago, I attended the NCT’s #HiddenHalf event, where several brave women attested to just that.

Has the hon. Lady had a chance to look at the clinical evidence base for the effectiveness of the three to four-month check? Is she aware of a good base of evidence from clinicians that it is a sensible use of money at that point?

I thank the hon. Gentleman for that intervention. I have not looked at the issue in that kind of depth. I have been working on it with local women and local groups who suggest that it would be good to reinstate it. I will look into it further.

The women at the #HiddenHalf campaign event said that their lives had been saved by a fortuitous visit to the right GP at the right time, but they know they were the lucky ones. The mother’s six-week check must also allow time for a full physical health check to prevent long-term and often totally avoidable health complications resulting from difficult deliveries. Furthermore, it is my belief that a course of pelvic floor physio should be provided for every single woman who has experienced a vaginal birth, as happens in France. I am working with a group of women on health policy for post-partum women. This debate focuses on the perinatal health symptoms of the hidden half, but many of the mental health conditions that health visitors report are triggered by the physical trauma of a difficult birth and women having to reconcile themselves to a completely new sort of body.

Those of us here today will not stop campaigning and raising the issue until the situation changes for new mothers and new families who need our help. We should get the full truth of post-natal motherhood out there and become a country that can rightly say, “There’s lots of help here for you. We will assist you and your families for as long as it takes. We are here to champion and celebrate you in being the happy, healthy, supported mother that you ought to be able to be.”

It is a pleasure to serve under your chairmanship, Mr Davies. First, I thank the National Childbirth Trust for its work and campaigning on this issue and the hon. Members for Stockton South (Dr Williams) and for South West Bedfordshire (Andrew Selous) for bringing this issue to the House. I thank all the Members who have spoken so passionately. There were common themes on access to support, expectations on mothers and being able to talk about post-natal depression.

Perinatal mental illness is crucial for families, and I welcome the calls for a more comprehensive six-week check and the implementation of the other recommendations made by the NCT. Other Members have talked about their experience, so I will mention my own, which was largely fine, other than the stress of being a new parent and being responsible for a new baby. Those things are overwhelming. New parents are given a tiny baby and they leave the hospital with it, and then they have to look after it for the rest of their life. That is quite a big deal, and we downplay it a little bit in society.

My pregnancies were trouble-free and my babies were both well, but in reflecting on this issue, I remembered vividly having panic dreams in which the baby had gone out of the cot. I would wake up in a huge panic, and everything was fine, but it reminded me that we are surrounded by all these hormones and feelings, and it is difficult and stressful, and we do not support mothers enough through that.

I was very glad of the support from the team at Bridgeton Health Centre and Townhead Medical Practice—I want to put it on the record that they were absolutely fantastic. However, when it came to the six-week check, I questioned the efficacy of getting people to fill out a tick-box form about their mental health. It seems to me pretty obvious that if someone did not want to disclose a mental health issue, they could easily fill in that form so that it passed, and nobody would ask any further questions. People have to actively seek help, at a time in their life when they do not know what is normal and hormones are flying all over the place. I hope that that can be improved, and that the check can be more detailed. At the moment, it is too easy to miss the key signs, as hon. Members have mentioned. It was good to hear the hon. Member for Stockton South talking about the feedback that he had from a patient. I hope that more doctors are like him, asking those questions in a way that will draw proper answers, and that time can be given to such things.

Conversations about mental health in society have changed a lot. However, as the hon. Member for Canterbury (Rosie Duffield) mentioned, how we talk about these things has not changed quite enough. I was struck by Serena Williams’ comments about her experience of post-natal depression. This is a woman who is known for her strength and resilience, and for being an athlete, champion and star. She struggled just like anybody else would, and found it incredibly difficult, but has been able to work through it. As we saw with her recent performances, she has come back very strongly, but we are all very vulnerable in those circumstances, and we cannot be complacent about how difficult it can be.

Research from the National Childbirth Trust found that only 50% of women get the help that they need at that key intervention point, and that stigma and embarrassment continue to be rife. The NCT report also highlights the genuine fear that women have—46% in the survey—of the consequences of a healthcare professional thinking that they are incapable of looking after their baby. Certainly in Glasgow, where there are many cases of social work intervention in families, women are scared that if they confess to any weaknesses, they will lose the care of their child. That might not be the case, but the fear is enough to stop women coming forward.

Socioeconomic factors are in play, and perinatal mental health problems are a major risk factor in poor outcomes for children and mothers. Mothers in areas of higher deprivation are far more likely to experience repeated mental health problems and predicted future problems. There is thought to be a direct causality between poor mental health and children’s development. A longitudinal survey in Scotland showed that children whose mothers were emotionally well had better social, behavioural and emotional development than those whose mothers had brief mental health problems. Those children had better development than those whose mothers had repeated mental health problems. That can affect children’s transition to school and their subsequent development and attainment. I recommend looking at the work of Scotland’s former chief medical officer, Sir Harry Burns, who has spoken passionately about the impact of children’s mental health and of parental mental health, and the consequences that it can have.

