Experts are backing the revamp,saying that for too long the mental health of new and expectant mothers has been neglected,despite women being at risk of developing mental illness during this vulnerable time.
One in two Victorian mothers are missing out on recommended screenings for postnatal depression.istock
“We can do better,” said Professor Jane Fisher,who contributed to the review and is the director of global and women’s health at Monash University.
National guidelines state that women should be screened at least once during pregnancy and once in the postpartum period.
But the review,which was quietly published online this week,found this was not happening,with most pregnant women missing out on screenings.
It revealed that maternal child health nurses and other clinicians were sometimes reluctant to screen women because “timely access to the right services is not available”.
Patchy maternity services,a lack of training and not enough time during maternal child health appointments were also fuelling the issue.
Perinatal and reproductive psychiatrist Dr Edna Lekgabe said mental health struggles were the number one complication of pregnancy and after birth,but this was often overlooked and physical conditions prioritised.
Lekgabe said one in four women experienced anxiety,one in five experienced depression,and one in 10 experienced obsessive-compulsive disorder in the perinatal period. She compared that to gestational diabetes,which develops in about one in six pregnancies,or preeclampsia,in fewer than one in 10 pregnancies.
“Other conditions are[a rate of] one in 1000,but we screen so carefully for that. Whereas mental health struggles,which is the number one complication of pregnancy and postpartum,are not[as rigorously] screened.”
Fisher said the most popular screening tool used in Victoria – the Edinburgh Postnatal Depression Scale – was designed for the UK’s National Health Service and did not always translate well into other languages. She said women who came from disadvantaged backgrounds also slipped through the cracks.
She said screening was important because many mothers did not disclose their mental health struggles or seek out assistance.
“Screening helps start that conversation by asking a consistent set of questions.”
The review also found that the existing services provided “limited opportunities” for fathers and non-birthing parents to undergo mental health screening. Julie Borninkhof,the chief executive of Perinatal Anxiety and Depression Australia,called for this to change.
“We know that maternal child health nurses in their visits do often encounter mums alone within the home because dads return to work. So we do have to change some of the approaches.”
The review was a recommendation of the royal commission into Victoria’s mental health system. The Department of Health commissioned KPMG and Monash University to review the current evidence and come up with recommendations.
These included developing new Victorian perinatal mental health screening guidelines,co-designing an approach to screening Aboriginal people and those from multicultural communities and improving access to services for those who are flagged as needing help.
An earlier inquiry into perinatal services in Victoria,published in 2018,also received a large amount of evidence about mental health concerns,often stemming from social isolation. It found that there was less support from relatives,neighbours,friends and the community than there was in generations past.
“We have lost the days when the neighbour knocked on the door and nursed the baby for a few hours whilst you had a rest,or brought food over etc,” said one of the mothers who gave evidence for the inquiry. “That sense of community is slowly diminishing.”
Australian Nursing and Midwifery Federation Victorian branch secretary Lisa Fitzpatrick said the figures were surprising because mental health was a critical focus of the state’s maternal and child health nursing service.
“The four-week appointment is dedicated to a comprehensive maternal health and wellbeing check,” she said. “This appointment is 60 minutes to enable a thorough assessment.”
She said this check was repeated at the eight-week appointment and subsequent appointments depending on parents’ previous responses.
Fitzpatrick said following advocacy from the union,the Victorian government had vowed to increase the length of each maternal and child health appointment by an additional 15 minutes.
She called for more resources and services to refer new parents for timely support.
Earlier this year,state coroner John Cain called for an overhaul of Victoria’s maternal and child health services,.
Arbuckle had received a score of 14 on the Edinburgh Postnatal Depression Scale,which indicated she could have “major depression” and should have prompted a series of interventions.
But these interventions,which included a referral to a GP and enrolment in her local centre’s enhanced maternal child health program,did not take place.
A spokeswoman for the state government said it had accepted all the review’s recommendations.
“We know how challenging pregnancy and the first couple of years following childbirth can be for new mothers – this report makes clear there is more we can do to support the mental health of parents,carers and families during this critical time,” she said.
The spokeswoman said the recent budget invested more than $86 million to increase the time children and families spend with maternal and child health nurses.
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