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We’re celebrating Mothers Day this weekend but despite progress, New Zealand is still not providing adequate care and support for new mums and their families. The far-reaching impact of perinatal mental health issues remains a reality that demands action and investment for the sake of families everywhere, writes Dionne Christian.
This story discusses depression, anxiety, and suicide.
Some 13 years ago, when I had a 6-year-old and nearly 2-year-old, I wrote about postnatal depression.
Having heard far too many stories about parents who were struggling with maternal – and paternal - mental health issues, and the ensuing pressures this places on families, I shared my story hoping it might drag the condition – described to me as “a mother’s little secret” – more into the public domain.
I wasn’t the first to try. In 2008, former PM Jenny Shipley and her husband, Burton, spoke about her personal experiences with PND. Shipley described it as “one of the most debilitating things I have ever endured...”
We were far from alone. While concrete statistics were – are – hard to come up, it was thought up to 30% of new mothers suffered a bout of depression or anxiety in the 12 months after their child was born and about 10% of new fathers did, too. It runs a spectrum from the “baby blues” – common, as hormone levels rapidly change in the first few days of giving birth – to the extremely rare postpartum psychosis.
The term “antenatal distress” wasn’t mentioned back then, nor did anyone talk much about anxiety. It meant “postnatal depression” was a catchall for myriad different conditions, all variations on a theme and all of which could have devastating impacts on families.
My article, Oh baby, what a mother load, prompted conversations. After all, as much literature says, “Once you start talking you will often be surprised at how many others have had similar experiences.” I was. After the initial flurry of talk – one friend even spoke about making a documentary, but funding was declined on the basis that the topic was too niche – things went quiet again and my daughters grew past the baby and toddler years.
Conversations eventually moved from “how are they sleeping at night?” to “when are you saying they have to come home at night?”
But just lately, I’ve been thinking again about postnatal depression – now termed perinatal anxiety and depression. The children of friends, who started their families earlier than I did, are now having their own kids; I’m working with more young women who are talking about pregnancy and birth.
So, I wanted to know what has changed since 2011 when, close to Mother’s Day, I told my PND story. Is Aotearoa New Zealand doing better at taking care of the mental health of its new parents and their babies?
No, appears to be the answer, given the first statement I found (in the Maternal Mental Health 2022 report) was this: “In Aotearoa, the largest cause of maternal death is suicide.” Sadly, that’s something we share with the rest of the so-called developed world, where suicide is the main cause of maternal death in the first year after giving birth, especially if there is a previous history of mental illness.
However, NZ’s maternal suicide rate is five times higher per capita than in the United Kingdom, but “significantly less” is invested in maternal mental health here. The MMH reports goes on to say that from 2006-2018, suicide accounted for 30 maternal deaths and Māori women are 3.35 times more likely to die by suicide.
It sounds disappointingly – disturbingly – familiar.
In 2011, the Perinatal Mental Health New Zealand Trust (PMHNZ) set up as a national umbrella group for the many community-based groups trying to support families with PND. Hopes were high that there would be more co-ordinated lobbying of government and that perinatal mental wellbeing might make it onto the agenda as a health issue that needed – needs – serious attention.
Since then, the PMHNZ has become Perinatal Anxiety and Depression Aotearoa (PADA), the name recognising that anxiety is as much a problem as depression and that antenatal depression and anxiety is also real.
PADA general manager Amy Castle and advisory board member Jacqui Coates-Harris, a registered psychiatric nurse who set up the Waikato DHB’s perinatal mental health service in 2002, say there’s less stigma about speaking out. They can rightly point to more resources for expectant and new parents.
PADA’s factsheets are in different languages and address topics from breastfeeding to parenting in the digital age. There’s even one called “Fact, fiction or fantasy… The idealisation of motherhood” that bluntly states that things like mothering is natural/instinctual, all women instantly love their babies, and pregnant women are blooming are, in fact, myths.
But Castle and Coates-Harris say there’s still no national screening programme or clear treatment pathway for those with PND.
“Let’s look at it from a Waikato point of view,” says Coates-Harris. “We have about 5000 births so given we know the prevalence of perinatal anxiety and depression is around 10-20 %, that means at least 10% of pregnant and new mothers can experience these conditions.
“This means that at least 500 of these women should be presenting to primary or secondary services [in Waikato] for help, but that is not the reality. Secondary services don’t see a third of that number, so where are these people getting support?”
Perinatal mental health services, as run through Health NZ Te Whatu Ora, usually only get involved if a birthing parent has moderate to severe PND. There is no single organisation to support those with milder symptoms. Whether PND even gets detected can depend on a parent’s willingness to admit they’re struggling and/or whether their midwife, GP or Plunket nurse picks up on possible signs.
But even if NZ had a national screening programme, where to refer parents to might be problematic. There are two residential mother and baby units; one in Christchurch and a newer one in Auckland, but both have fewer than 10 beds and will care for those with moderate to severe PND.