In Scotland, we have moved towards a nationally co-ordinated systemic approach. The Scottish Government’s new mental health strategy for 2017 to 2027 focuses specifically on allowing children to start their lives with good mental health. The Scottish Government have funded a national managed clinical network on perinatal mental health to the tune of £173,000 per year. It is the first MCN covering mental health in Scotland. The network will provide a focus, enabling us to improve standards for all children and new mothers across Scotland. The MCN is multidisciplinary, involving specialists in perinatal mental health, nursing, maternity and infant mental health. The establishment of the first network for mental health is part of the Scottish National party Government’s determination to give mental health parity with physical health. I understand that such clinical networks work in other parts of the health service and have a proven track record of driving up standards of care across the board.

I have seen figures that suggest that one in eight babies in Scotland are born to a parent who has experienced mental health issues, so it is significant and widespread. We know that perinatal mental health problems do not only affect mothers; they have a wider impact on the family. The MCN is taking forward a work plan addressing that, which includes assessing current provision across all levels of service delivery in Scotland. In the longer term, that will ensure that all women, and their infants and families, have equity of access to the perinatal mental health services that they need right across Scotland, where we have huge rural areas, many islands and various geographical challenges to overcome.

In its review of the current provision, the network will pay particular attention to the pathways into care for women who may live some distance from an existing mother and baby unit, and will make recommendations on improving access where difficulties emerge. The hon. Member for Strangford (Jim Shannon) spoke passionately about the issues that that causes in Northern Ireland and in Ireland more widely, where women cannot access mother and baby units and the support that they need. It must be even more stressful if a woman has to travel over the sea to get to a unit that provides the support they dearly need. In doing so, they will lose contact with family networks that could also support them.

Another core remit of the MCN is to determine what training midwives, health visitors, primary care and mental health professionals—

I see we have had a change of Chair, Mr Rosindell. It is good to see you.

As I was saying before we were interrupted by the vote, the managed clinical network aims to ensure equitable co-ordinated access to mental health provision for pregnant and post-natal women. It seeks to understand current provision and promote improvements in local services, including access and options for families, professional expertise and effective service delivery. Beyond that, it will seek to contribute to improved early years health and development for infants, as part of a broader Scottish Government intention for improved early intervention. The MCN will make fuller recommendations before the end of this year on what services should be available in all board areas to meet the needs of women and their families.

The most exciting part about that for me was the women and families maternal mental health charter, “My Right to Good Care from NHS Scotland for my Baby, my Family and Me”, which was launched on 4 June. The charter has nine points, which I want to put on the record. They are, first, the right to be at the centre of my care, so that I have the information I need to make the best decisions for me, my pregnancy and my infant’s future health; secondly, the right to be seen by staff who have the appropriate level of knowledge and skills to assess and care for me; thirdly, the right to preconception and pregnancy advice and care if I have a pre-existing mental health condition; fourthly, the right to access expert advice and care about my maternal mental health when I require it, wherever I live in Scotland; fifthly, the right to have priority access to talking therapies during my pregnancy and post-natal period; sixthly, the right to be admitted jointly with my infant if I need in-patient mental health care; seventhly, the right to discuss my maternal mental health without fear of stigma or being judged; eighthly, the right for my family to have the information they need to help me and to get help for themselves; and ninthly, the right for my baby to have parents who are supported with their mental health. All these are very good points, which are the bedrock of what we should see in a mental health service for women and infants.

I cannot end my speech without mentioning my role as chair of the all-party parliamentary group on infant feeding and inequalities. The discussion in this country about breast feeding versus bottle feeding has become increasingly divisive. I do not want to venture into it, but a cause of many issues is the pressure on women to have the perfect, glowing, spotless, white-bloused-in-a-perfect-home version of breastfeeding, but that is unrealistic. It is more like chaos surrounding a knackered mother with all the surfaces covered in vomit and soggy muslin cloth—or maybe that was just me.

The hon. Member for Stockton South mentioned the perfect baby ads that we see and the idealised images of motherhood. We put pressure on mothers all the time without necessarily supporting them with being a mother and with the learned skill of breastfeeding. By not providing that support, we set women up to fail. Many carry that very personal pain around for a long time. It should not be that way.

The hon. Lady is making a very compelling case. I am sorry that I was unable to attend the start of this debate, but I commend Members on both sides of the House for bringing us together to discuss these very important matters. Does she, like me, worry that the reduction in antenatal services and services for new mums and dads, particularly in our children’s centres, increases the challenges that new parents and expectant parents face?

