Maternal mental health during a pandemic: A rapid evidence review of Covid-19’s impact

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From early on in the Covid-19 pandemic, the Maternal Mental Health Alliance (MMHA) and Centre for Mental Health were concerned about the increased mental health challenges that women during and after pregnancy were likely facing as a result of the pandemic and government-imposed restrictions introduced to tackle it.

Thanks to Comic Relief ‘Covid Recovery’ funding, the MMHA commissioned the Centre to explore just how much of a challenge the pandemic has placed on perinatal mental health and the services that support women, their partners, and families during this time.

This report draws together all of the available data collected during the pandemic for the first time.

Together, we’re calling for:

1. Ministers to protect and enhance services supporting perinatal mental health, including voluntary sector groups

2. Relevant bodies to re-assess the true level of demand in light of the pandemic

3. Research to be commissioned on the pandemic’s ongoing impact, including for women and babies of colour, and those from disadvantaged backgrounds.

Reflections from parents with lived experience

Key findings

The evidence shows a significant decline in maternal mental health during the pandemic:

    1. The pandemic has posed mental health challenges for women during pregnancy and early motherhood
    2. The impact has been unequal
    3. Perinatal mental health services had worrying gaps even before the crisis
    4. Informal support has been detrimentally impacted
    5. Changes to labour and birth because of the pandemic have increased stress and anxiety
    6. Concern for infants and babies has increased stress and anxiety
    7. There have been missed opportunities for understanding / fully responding to what being classed as vulnerable really means in the perinatal period
    8. Whilst still awaiting data, significant concerns exist for women with pre-existing mental health conditions
    9. Despite the increased need, services supporting women and families were impacted detrimentally
    10. The workforce supporting women and families in the perinatal period is facing its own wellbeing challenges and needs support
    11. Increased demand for voluntary and community services, who themselves have been impacted
    12. Virtual contact massively increased with mixed potential consequences and a need for evaluation

Read the report for more detailed findings  >

Recommendations for action

The report commissioned by the MMHA and conducted by Centre for Mental Health makes the following eight urgent recommendations for action:

Recommendation 1: Assessing the true level of demand
We call on the Department of Health and Social Care in England, and the equivalent bodies in the devolved nations, to conduct an immediate assessment of the level of need for perinatal mental health services in light of the impact of the pandemic. Previous assumptions will need to be updated to reflect higher levels of need as a consequence of the crisis. This is essential to get the right services and workforce in the right places as soon as possible.
Recommendation 2: We want to future-proof perinatal mental health services against future pandemics or similar public health crises
We are calling on the UK Government and devolved assemblies to guarantee a minimum high standard of mental health care and support for pregnant women and mothers of young infants. We want to ensure that perinatal mental health staff numbers are maintained, and where staff redeployment proves necessary in a crisis, mental health services must be maintained.
Recommendation 3: We need up-to-date data to understand the changing picture
NHS Digital and equivalent bodies in each of the devolved nations should collect and publish routine data on the mental and physical health of women during the perinatal period. This should include data on the uptake of perinatal mental health services, on deaths from all causes, and on hospital admissions. Data must include robust monitoring across equality groups to identify inequalities in prevalence, experience and outcomes.
Recommendation 4: We need to tackle racial discrimination within health systems and adverse outcomes for people of colour
The NHS in all four nations needs to address the disparity in maternal mental health outcomes caused by the crisis, and by longer-term issues, for women of colour. In England, this should be included within the Advancing Mental Health Equalities strategy and the Patient and Carer Race Equality Framework.
Recommendation 5: We need better research
We are calling on those funding and conducting research across the UK to prioritise understanding the longer-term emotional and psychological impacts of the pandemic on young families. This might include research with women with existing mental health difficulties, and groups that have been particularly affected by the pandemic. We need to hear from particularly vulnerable groups of women, and groups whose voices are seldom heard. We recommend research on the impact of women’s mental wellbeing on their partners and infants, and research on partners’ mental wellbeing and the impact this can have on women.
Recommendation 6: We need to understand the impact of ‘remote’ mental health care
Where face-to-face services have been replaced by remote services, we must understand how they work and whether there is an impact on quality, choice, patient satisfaction and most of all whether they help people deal with their mental health issues. We are calling on the NHS to fund new research, to ensure those women who do not have access to digital technology get the support they need, and to make sure digital options are not a way to save money at the expense of face-to-face consultations and therapies.
Recommendation 7: Government and NHS must recognise the importance of voluntary and community organisations
NHS organisations commissioning mental health services must recognise and value the role of voluntary and community organisations in meeting women’s mental health needs during the perinatal period. We are recommending that funding should extend beyond short-term support for projects and initiatives, to provide organisations working in communities with stable long-term support and help with core costs and adaptations during crises.
Recommendation 8: We must support the mental health of all health and care staff
NHS employers in all parts of the UK and in every organisation must support the mental health and emotional wellbeing of staff working with women and families during the perinatal period, recognising the risk of exhaustion, anxiety, depression and post-traumatic stress disorder (PTSD) created during the pandemic.

Download the report to find out more  >

More information about the report

The three main activities of this rapid review of the evidence were:

  1. a literature review of the available published and unpublished/non-peer-reviewed literature
  2. verbal evidence-giving events, attended by parents with lived experience, clinical and voluntary sector representatives
  3. written submissions.

In addition, the Centre reviewed available public source national data on perinatal mental health services and conducted a survey of voluntary and community service providers.

An enormous thank you to the organisations who conducted and shared their research with us, the parents who spoke about their experiences, and all those working in perinatal services who have provided care and support to women and families during an extremely challenging time.

If you have questions about the research, please email us at info@maternalmentalhealthalliance.org.

 


Logos of MMHA, Centre for Mental Health and Comic Relief funded