An NSPCC report from June this year found that:
The wellbeing of more than one in 10 newborn* babies in England could be improved if all new mothers with mental illness had equal access to good services
Mental health problems – including depression, anxiety, post-traumatic stress disorder and schizophrenia – can begin or escalate when a woman is pregnant or in her child’s first year.
They can have a damaging effect on family life, and in the worst cases, impact on babies’ health and welfare.
Evidence shows that the vast majority of these illnesses are preventable and treatable, and with the right support, the negative effects on families can be avoided.
This echoes our findings and the feedback from our Pregnancy Outreach Workers.
So why are so many pregnant women slipping through the cracks? Because they are medically low risk.
In safeguarding terms, a “vulnerable adult” tends to mean an adult who is vulnerable to abuse or exploitation, and much of the advice is directed towards care of the elderly. If a pregnant woman or mother doesn’t meet the criteria for a vulnerable adult – in other words if she is not suffering direct physical or emotional abuse, or neglect – then she doesn’t get support. She is seen as having adequate mental capacity and able to cope alone.
There are services are designed to support the mother but don’t always come through (eg pregnant women are supposed to see a health visitor but, in our experience, many don’t). A shocking 73% of maternity services do not have a mental health midwife.
This list of risk factors for poor mental health, taken from NHS Scotland’s Early Years website, is typical of the “middle ground” that our more complex clients occupy.
- experience of poverty and deprivation
- experience of gender based violence
- experience of stigma or discrimination
- living in isolation
- having been in care
- alcohol and substance misuse
- being a teenage mother
Despite all these factors – these pregnant women are not considered vulnerable by definition.
Danni*, one of our more complex clients, already has two children in care, and received Pregnancy Outreach support for her most recent pregnancy. POW manager Michelle explains, “Lack of support in the past means that Danni has continued to lead a chaotic lifestyle and to have more children. This time round, she’s had extended support from a POW, but she still is not engaging with Social Workers. She feels that they are only there to take her children away and judge her. She misses appointments, saying, ‘I feel like a failure’ and ‘what’s the point, you’re taking my kids off me.’
“Like an unfortunate number of women, Danni is ‘vulnerable… but does not meet the criteria of a vulnerable adult,” Michelle continues. “She’s been told by doctors that she’s not clinically depressed, so the support available is limited. If she’s not engaging – missing appointments with her drug worker, for example – no-one chases it up. When anything happens – like recently, when her access to her children was reduced – she’s quick to relapse.”
In fact, most of the safeguarding advice given to support workers for new mothers is based around the child. A mother who has a chaotic lifestyle or a drug dependency is seen not as someone in need of support herself, but as an abuser of a vulnerable child. We absolutely know that the safety of children is paramount, what we recognise is that it is not only them that need protection and support.
In other words, there is a gap between social services’ concern for the unborn child, and concern for “vulnerable adults”. Many of our clients occupy this space. 213 of the clients we are supporting at the moment have identified mental health issues and 126 are experiencing domestic violence.
Children in care
We’re seeing how unaddressed maternal mental health issues can lead to more children in care, and there is a cycle attached to this. We are recognising a missed opportunity to break a vicious cycle. The lack of support at such a crucial time means that many vulnerable women return to a chaotic lifestyle lost in a gap between services.
In fact, at this vital time, all sorts of support that parents had been receiving – for example, access to a family support worker – is actually withdrawn. Parents on parenting courses lose their place on the course when they lose care of their child. The implication is that the mother of a child who’s been taken into care is no longer a parent and no longer requires support.
Far too many children are in the Local Authority care and there is a plan to move children into more stable environments through adoption. Surely there must be an equal priority to help pregnant women be fit mothers to take care of their own children? The vast majority want to, and are devastated when this is not possible. A common response is to get pregnant again, and so the cycle starts over.
The POWs are able to create solid, structured mental health support for the mother. They help create the conditions suitable for children to be brought into a family and to strengthen the maternal bond.
This is why I’d like to see the sort of support that Gateway POWs offer – dependable emotional support and practical advice – to become the mainstream.
*names have been changed