Absolutely. I visited a children’s centre in Blackpool and spoke to people involved with the Breastfeeding Network, and they said they had seen the peer support service cut suddenly. That service was crucial, because it was doing the job that the community services and health visitors did not have time to do. It was providing early intervention and support with mental health issues and all the other things that mothers need. I understand that the hon. Lady is very committed to this issue. Early intervention services are absolutely crucial. Children’s centres—somewhere that women can go—are so important, because going to them is an easy first step for women to take. They are not scary; they are accessible and are right on the doorstep—or they certainly should be.

The Breastfeeding Network cites evidence that breastfeeding can have a preventive effect when it comes to mental illness. It said:

“A large scale research study published in 2014 showed that mothers who planned to breastfeed and who actually went on to breastfeed were around 50% less likely to become depressed than mothers who had not planned to, and who did not, breastfeed. Mothers who planned to breastfeed but who did not go on to breastfeed were over twice as likely to become depressed as mothers who had not planned, and who did not breastfeed.”

Providing support for women’s breastfeeding goals is absolutely crucial. If women want to do it but are set up to fail, that can have a serious negative impact. The positive impact of the oxytocin, the bonding and the skin-to-skin contact can be crucial in helping women and children through what can be a very difficult period.

Women on antidepressants are given the often erroneous advice that they should stop breastfeeding. Some 15% of enquiries to the Breastfeeding Network drugs in breastmilk helpline, run by the amazing Wendy Jones, are about that very issue. Evidence demonstrates that giving up breastfeeding is not necessary in many cases, and that if a mum stops breastfeeding before she is ready, that can have a further negative effect on her mental health. I encourage the Minister to look at the drugs in breastmilk helpline and perhaps find some funding for that voluntary service, because GPs and pharmacists often rely on it to give advice to women.

The key to all of this is support for women in how they decide to feed their baby and in the choices they make in life. There is a real postcode lottery. I encourage the Minister to examine this further and to speak to the UNICEF UK Baby Friendly Initiative, which has been cataloguing come of the cuts.

In Glasgow, support also comes from the community, in the shape of groups such as Glasgow South PANDAS, run by Lauren Tonner. The group meets regularly and allows parents to talk about their concerns. As we have heard, it can be difficult to open up, but NCT research shows that opening up and seeking help generally leads to much better outcomes. I encourage those experiencing challenges to find a way to take the first step towards accessing support. It is important to state and restate that women in that situation are not alone. There is always support there for them, and there must be ways of ensuring that women understand that. Handing them a leaflet is not good enough; there must be support and talking therapy.

My wider concern is that we are not supporting women enough anymore. When they go into hospital to give birth, they have to leave very quickly. Community services are often not there, and families are more fragmented and further apart nowadays. That is an issue particularly for women with insecure immigration status, those who have not been in the UK very long, and those who are living in communities where community resilience has broken down and people do not know their neighbours well enough to ask for support. A friend of mine told me recently that she had wonderful neighbours who were there for her when she had her baby, which made a big difference to her when she was struggling. We need to do all we can to help women who are struggling to put food on the table, or are struggling with other aspects of life, such as maternity discrimination and all the other societal pressures on them. All those things contribute to post-natal depression and women’s poor mental health.

I hope UK Ministers and my colleagues in Edinburgh can share best practice and seek to remove barriers to support for women experiencing perinatal mental health issues. We owe it to every family to ensure that having a baby is a time when women can feel safe, supported and cared for.

It is a pleasure to serve under your chairmanship, Mr Rosindell. I congratulate my hon. Friend the Member for Stockton South (Dr Williams) and the hon. Member for South West Bedfordshire (Andrew Selous) on securing this important debate and on how they opened it. We have heard contributions from the hon. Member for Strangford (Jim Shannon), my hon. Friend the Member for Canterbury (Rosie Duffield), the hon. Member for Bath (Wera Hobhouse) and the Scottish National party spokesperson, the hon. Member for Glasgow Central (Alison Thewliss). We also heard interventions from the hon. Member for Thirsk and Malton (Kevin Hollinrake), my hon. Friend the Member for West Ham (Lyn Brown) and, just a moment ago, my hon. Friend the Member for Liverpool, Wavertree (Luciana Berger).

Pregnancy, birth and becoming a parent can be a special and rewarding time for many people. As we have heard, it is a time to celebrate new life and the start of the exciting journey into parenthood. However, for others, the stress and upheaval of pregnancy and becoming a parent can trigger existing mental health problems or spark new ones. Perinatal mental health issues can include severe mental health disorders that require severe immediate hospital treatment, such as postpartum psychosis. It may affect only two cases in 1,000, but it is a very serious condition and can put new mothers at risk of harming themselves and their baby. The issues can also include most common mental health conditions, such as depression, anxiety, post-traumatic stress disorder, obsessive compulsive disorder and panic attacks. My hon. Friend the Member for Stockton South spoke very well about the impact of those mental health conditions on the child’s development.