“It’s catering to the needs of the few, rather than the many,” says Coates-Harris, who would like to see more funding earmarked for more community initiatives.
Mothers Helpers is a community-based group founded in 2010/11 by Kristina Grace, after she went 18 months with PND but without a diagnosis. A registered nurse and social worker, Grace says Mothers Helpers uses evidence-based prevention, treatment and recovery options in its work. These options include Out of the Fog, a 10-week recovery programme available throughout the country.
“About 680 women approach us every year,” says Grace. “That’s good, in terms of people recoginising they’re struggling, but most are self-referrals. That tells me we are still not getting clinicians identifying and referring mothers for help and support. We need to keep reminding people that’s it’s okay to talk about it without judgment.”
Peer support can play a role in helping parents deal with PND, but Grace worries that many community groups, often run on the smell of an oily rag, are staffed by volunteers who don’t have the clinical skills to effectively treat it.
Like many other groups, Mothers Helpers receives no government funding, instead relying on grants from charitable trusts. Through the Maternal Care Action Group she set up, Grace has spent years lobbying various governments for more targeted help and support but has now stepped away to focus her energy on helping parents.
Similarly, the Perinatal and Maternal Mortality Review Committee has made several recommendations aimed at reducing our maternal suicide rate. These include measures such as antenatal maternal mental health screening; a stocktake of maternal mental health services across NZ; a national pathway for accessing maternal mental health services that includes cultural appropriateness; the establishment of a Perinatal and Infant Mental Health Network to provide a national forum to discuss issues; and improved awareness and responsiveness to the increased risk for Māori women.
There has been a stocktake of perinatal mental health services across NZ, but very little else. Grace points out that in the $2 billion package rolled out by the last government for mental health, nothing was targeted at perinatal mental health.
Some $664 million went toward the “Access and Choice” programme to fund 1100 health improvement practitioners (HIPs) and health coaches in GP clinics and primary health settings. The idea behind this is that when a patient is identified with a mental health or addiction issue, they can see – at the same place – a trained mental health worker.
That scheme took workers from other parts of the mental health system and there has been no formal evaluation of it. Nor has there been much promotion of it, says Grace. “I’m not sure that the people who might need it know it’s there.”
Even so, publicly funded GP counselling sessions are often limited to three or four sessions. That is not enough to uncover what is often the tip of the iceberg, says Coates-Harris.
“There are often ghosts in the nursery that come from how our grandparents were parented and how they parented. It’s generational. I think we’re doing future generations a disservice by not being able to see them through the public service.”
As she points out, many other societal factors impact on parents and families, including relationship breakdowns and estrangement from wider whānau, the cost of living, housing and job insecurity.
She and Castle talk about the importance of the “it takes a village to raise a child” approach where, in the past, there were more family and friends to help. Now, we have absent neighbourhoods where new parents can find themselves isolated for hours on end.
“I like to talk about Kmart therapy,” she says. “It’s about just getting out of the house. You get dressed, you head out with the baby, and it’s not about buying stuff but being in a different environment where there’s nice lighting, bright colours, things to look at, other people around. When you’ve got a baby, other people will often stop to talk to you.
“Many struggle with the idea of getting out of the house, because it might disrupt a baby’s routine, but ‘cabin fever’ is real, so dealing with that is just as important. There has to be time to create ‘new neighbourhoods’.”
In 2011, I ended my story by acknowledging issues around pregnancy, birth and parenting were complicated. I stressed the importance of building a supportive community – a “new neighbourhood” – around you, and the fact that PND does pass and can, in fact, leave you feeling stronger and surer in yourself.
“The key is discussing the issue and getting help quickly,” I wrote.
That remains true, but it saddens me – actually, it makes me angry and extremely frustrated – to think that who might help you to get help and what that help might look like often remains determined by what you can afford, where you live and your life circumstances.
It remains to be seen what our new government will do, but if it’s serious about building a better future for all New Zealanders, better supporting new parents is a good place to start.
Where to get help:
- Lifeline: Call 0800 543 354 or text 4357 (HELP) (available 24/7)
- Suicide Crisis Helpline: Call 0508 828 865 (0508 TAUTOKO) (available 24/7)
- Youth services: (06) 3555 906
- Youthline: Call 0800 376 633 or text 234
- What’s Up: Call 0800 942 8787 (11am to 11pm) or webchat (11am to 10.30pm)
- Depression helpline: Call 0800 111 757 or text 4202 (available 24/7)
- Helpline: Need to talk? Call or text 1737
- Plunket 0800 933 922
- https://mentalhealth.org.nz/
- https://www.mothershelpers.co.nz/
- https://pada.nz/
- https://www.mothersmatter.co.nz/
If it is an emergency and you feel like you or someone else is at risk, call 111
