Marce 2018 – Global Experiences, Global Dialogues, Global Responses

Sally Hogg attended the Marce Society 2018 Biennial, to share learning and gain insights into global best practice in maternal mental health.

It was an absolute privilege to attend the International Marce Society Biennial meeting in Bangalore last week. The meeting brought together over 500 delegates from 31 countries to discuss the latest science and practice in protecting and promoting maternal mental health. I was there to share learning from the MMHA Mums and Babies in Mind Project, alongside trying to capture useful insights for those at home.

This was the first time that a Marce conference had been held in the Global South. The conference really opened my eyes to the challenges facing Low and Middle Income countries where the vast majority of the world’s babies are born, the prevalence of perinatal mental health problems is particularly high, and there are fewer resources to support families. The conference chair, Jane Fisher, powerfully reminded us that enabling mothers to be healthy is key to enabling children, and therefore societies and economies, to reach their full potential and thrive.

The conference was held in the National Institute for Mental Health and Neuroscience (NIMHANS) in Bangalore, which is a large mental health hospital and academic centre. NIMHANs has a 5 bedded Mother and Baby Unit, which is the only unit in a country where 26 million are babies born each year. The facilities were, in many ways, basic compared to the UK. But there was much that we could learn from them: The MBU had beds for a family member to stay with women (albeit only for female relatives – not dads or male partners). There was a strong multidisciplinary team including lactation support, which was particularly interesting to me, as we have recently done some work about the need to improve breastfeeding support and advice for mums with severe mental illness. NIMHANs hospital – including the MBU – incorporates yoga into the care they provide to patients. I was sorry that due to the full conference programme, I didn’t get a chance to learn more about the use of yoga.

It was a very full conference, with three long days of high quality presentations and discussions. As is often the case at events with many parallel sessions, it was hard to choose what to attend. I focussed on presentations which had clear implications for policy and practice, which meant I missed a lot of interesting stuff about the biological determinants and mechanisms of mental health problems.

So what were my highlights and take home messages from the presentations and symposiums I did attend?

I was challenged by a symposium chaired by Susan Ayers that really brought to life the complexities and limitations of screening.

I was excited by Jane Fisher’s launch of the new WHO nurturing framework which I think provides a useful way to talk about early child development with policy makers.

It was heartening to see that the UK is one of the countries that is leading the way in the provision of specialist community and inpatient services. Our campaigning is inspiring others too – we heard about maternal mental health alliances developing in Canada and Africa and of people considering how to replicate our powerful maps of provision, and there was regular use of the #everyonesbusiness message.

I was encouraged to hear about how services were being designed with implementation and scaleability in mind: Maria Muzik discussed the co-production of the MomPower intervention, and Heather Rowe described research with parents, providers and policy makers to inform the development of support for new parents.

Birth trauma was a recurring theme in the conference. As Evita Fernadez described in a plenary, “the way in which we give birth has major implications for women’s future health and that of their babies” and yet there is a “crisis in childbirth” with many women experiencing traumatic births in India and around the world. Evita spoke encouragingly of the tide starting to turn thanks to powerful campaigns to harness womens’ voices and to global recognition of women’s rights to respect, support and choice in their birth, by organisations such as the World Health Organisation. In another plenary, Jon Cox prize winner Bryanne Barnett called on professionals to gain an in-depth understanding of the current and past experiences of women, including recognising and respond to both the physical and mental harms that result from traumatic birth. In a great symposium on birth trauma, Susan Ayers discussed evidence that positive support during birth can buffer against stressful events, whereas a lack of support or interpersonal difficulties increase risk of PTSD. Pauline Slade presented the Straw-b self-help tool which contains information and psychological exercises for women at risk of PTSD. And, in perhaps the most surprising study of the conference, Antje Horsch, showed that women who play tetris for 15 minutes in the 6 hours following an emergency c section are less likely to develop PTSD (which is thought to be because visuo-spatial tasks can change the way in which therefore reduce the likelihood of intrusive memories.)

Whilst the conference showcased a wealth of fantastic practice, we were constantly reminded that the majority of women in the world who are experiencing perinatal mental health problems are not getting support. It wasn’t all doom and gloom however. There were a number of examples of innovations which could enable more women to access evidence based support: Atif Rahman shared the evidence of the impact of the Thinking Healthy (CBT based) intervention which has had a proven impact on women’s mental health in LMIC countries when delivered by community health workers or peer supporters.

Cerith Waters shared how his stretched service in Wales had developed a Perinatal Play and Development group, which enabled the service to have more contact with women. The 6 week group includes mindfulness, psychoeducation and elements of watch, wait and wonder.

Finally, a number of speakers from Australia, including Jeannette Milgrom and Jane Fisher showcased digital interventions which could drastically improve the reach of services. We were reminded that 63% of the population in low and middle income countries have a smart phone (something that was clearly on show when out and about in Bangalore!).Siobhan Loughnan shared positive results from use of a short, three session perinatal iCBT intervention called MUMentum, which can be used as self-help or as an adjunct to face-to-face support. Jeannette and Jane spoke about  the Mumspace website, which hosts a range of universal, targeted and specialist interventions (including the Baby Steps, Mind Mum MumMood Booster apps) and the What Were We Thinking intervention, which helps parents to learn about caring for their baby (including crying, soothing and sleep) and about their journey as parents  (including their relationship) through a group based seminar for parents, website, app and moderated peer-to-peer blog, all supported by a training programme for maternal and child health nurses (equivalents of our health visitors)  .

There were some things missing from the conference. The audience was largely health professionals or academics. I felt that the input of community or charitable organisations was missing, and I didn’t see much on place-based and whole system approaches.

But overall it was a fantastic three days. I left feeling that although there is a huge amount to do, but there is lots of valuable work to learn from, and in the UK we are privileged to have opportunities to put this learning into practice.