Given the expectation that pregnancy and becoming a parent should be a joyful time, women who experience those conditions can feel even more stressed and unhappy, and often that they are somehow to blame for their condition. A study by the Boots Family Trust in 2013 described some of those experiences. One mother said:

“I avoided friends at all costs as I lost the ability to communicate and became very isolated”.

Another said:

“I’m currently into my second pregnancy and think I am suffering from depression…I feel scared and feel like I have trouble bonding with this pregnancy…I don’t know what is wrong with me.”

We know that one in five women will experience mental health problems during pregnancy. Given the high prevalence of mental health issues in new and expectant mothers, the woman I just quoted should not have had to feel like something was wrong with her. We have heard many excellent examples in the same vein in this debate. One way to prevent women from feeling isolated or somehow to blame is by identifying those mental health issues and ensuring the proper support is put in place. Unfortunately, as hon. Members said, too often that does not happen.

Hon. Members rightly highlighted that identification is a major barrier to accessing support for mental health issues. I join them in congratulating the National Childbirth Trust on its #HiddenHalf campaign. The research underpinning that campaign shows that nearly half of all the mental health problems that new mothers experience are not picked up by health professionals.

As we have heard, early intervention is key. The sooner issues are identified, the quicker people can access appropriate support, and that surely drives better outcomes. It is simply not good enough that only half of perinatal mental health issues are picked up. As my hon. Friend the Member for Stockton South detailed, GPs should offer a post-natal check about six weeks after the baby’s birth. We have heard that a properly delivered check-up can have a transformative effect on new mothers who are experiencing mental health problems. Research by the National Childbirth Trust found that women directly questioned by a GP about their mental health were almost seven times more likely to disclose a mental health problem. If mental health problems are left untreated, they can escalate into much more severe mental illness.

The National Childbirth Trust also found that 95% of women who had experienced a mental health problem felt it affected their ability to cope or look after their children or family relationships. As we have heard, the six-week post-natal baby check is mandatory, but the maternal check was left out of the GP contract. As a result, the maternal check is often not done at all or becomes a rushed conversation at the end of the baby check. In one third of cases, the maternal check was estimated to last three minutes or less.

The National Childbirth Trust recommends that the Government fund the six-week maternal post-natal check so that GPs have the time to give every new mother a full appointment for the maternal check. As we have heard, the National Childbirth Trust also recommends an improvement in the guidelines for best practice around maternal mental health, including a separate appointment for that maternal six-week check, and they recommend better methods of encouraging disclosure of maternal mental health problems.

I have looked at the NHS England guidance, which states:

“There are no set guidelines for what a postnatal check for mothers should involve.”

It also states:

“The following is usually offered, though this may vary according to where you live...You will be asked how you are feeling as part of a general discussion about your mental health and wellbeing.”

We can and must do better than that.

I have already mentioned the pressure on women to feel happy after the birth of a child and how mental health issues can lead to their feeling that there is something wrong with them. It can often lead to women putting on a brave face. One woman, responding to the Boots Family Trust survey, said:

“I was terrified to admit to any health professional as I was scared they would take my son away.”

That is exactly the point made by the hon. Member for Glasgow Central and it demonstrates the challenges that GPs face in identifying mental health issues. Merely asking how a new mother is feeling is no substitute for a properly trained staff member identifying mental health issues and knowing how to encourage disclosure.

The National Childbirth Trust recommends that NHS bodies should support and invest in initiatives to facilitate and further develop GP education on maternal mental health. Earlier, my hon. Friend the Member for West Ham touched on the fact that investment in perinatal mental health would result in savings. It is worth thinking about how much that might be.

The statement from the Royal College of General Practitioners about perinatal mental health said that post-natal depression, anxiety and psychosis carry an estimated total long-term cost to society of about £8.1 billion for each one-year cohort of births in the UK, and 72% of the cost relates to adverse impacts on the child. That reinforces the very important points that my hon. Friend the Member for Stockton South made earlier. More than a fifth of those total costs—£1.7 billion—are borne by the public sector: mainly NHS and social care. I hope that that all helps to give the Minister ammunition. Sadly, the average cost to society of one case of perinatal depression is estimated to be £74,000: £23,000 relates to the mother and £51,000 to the impact on the child. There is every reason to try to make the case being made in the debate today.

We must make sure that, where a diagnosis has been made, appropriate treatment and support is made available. According to the Maternal Mental Health Alliance, a quarter of pregnant women and new mothers cannot access specialist perinatal mental health services that meet the full National Institute for Health and Care Excellence guidelines. Only 7% of the women who reported experiencing a maternal mental health condition were referred to specialist care. It took more than four weeks for the 38% of the women who were referred to be seen. Shockingly—we have heard several examples—some women waited up to a year for treatment. My hon. Friend the Member for Canterbury talked about such an example. In fact, it was recently revealed that there were only 131 specialist perinatal beds in the whole of the UK, with none in Northern Ireland or Wales.

