How the U.K. model of postpartum depression care could guide Canada's treatment plan

Years ago, U.K. mother and baby psychiatrist Alain Gregoire would review case files of new mothers who had died by suicide after their postpartum depression and anxiety went untreated.

"Women who not [only] got bad care but got shocking rejection and disinterest in their so-called care from the health system," he said.

"I've seen a woman who survived by chance because she went to live with her grandparents — where there were some specialists — from her own home, where there was nobody at all. It literally saved her life."

A similar problem persists in Manitoba and throughout Canada.

Delsie Martin, who has a six-month-old son and a two-year-old daughter, says she had been having recurring thoughts of dying when she went to the Neepawa Health Centre in August.

She says a doctor at the hospital sent her away without any treatment or referrals to other services.

In 2014, the U.K. government made maternal mental health a priority and worked to ensure people who are at high risk of harming themselves or their babies always had good access to care from skilled professionals.

The results have been staggering, he says.

Gregoire, who is the head of the Maternal Mental Health Alliance (MMHA) of the U.K., says a similar model could be applied in Canada to prevent people such as Martin from slipping through the cracks.

Martin told CBC News in an interview last week that her doctor said: "You have no reason to be depressed."

The mother says she told the doctor she was on medication for postpartum depression, which she suffered from after her first child as well.

Martin says the doctor urged her not to have more children and dismissed her concerns about finances.

U.K. model

Perinatal mental health care doesn't have to be that way, Gregoire says.

In 2015, the year after the U.K. shifted its mental-health focus, the British government committed £75 million (roughly $125.3 million Cdn, according to the Bank of Canada's oldest available exchange rates from 2017) in the budget for perinatal mental health care.

The next year it announced an additional £290 million ($484.6 million Cdn) as part of its five year plan.

In 2019, all regional, clinically led bodies received annual funding for specialist perinatal mental-health services in their baseline budgets.

The government plans to increase funding every year until 2024 to ensure more women are able to access services and help for their partners.

This spending is due to the advocacy of the MMHA, which was established in 2011 when women with lived experience came together with clinical providers to call for change in the U.K.

The alliance's "Everyone's Business Campaign" is working to ensure all women throughout the U.K. who experience a perinatal mental health problem to receive the care and support they and their families need, wherever and whenever they need it.

In the last eight years, some of those goals are starting to be realized, Gregoire says.

"We've seen a real transformation in their experience of care and support for their mental well-being."

The alliance is working to improve access in Northern Ireland, Wales and Scotland, as well as to ensure that people with mild to moderate perinatal mental health problems have improved access.

The U.K. alliance has also shifted to provide support for other countries working to make changes through the Global Alliance for Maternal Mental Health.

Applying that model in Canada

A Quebec-based psychiatrist and professor is calling on the provinces and territories, who determine their own health care models for the most part, to work together to ensure a model similar to the U.K.'s is put into place in Canada.

Tuong-Vi Nguyen, an assistant professor in both the psychiatry and gynecology and obstetrics departments at McGill University, says the whole family suffers when the birthing parent experiences postpartum depression.

"The risk is not just to productivity of the mother or how soon she comes back to work after delivery, but it's really about the health of the whole family," said Nguyen, who is also a practising reproductive psychiatrist.

Partners of mothers with postpartum mental health challenges are between 25 to 50 per cent more likely to develop mental health problems of their own, Nguyen says. Mothers with anxiety and depression during pregnancy also have children who, in middle-adulthood, are more likely to develop diabetes and hypertension, she says.

Before the pandemic, about one woman in seven would experience postpartum depression or anxiety, according to organizations including the American Psychological Association. 

Researchers involved in a 2021 international study of nearly 7,000 pregnant and postpartum women say that number has increased to one in three.

At the same time, there are not enough mental health providers to meet everyone's needs.

"Five years ago, I had difficulty convincing people to start psychotherapy. Now, even when someone is ready, the wait list is much longer," Nguyen said.

Manitoba also has the lowest rate of psychologists in the country: about 20 per 100,000 people compared with the national average of about 50 per 100,000, according to data reported in the summer by the Manitoba Psychological Society.

The need is there, but the political will to address perinatal mental health is not, Nguyen says.

The federal government says it's supporting postpartum and perinatal individuals in many ways, including spending $26.5 million annually for the Canada Prenatal Nutrition Program, which serves 236 projects with more than 45,000 participants, according to Natalie Mohamed, a media relations adviser for Health Canada and the Public Health Agency of Canada.

She added that in 2017, Canada committed $5 billion over 10 years in targeted funding for provinces and territories to improve access to mental health and substance use services, and has also created an online portal called Wellness Together Canada that provides free access 24/7.

However, neither initiative specifically prioritizes perinatal mental health.

A provincial spokesperson flagged its 2021 report, A Pathway to Mental Health and Community Wellness: A Roadmap for Manitoba, which the province spent $17 million to support in the first year of the plan.

The spokesperson says the roadmap identifies five strategic focus areas and represents the Manitoba government's plan to "create an integrated, responsive and accessible system" that meets the needs of Manitobans. However, it doesn't mention perinatal mental health.

Nguyen wants to see Canada develop a national perinatal mental health strategy and ensure there's funding to put it in place.

Costs of not caring

The health-care system spends astronomical amounts when maternal mental health isn't addressed.

The London School of Economics and Political Science found in a 2014 report that perinatal depression, anxiety and psychosis carry a total long-term cost to society of about £8.1 billion ($13.6 billion Cdn) for each one-year cohort of births in the U.K.

Another report published in 2022 found that addressing those unmet maternal mental health needs and changing how pregnant and postnatal women are treated could have a net economic benefit of £490 million ($805.9 million Cdn)  to the country's health service over 10 years.

Nguyen, who helped develop a similar calculator for Canada, says this country's costs are comparable.

The calculator, which derives data from before the pandemic, found that in Canada the costs associated with perinatal mental health problems each year amount to $6.7 billion. In Manitoba, those costs are roughly $309 million.

"We've known the human cost of perinatal mental disorders for awhile … It's too bad that we need to talk dollars and economic costs in order for people to be incentivized to act," Nguyen said.

If you or someone you know is struggling, here's where to get help:

• Talk Suicide Canada: 1-833-456-4566 (phone) | 45645 (text between 3 p.m. and 11 p.m. CT).
• Kids Help Phone: 1-800-668-6868 (phone), live chat counselling on the website.
• First Nations and Inuit Hope for Wellness Help Line: 1-855-242-3310.
• Canadian Association for Suicide Prevention: Find a 24-hour crisis centre.
• This guide from the Centre for Addiction and Mental Health outlines how to talk about suicide with someone you're worried about.