News

One in five mothers not receiving perinatal mental health checks


Evelyn Lewin


10/06/2020 12:26:02 PM

Screening rates have improved significantly, but experts say there is more work to be done.

Pregnant woman looking at iPad
Dr Wendy Burton says it is important to routinely ask pregnant women about their mental health at every appointment.

Rates of perinatal mental health screening have improved significantly.
 
The percentage of women screened both antenatally and postnatally increased from 21.3% to 79.3% between 2000 and 2017.
 
The percentage of women not screened decreased from 40.6% to 1.7% over the same period.
 
Such are the findings of new research, based on a longitudinal community‐based study of self‐reported perinatal mental health screening of 7566 mothers.
 
Dr Wendy Burton, Chair of the RACGP Specific Interests Antenatal/Postnatal Care network, told newsGP she is pleased by those findings.
 
She believes improved training for health professionals and changes to Medicare item numbers have contributed to the high screening rate.
 
‘There has been a lot of work done to ensure every woman receives mental health, alcohol and drug screening, and domestic violence screening at or after the 28-week gestation mark, and again at the six-week postpartum mark,’ Dr Burton said.
 
Despite the encouraging results, the study also found one in five women do not receive these mental health checks, and at-risk women are more likely than others to miss out.
 
Women who reported emotional distress in the survey before giving birth were 23% less likely to have been screened antenatally and postnatally than women who had not reported emotional distress.
 
Furthermore, older mothers were 35% less likely to be screened during pregnancy and after birth than younger mothers.
 
‘It’s disappointing to see,’ Dr Burton said.
 
‘Especially [when] some of the higher-risk women, [who] could be better placed on the radar, have actually been slipping through the cracks.’
 
Dr Burton believes this may be occurring because health professionals can place physical needs above mental health issues.
 
‘Sometimes we get so focused on the immediate, physically necessary [needs] and we just do overlook those [issues of mental health],’ she said.
 
Dr Nicole Highet is the founder and executive director of the Centre of Perinatal Excellence (COPE). She agrees that the lack of perinatal screening for mental health is concerning.
 
‘This is disappointing, particularly when we know that if emotional and mental health problems go undetected and untreated, this can have significant long-term personal costs to individuals and families, as well as costing the community more broadly,’ she told newsGP.
 
Dr Burton said there are a number of measures in place to help address these issues, including through COPE, which is home to the national perinatal mental health guidelines.
 
Dr Highet said further steps are being taken to address perinatal mental health screening, including the creation of the iCOPE digital screening platform. This program is being implemented in many healthcare facilities, including at general practices and in public maternity hospitals.
 
Dr Highet said iCOPE meets all Medicare Benefit Schedule (MBS) requirements and identifies at-risk pregnant women or those experiencing symptoms early, rather than having to wait until such women reach ‘crisis point’.
 
‘The success of iCOPE in providing more efficient, effective and inclusive screening … has resulted in the Commonwealth Government’s commitment to roll out iCOPE across every public maternity hospital in 2020–23,’ Dr Highet said.
 
While Dr Burton said gains are being made in perinatal mental health screening, the issue needs to remain at the forefront of practitioners’ minds when assessing women in the perinatal period.
 
‘One of the things I do when I’m educating GPs is say, “Hands up how many have looked after a woman in pregnancy who’s had syphilis, rubella, hepatitis C or HIV”. And very few, if any, hands go up,’ she said.
 
But when Dr Burton ask how many GPs have looked after a woman in pregnancy who has anxiety or depression, ‘practically every hand goes up’.
 
‘We screen routinely for those other things, and it’s critically important that we screen for mental health because it’s far more common than all the other things we’ve been screening for,’ she said.
 
Dr Burton said this screening needs to be done through formal assessment at 28 weeks’ gestation and again at the six weeks after delivery. It is also important, however, for GPs to ask every woman at every visit if they are okay, and if they are safe.
 
‘That should be locked and loaded as a routine part of everyday maternity care, just like we take blood pressure, check the fetal heart rate and fundal height,’ Dr Burton said.
 
‘This should just be embedded.’
 
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