We know that pressure on mental health trusts comes from money earmarked for mental health services being used to pay for other areas of the NHS. The Labour party would ring-fence mental health spending so that funding for mental health services is not siphoned off to pay for other priorities. In this debate we have heard much detail of the #HiddenHalf campaign. The Opposition support that important campaign and we would look at implementing it in government. We call on the Government now to make resources available so that every mother is given the perinatal support that she deserves. It is important that we also include that commitment to ring-fence mental health spending so that the funding that is meant to be for mental health services does not go to other priorities in the NHS.

The Government have made some commitments on perinatal mental health, and I am keen to hear from the Minister, if we have time, what progress has been made. The five-year forward view for mental health set a target to ensure that by 2021 at least 30,000 more women each year would be able to access specialist mental health care during the perinatal period. Given that we are now halfway through that phase of the five-year forward view for mental health, can the Minister tell the House what progress has been made towards that target and whether NHS England is on track to meet it?

In autumn 2017, at the maternal mental health ministerial roundtable, a number of commitments were made to improve perinatal mental health services. They included a commitment that the Department of Health would work with health system partners and other Government Departments to deliver improvements in perinatal mental health services, and a commitment that NHS England would expand specialist mental health services by 2021 to meet the needs of women in all areas. We have heard, as we hear in so many debates on health and social care, about very unfortunate postcode lotteries, so how is NHS England doing in expanding those specialist services to meet the needs of all women?

My hon. Friend is making a strong case, as have other colleagues, about the inconsistency of the availability of perinatal mental health services. Although there has been some investment, there are still many areas where there is no sufficient, adequate or indeed any immediate access, and mothers still have to travel too far across the country to access a bed if they need one in a mother and baby unit. Does she share the concern expressed by the British Medical Association that there is a 20% difference in referral rates in some areas, which illustrates the inconsistency of care? When the issue is so critical not only for the mother but for the child in its lifetime, that is something that the Government should urgently address.

I absolutely agree with my hon. Friend. It is very important that the Minister tells us now or after the debate what is happening to expand the services so that we do not have what are almost deserts, where women have to travel either to get a bed or to get the service that they need.

Finally, there was a commitment in autumn 2017 that NHS Health Education England would support the roll-out of GP perinatal mental health champions across England. I am sure it would help if there was in every area a perinatal mental health champion speaking up for their own area. Will the Minister tell the House what progress has been made on these important commitments?

I want to conclude on a wider point about women’s mental health. Women are more likely to suffer from mental ill health than men, and yet too often women’s specific mental health needs remain a blind spot. Research by Agenda, the women’s mental health charity, has shown that mental health trusts are too often failing to consider women’s specific needs. Only one of the 35 trusts that responded to a freedom of information request by Agenda had a strategy on gender-specific mental health services.

Fourteen years ago, the Labour Government launched a comprehensive women’s mental health strategy to address the specific mental health needs of women. Sadly, that strategy was ditched by the coalition Government, and women’s mental health has since slipped down the policy agenda. The Mental Health Foundation has described it as being “almost invisible” in Government policy.

We have had an excellent debate today in which many useful examples have been given and many good points made. There is a strong feeling that we want to help the Minister do something about this issue. Will she in future match Labour’s commitment to have a national women’s health strategy that would work to deliver the targeted support that women and girls need?

It is good to see you in the Chair, Mr Rosindell. The debate has been excellent. I have enjoyed listening to all the speeches, which, without exception, have been thoughtful, constructive, and, in the case of people who have been through motherhood, very honest and gritty about the reality of the situation that we face. I pay tribute to the hon. Member for Stockton South (Dr Williams) for making as articulate a speech as possible on the issue. It covered the whole breadth of subjects that we need to consider. It was a real pleasure to listen to him. I will say the same about my hon. Friend the Member for South West Bedfordshire (Andrew Selous). I am pleased to see two men leading the charge on this subject. It is an important message that this is not a woman’s problem; it is a problem for society and for families. Ultimately, if we do not tackle it, society picks up the tab. It is great that two male Members of the House are leading the charge.

Many themes have come up in the debate, and I will try to address them all. I will begin by tackling the issue of the first 1,001 days. A number of hon. Members present are members of the all-party parliamentary group for the prevention of adverse childhood experiences. We recognise that the period from conception to age two is vital for every child’s development, and that is why we are prioritising and focusing on ensuring that there is sufficient perinatal mental health support at that stage. On the wider issue of adverse childhood experiences, the hon. Member for Stockton South mentioned that having four of them makes someone more likely to end up in prison. This is about the best kind of early intervention—for me, that is a no-brainer. We can identify those young people or children who are most at risk of falling out of society. Therefore, we should look at how best we can intervene early to support them.

