Early pandemic saw surge in 'severe symptoms' for women with perinatal mental illness

But for some women, the struggles of pregnancy and new motherhood can tip into a mental illness which requires specialist treatment from a perinatal mental health team.

Even in normal times, more than one in 10 women are thought to experience a mental illness during pregnancy or within the first year of having a baby - known as the ‘perinatal’ period - and suicide due to mental illness is one of the most common causes of death in women in the first year after childbirth.

Doctors are yet to understand the full impact of the pandemic on maternal mental health but in Leeds, health chiefs have told the Yorkshire Evening Post that the city saw a surge in more severe cases of women with mental health issues after the first lockdown back in March.

Consultant perinatal psychiatrist, Dr Gopinath Narayan is the clinical lead of the city’s perinatal service which includes a regional inpatient mother and baby unit and a Leeds perinatal community service.

He spoke to the YEP as part of our #SpeakYourMind campaign, which aims to raise awareness and break down the stigma surrounding mental health issues in Leeds.

Dr Narayan said that at the beginning of the pandemic it became clear that a number of women had put off seeking help - some to a potentially dangerous extent.

Referrals initially dropped by almost half, during April and May, as it is thought many tried to manage their symptoms at home, anxious about Covid-19.

The service then saw a "rebound" with a near-doubling of referrals over the next four-to-six weeks as those struggling finally sought much-needed help.

Dr Narayan said: “We noticed after the first lockdown that we did see women come to us more unwell than usual.

“They were coming to us quite severely unwell, who probably should have sought help earlier.

“In someone women, not seeking help can mean a progression of illness to a stage where psychotic symptoms such as delusions and hallucinations develop or suicidal thoughts become apparent, as well as poor self-care."

Post-partum psychosis is a perinatal mental illness considered so severe it is deemed a psychiatric emergency and requires immediate, specialist treatment in the in-patient unit.

Swift diagnosis is key as the condition can develop at an alarming speed.

“It progresses very rapidly,” says Dr Narayan. “Initial onset to full-blown symptoms can occur within a matter of hours. No other mental health condition progresses so rapidly.”

A complication in accessing help however, is that the condition is also described as “kaleidoscopic".

Dr Narayan said: “It means the picture can change constantly. What you see in the morning is not what you see in the evening and not what you see the next day. Also they have lucid intervals so if a professional who is not aware of this sees someone during a lucid interval they may think they are well.

“These are the reasons why we need specialist [perinatal] teams working with women.”

He said: "Most of the women we have in our in-patient ward will be women with post-partum psychosis or women with severe depression - so severe that they experience suicidal thoughts or psychotic symptoms.

"In the community service, a whole spectrum of conditions are seen, ranging from anxiety disorders, depressive illnesses, obsessive compulsive disorders to severe psychotic illnesses which do not need inpatient treatment."

Dr Narayan said the vast majority of cases of perinatal mental illness are women with depression and anxiety disorders.

Of particular concern to the service are women who have been severely unwell in the past or who have bipolar disorder.

Women with bipolar disorder have a 50 per cent chance of developing post-partum psychosis, compared to around one in 500 to one in 1,000 of the general population.

Dr Narayan said: “That was the drive behind starting the [perinatal] service. They are the women we are concerned the most. These women need closely joined-up care with maternity services and detailed perinatal care plans."

More and more women are being treated by the perinatal mental health team each year, both in the city and nationally.

In 2016, the NHS, in its ‘Five Year Forward View for Mental Health, pledged its perinatal mental health services nationally would aim to help a total of 30,000 women by 2020/21, with increased funding and staffing.

Indeed, in Leeds the team itself has been increasing in size even during the pandemic and NHS Digital figures show the number of women in the city accessing the service has more than doubled between 2019 and 2020 alone, from 265 to 550 - although Dr Narayan said this figure is actually lower than expected due to the impact of the pandemic.

A new ‘Long Term Plan’, published last year, aims to increase the national total to 66,000 by 2023/24, such as by expanding the service to include women with babies up to two years of age.

It also acknowledges the partners of women, with a pledge to assess their mental health too, along with women suffering from ‘perinatal trauma’, such as a difficult previous labour or who have lost a child in pregnancy or shortly after birth.

In Leeds next year, the team aims to help around 1,000 women - a target of 10 per cent of the city’s 10,500 birth rate.

And sadly the need will be there.

Dr Narayan said: “For reasons we don’t know precisely, women are at a highest risk of being admitted to mental health [services] in the first few weeks of delivery compared to any other period of their lives.”

Mental health conditions which existed before labour have a tendency to become worse post-natally.

Dr Narayan said: “The causes are multifactorial, involving a combination of biological, psychological and social factors.”

But thankfully the prognosis for women with perinatal mental illness is positive.

“Most of the women we work with get well” he said. “The outcome is very good.”

Laura McDonagh, head of operations for the perinatal mental health service at Leeds and York Partnership NHS Foundation Trust, said the NHS’s dramatic expansion in support to new mums, as shown in the increasing numbers of women accessing the service in Leeds, demonstrates “the positive steps forward” in perinatal mental health services in recent years.

She said: “Untreated mental ill health during pregnancy or that which affects the bonding with a new baby can be devastating, but to anyone who is struggling with their mental health at this difficult time, our message is clear: the NHS is here for you, so help us help you and come forward for the care you need.”

Dr Jane Mischenko, lead commissioner for children and maternity at NHS Leeds CCG, also urged women to speak out about any worries, to friends and healthcare professionals.

She said: “Becoming a new parent is really exciting and sometimes quite challenging.

“There are many changes that happen both physically and emotionally, which can lead to some parents struggling with their mental health.

“This can be during pregnancy and after their baby is born.

“Lockdown is an additional stress and worry for new parents, as friends and family support and the opportunity to meet peers is not as easily accessed and a feeling of loneliness is all too common.”

She added: “Getting more help and speaking to others about how you’re feeling is really important.”

A spokeswoman for Maternal Mental Health Alliance, a charity and coalition of organisations working with women and families affected by perinatal mental health, said they know the pandemic "has been particularly difficult and stressful for many pregnant women and new mums".

She added: "To prevent women and families from falling through the gaps, services supporting them with their mental health must be protected and well-resourced.

"The ways in which new mums access support may have changed due to the pandemic, but services are still open and are needed more than ever. It is really important to prioritise your mental health at this time, and ask for help if you or a loved one needs it."

For more information on the service visit https://www.leedsandyorkpft.nhs.uk/our-services/perinatal-service/ and also visit http://mindwell-leeds.org.uk/baby for more information on support during pregnancy or birth during the coronavirus pandemic.

Important websites and numbers:

Visit www.mindwell-leeds.org.uk/coronavirus

West Yorkshire mental health 24/7 support line, provides confidential advice - 0800 183 0558

Leeds Mental Wellbeing Service, for anyone aged 17 or over: www.leedsmentalwellbeingservice.co.uk

For children and young people: www.mindmate.org.uk

For those struggling with alcohol and drug use: www.forwardleeds.co.uk

A mood self-assessment is here: https://www.nhs.uk/conditions/stress-anxiety-depression/mood-self-assessment/

Leeds Mind: 0113 305 5800, or email [email protected]

For people in crisis:

Connect, open 6pm-2am on 0808 8001212 or online chat at www.lslcs.or.yk

For people in crisis: Leeds and York Partnership NHS Foundation Trust’s 24/7 single point of access on Freephone 0800 183 1485.

Samaritans Leeds - 116 123 or 0113 245 6789

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