I am delighted to hear the points the Minister has made about the importance of the first 1,001 days and the nought-to-two agenda. On that basis, might we expect the Government to respond to their Green Paper consultation on young people’s mental health by putting in place measures to support and help under-fives?

As I have often said, the real focus of the Green Paper is on schools and measures that we are taking with the Department for Education. However, the hon. Lady and others will be aware that we have committed to extra funding for the NHS and we are working with NHS England on what we can all expect with that extra funding. I am open to representations as we develop that 10-year plan as to what else we can do in this space. As we are in discussions with NHS England, I cannot make any commitments but this is exactly the time when we should rigorously be testing policy suggestions and interventions that we might be able to deliver.

It was reported in the Health Service Journal two days ago that the chief executive of the NHS, Simon Stevens, has outlined five priorities for the 10-year plan and that one is reducing health inequalities. Does the Minister think that a serious focus on reducing health inequalities—particularly those that are embedded from the beginning of life—should be a focus for the 10-year plan?

The hon. Gentleman earlier used the phrase “spend to save”, so the answer is yes, because obviously if we make interventions earlier and they help people to help themselves, there is a long-term saving to the NHS. That is the exact spirit in which we are entering the 10-year plan for the NHS. I look forward to hearing suggestions from the APPG—get in touch with us soon.

I thank everyone who has contributed to the debate and hope that we can go forward with the shared objective of doing the best we can for new mothers. By that I mean not only improving services, but giving support in general to women who are going through the experience of motherhood. As many Members have said, we are offered a fairy tale fantasy about how everything is perfect and wonderful, when actually there is a lot of associated vomit, pain and misery—joyful as the experience is overall. We need to tackle the taboo, because the fact that we think that everything is a perfect fairy tale means that the pressure on those women who are struggling makes them feel like failures. They are not: it is all entirely normal.

I am always struck by the fact that one in three women suffers from incontinence. People do not know about it, because everyone suffers in silence and just gets on with it. I often ask, “How would it be if one in three men suffered from incontinence?” We would hear about that a lot more. We need to be generally more open and give women the message: “Do you know what? It is normal to feel you are struggling, and feel miserable, because you have gone through a life-changing experience and a physical trauma. It is inevitable that it will affect your mental health.” Giving them the message that it is normal is half the battle, because they will realise that they are not a failure but just need to manage and work through the situation. We need the right services in place to help them.

Is the Minister aware of the Best Beginnings “Baby Buddy” app, which has videos of parents sharing their experiences to help reduce the isolation some parents feel? It encourages women to take the time to look after themselves and their relationships, if they are with a partner. Does she agree that that is practical? It is free and lottery funded. It is not making a profit, as far as I am aware. I think it is run by a charity. Things like that can be helpful to mothers who might otherwise be quite isolated.

That sounds like a good resource, not least because it means women can get access to help in a more anonymous, less threatening way. We need sufficient tools to be available for women—and families, for that matter.

We have heard constantly throughout the debate that women are not always asked about their mental health in GP health checks. For that matter, they are not always asked about their physical health either; it is all about the baby. One of the challenges we have in improving the way in which we deliver health comes from the fact that an NHS practitioner faced with a patient will focus on the immediate problem and not the patient’s holistic needs. There is a need to consider mother and baby together. A baby cannot be looked at in isolation. The role of the mother, and the relationship with the mother, is part of the child’s welfare. We need to spread better practice in that regard.

I agree very much about looking at the mother as well as the baby, but does the Minister agree that, where there is a relationship with a partner, dad must not be left out, and that working on the couple’s relationship is a key matter, given that mums probably look to their children’s parent more than anyone else for emotional and practical support?

I thank my hon. Friend for being my conscience—we absolutely must not forget dad or partner, or for that matter the wider family. Members have expressed concern about the declining number of health visitors, and the beauty of having a health visitor is exactly the fact that they develop a relationship with the family and can talk to dad as well. Quite often, dad feels excluded from the process.

I agree and do not think the two points are in conflict. We need both—we need the wider package of support.

The theme we have been considering—of women not always being asked about themselves, and its being all about the baby—is not confined to the issue of perinatal mental health. Women face that across the board with respect to their health. The hon. Member for Worsley and Eccles South (Barbara Keeley) spoke about a women’s health strategy and women’s mental health. I co-chair a women’s mental health taskforce with the chair of Agenda, and in the coming weeks we will present our report on a year-long piece of work. It will have information about tools to enable the health service in general better to support women’s mental health. I am also doing more to raise the whole issue of women’s mental health, because I feel strongly that women are often disempowered in health settings. We need to give them the tools to take control of their own care and to feel empowered to engage in good conversations with medical professionals, to benefit their health.

We have heard anecdotal accounts of women’s experiences, and what has come across is the arrogant behaviour of some medical professionals. They see a large number of patients and they are not always sensitive to how best to communicate with certain individuals. We need that practitioner-patient relationship to work a lot better, particularly in the case of women. I am open to representations from everybody about what tool we can use.

The hon. Member for West Ham (Lyn Brown) is no longer in her place, but I have been impressed by her work on hysteroscopies with women. We are developing tools on that. I reassure all Members that women’s health and the way in which the national health service can better serve women are high on my agenda. I am not going to stand here and say that the world is perfect, but we have made perinatal mental health a priority in the five year forward view. We are midway through that review, so I should give Members an account of how far we have got and what more needs to be done.

To go back to 2010, the situation was really quite poor. Only 15% of localities had fully fledged specialist services in the community, and 40% of communities provided absolutely no service at all. People talked about a postcode lottery; clearly, we could not allow that to continue. We need to work towards universal provision. We are implementing the recommendations of the five year forward view for mental health taskforce, which reported in 2016. From 2015 to 2021, we are investing £365 million into perinatal mental health services. NHS England is leading a transformation programme to ensure that, by 2021, at least 30,000 more women each year are able to access specialist mental healthcare during the perinatal period. In May, NHS England confirmed that, by April next year, new and expectant mums will be able to access specialist perinatal mental health community services in every part of the country. We are making progress. The key to that is community provision.

I asked the Minister a specific question: we are halfway towards the deadline for the 30,000 target—does she know how that target is going? Has there been an improvement of 15,000?

I will write to the hon. Lady with some detail on the figures, but the point is that the access is there. Obviously, it will take time to become embedded. We have a good direction of travel to deliver against that commitment and we will continue with that. Community-based provision is key, but we also need to ensure that there are sufficient specialist perinatal mental health beds in mother and baby units for particularly severe cases. NHS England has taken a more strategic approach to commissioning, so that there is a level of access that does not involve wide-scale moving out of area.

As ever with transformation programmes, change takes time, but we are on track to meet our commitments. We are investing £63.5 million this financial year to support the development of those specialist perinatal mental health community services across England. Our pace of change is to enable 2,000 more women to access specialist care. Last year that was exceeded, so we should maintain the pace that we planned in the five-year forward view.

I have visited one of the new in-patient mother and baby units in Chelmsford, where there are four new beds. That centre is expanding its capacity. As well as opening new centres, we are expanding the capacity of existing ones to give more support. In Devon, the trust opened a four-bed mother and baby unit in a reused space in April this year while the new unit is being built, so we still have that provision even though there is not the physical space. By the end of this financial year, we will have expanded the capacity of those beds by 49% since 2015 and there should be more than 150 beds available for mothers and babies in those units.

We are also expanding psychological therapy services, which successfully treat many women who experience common mental health conditions such as depression and anxiety disorders during the perinatal period. We have set an ambition for at least 25% of people with common mental health conditions to access services each year by 2020-21, including extending provision to ensure swifter access for new and expectant mothers. However, as we have heard today, getting perinatal mental healthcare right is not just about expanding specialist services in isolation. Many professionals in different parts of the health and care system are well placed to support women in the perinatal period. NHS England is working with partners to ensure that care for women is integrated and joined up effectively. More than £1 million was provided in 2017 to enable the training of primary care, maternity and mental health staff, to increase perinatal mental health awareness and skills.

NHS England has also invested in multidisciplinary perinatal mental health clinical networks, which will include GPs across the country to support that strategic planning, working across services to ensure that those wider services are in place. The role of GPs is central in identifying when someone is suffering from perinatal mental illness, and to ensure that those women are directed towards treatment. The role includes monitoring early-onset conditions, including pre-conception counselling, referring women to specialist mental health services, including access to psychological therapies, and specialist perinatal community teams where necessary.

I am aware of the NCT’s #HiddenHalf campaign; I am grateful for its campaigning on this important issue. The National Institute for Health and Care Excellence recommends post-natal checks for mothers and new-born babies. NHS England expects commissioners and providers of maternity care to pay due regard to the NICE guidelines. My hon. Friend the Member for South West Bedfordshire raised this issue and said that, since this was part of what we should expect from GPs, it seemed anomalous that so many mothers and babies were not getting such checks. We make clear to GPs what we expect of them, as part of their contract, but ultimately we rely on clinical commissioning groups to ensure that GPs deliver against the obligations that we expect of them. This is not the only case where this happens—many GPs are not delivering learning disability health checks either. We need to be clear with NHS England that we expect that obligation to be delivered.

The hon. Member for South West Bedfordshire referred to a maternity additional service that only four general practices have opted out of. Is the Minister aware of what period of time that additional service covers?

I will come back to the hon. Gentleman, but this area requires further exploration because we need to be clear about how we deliver on those things.

I will gladly tell the Minister: the period of time covers pregnancy but ends 14 days after birth. Whereas it may be very appropriate for a GP to provide care during that time, the additional service that the hon. Member for South West Bedfordshire referred to ends 14 days after birth. We are talking about a different issue: the opportunity to do a check six weeks after birth. There is no commissioning of that check at the moment. It is helpful that the Minister says that she expects commissioners to commission that check, but is that a commitment from the Government to ensure that commissioners are funded to be able to commission that six-week check?

I was coming to that—I was just dealing with the point made by my hon. Friend the Member for South West Bedfordshire.

Moving on from the NICE guidelines, we clearly expect GPs to do their part in identifying and supporting women. We are aware of the campaign, but any changes to GP contracting arrangements to specifically include the six-week check-up would need to be negotiated with the GP committee of the British Medical Association. Those negotiations are taking place and will be completed by September. I cannot give any firmer commitment than that, other than to say that we obviously want to see GPs make their contribution.

I just want to reiterate what I said earlier: the Opposition support that campaign and would look at implementing it in government. I outlined that the NCT put a cost of £20 million on it. Clearly, the Minister could have that figure checked out, but it is balanced against the £1.2 billion extra cost to the NHS and social care of perinatal mental health problems in every one-year birth cohort. There really is a point here about investing to save further down the road.

I thank the hon. Lady for that. As she says, if we are talking about £20 million in a broader settlement, that clearly should be under consideration given the outcomes that could be achieved on the basis of the evidence we have seen. I am not negotiating the contract, but we will have the outcome of those negotiations in the not-too-distant future. Members on both sides of the Chamber expressed very clearly the view that they want GPs to be able to do more to support new mothers. That message has been well noted, and I thank Members for making it. They said they wished to give me as much as assistance as they could in my battles on these things, and they certainly made a very strong case.

I want to come back to health visitors. I am a firm believer that health visitors are uniquely placed to identify mothers who are at risk of suffering, or are suffering, perinatal mental health problems and to ensure they get the early support they need. In fact, I visited the Institute of Health Visiting only a couple of weeks ago and heard a moving story from a new mum who had gone through a mental health crisis. It is striking that she had experienced all the feelings we have talked about—she felt there was something wrong with her, she could not bond with her baby, and she got more and more depressed and withdrawn about it. The other interesting thing about that case was that it was dad who felt utterly powerless to do anything. Only their relationship with their health visitor enabled them both to reach out for help.

I am under no illusions about the importance of health visitors. I was privileged to meet so many fantastic advocates for them as part of the NHS’s 70th birthday. They are our eyes and ears in so many ways, and they are our intelligence network in tackling adverse childhood events. I am full of praise for the important job they do in supporting new parents and families through a child’s early years. I am really pleased about the success of the Institute of Health Visiting perinatal and infant mental health champions training programme. Those 570 champions play a crucial role in spreading good practice and early identification of mental health problems.

Some hon. Members raised concerns about the decline in the number of health visitors. There was a substantial increase in the run-up to 2015, and there has been a fall since. I am bothered about that, so I will look at how we can encourage local authorities to alter that situation, recognising that in some areas local leaders have realised that health visitors can do so much more to deliver better outcomes for their communities. Blackpool, for example, has substantially increased the number of visits. I am really looking forward to seeing the outcome of that work, so that we can encourage that good practice in other local authorities.

I reiterate my thanks to all Members for their thoughtful comments and questions, but I especially thank the hon. Member for Stockton South and my hon. Friend the Member for South West Bedfordshire for securing the debate. I am very proud of our direction of travel in delivering and transforming perinatal mental health services so that we ensure that more expectant and new mothers are able to access high-quality mental health support, but we should never be complacent about that. I look forward to continuing the transformation programme.

I thank all the Members who stayed here to contribute to the debate. I also thank the organisations—particularly the National Childbirth Trust—that contributed to filling our minds with useful information. I am proud to have brought this issue to Parliament as a man. As many Members said, this is not a women’s issue—it affects us all, and it needs to be taken really seriously. As the hon. Member for South West Bedfordshire (Andrew Selous) said, it is everyone’s business.

We have discussed a very vulnerable time in a woman’s life—the time when she is most likely to develop a mental health problem. We heard about the impact of such problems on a woman, her family and particularly her child. It is heartening to hear that the Government are listening, and I hope that that continues to manifest itself in action—particularly on the GP contract negotiations, but also on the many other things that could be done to improve the lives of these women, their families and their children.

Question put and agreed to.

Resolved,

That this House has considered perinatal mental illness.