Rehman introduces new Bill on perinatal mental health services

The number of specialist Mother and Baby Units in England could be increased under a new Bill introduced in Parliament today, which offers an innovative approach to the distance patients have to travel to access services.

With the support of the Royal College of Psychiatrists, Rehman has proposed legislation to assist the tens of thousands of woman affected by perinatal mental illness every year and to bring an end to the unacceptable variation in services.

Up to twenty percent of women are affected by mental illness during pregnancy or within a year of having a baby, and they are 33 times more likely to be admitted to a psychiatric ward after giving birth than at any time in their lives.

In England there is a shortfall of specialist facilities, with many mothers either being unable to access this life-saving care or having to travel hundreds of miles. Both NHS England and NICE have acknowledged that a further 60-80 beds are needed to cope with those at risk.

Specialist care is provided by Mother and Baby Units, which are equipped to support mothers in caring for their child whilst they receive treatment for a range of mental illnesses.

Under Rehman’s Bill, the NHS would have to guarantee an appropriate level of provision for Mother and Baby Units in England, ensuring that 95% of patients do not have to travel more than 75 miles to reach expert care.

A recent report by the LSE and Centre for Mental Health has estimated that perinatal mental health costs society £8.1 billion, representing £10,000 for every single child born in the UK. In contrast, the funding required to address the shortfall in beds would only be £7 million a year.

Rehman said:
"The arrival of a baby should be a joyful occasion, but for some, pregnancy can lead to mental illness. Perinatal mental illness has for too long been overlooked in our country, and many women are not receiving access to the specialist care they need.

"I have introduced a Bill, with the help of the Royal College of Psychiatrists, to end the current unacceptable variation in support and compel the NHS to ensure that women can have access to Mother and Baby Units, which provides expert and lifesaving care."

Professor Sir Simon Wessely, President of the Royal College of Psychiatrists said:
"The current situation, where women have to travel thousands of miles to access Mother and Baby Units, is unacceptable. NHS England and NICE already agree that we need more specialist care but have been unwilling to provide it. Under Rehman Chishti’s Bill, we can ensure that all mothers that need it can access this vital specialist service."

Dr Giles Berrisford, Consultant Psychiatrist, Birmingham Perinatal Mental Health Service said:
"Mental illness at any time can be devastated, but when it so closely follows the birth of a child and ultimately results in families being torn apart: either with mothers separated from their babies, or fathers having to travel hundreds of miles to visit their new family, it seems particularly cruel.

"The provision of additional Mother and Baby Units would help these families at their time of greatest need; supporting mothers, fathers and babies. I am very grateful to Mr Chishti for bringing this Bill forward."

Rehman’s speech can be found below (Please check against delivery):

Mr Speaker, I beg to move,

"That leave be given to bring in a Bill to make provision about the appropriate level of access to NHS services and accommodation for mothers with perinatal mental illness; and for connected purposes."

This Bill is in addition to my other Bill on the need for Accountability and Transparency in relation to commissioning of Mental Health Services.

I thank the Minister, for meeting myself and the team from the Royal Colleague of Psychiatrists, led by its President Professor Simon Wesley who are fully supporting these Bills.

We have come a long way in improving attitudes to mental illness over the past few years, and I pay tribute to the work of both the current Government and the Coalition Government for their efforts to improve the quality and provision of care for people with mental health.

And nowhere is improvement needed more than for women with perinatal mental illness. Perinatal mental illnesses are those which start or are already present during pregnancy and the initial year after birth. This is a time when risk of mental illness is heightened, and approximately 10-20% of women will experience a mental illness in the year after childbirth. In fact, a woman is 33 times more likely to be admitted to a psychiatric ward after giving birth than at any other time in her life. This represents tens of thousands of women in England every year.

The consequences of not intervening adequately can be severe. These are women who might be catatonic, delusional, experiencing hallucinations or suicidal thoughts, and may be unable to recognise their family or even their baby. Not only is this a traumatic experience for them, but unsurprisingly the child’s development can be severely impaired.

Tragically, suicide is a leading cause of maternal death, associated with approximately 15% of overall deaths in the perinatal period. And although cases are rarer, some women will kill their child as a result of their illness.

Recently we all would have seen the Coroners reports in the Media into the tragic case of Charlotte Bevan who committed suicide along with her baby, and her Parents call for extra Perinatal Units, as well as the Coroner calling for better services.

Aside from this tremendous human cost, there is an economic cost which far outweighs the cost of providing adequate treatment. A comprehensive economic evaluation conducted last year by the London School of Economics and the Centre for Mental Heath calculated that the annual cost of perinatal mental illness to the NHS is £1.2 billion, and the total cost to society is £8.1billion.

Although many cases of perinatal mental illness can be managed by services based in the community, there are thousands of cases each year when specialised care is required, and the mother will have to be admitted to hospital.

In these circumstances, typical adult psychiatric wards are inadequate as they are not equipped to allow the baby and mother to remain together and bond. Specialised Mother and Baby Units - which are the subject of this Bill - are designed with this in mind, and research indicates that women with serious perinatal illness will have better outcomes and better relationships with their infants if cared for in these specialist units.

Guidance from the National Institute for Health and Social Care Excellence accordingly recommends that mothers who require inpatient treatment for any mental health problem in the perinatal period should be admitted to one with their child.

Last month, I had the pleasure of seeing the fantastic work that these specialist units do first-hand, when I visited the Margaret Oates Mother and Baby Unit in East London.

The Scottish NHS is some years ahead of ours when it comes to providing these vital services. Since 2003 their Mental Health (Care and Treatment) Act - which was the inspiration for this Bill - has stipulated that their commissioners must provide enough Mother and Baby Unit services so that women with depression (who require inpatient admission) and their infants can be accommodated together.

However, there is no similar provision in English law, and both NHS England and the National Institute for Health and Social Care Excellence have acknowledged that there is a significant national shortfall in the provision and distribution of Mother and Baby Units of approximately 60-80 beds. As a result, women with serious mental illnesses are forced to be either admitted without their babies to general adult psychiatric wards or to travel hundreds of miles out-of-area to a specialist Mother and Baby Unit- both of which have damaging consequences for the mother and baby. Dr Liz McDonald, one of the country's leading perinatal psychiatrists, calls this ‘the bleakest of all postcode lotteries'. I agree, and this Bill seeks to correct that.

It’s important to note that the number of beds needed is not the only consideration - thought must also be given to where they are located. I recently met with Dr Giles Berrisford, a senior perinatal psychiatrist who runs an excellent Mother and Baby Unit in Birmingham. He told me that he’s received patients from as far away as Cornwall, and that new motherhood, the onset of mental illness and then having to travel huge distances for care and being separated from families, friends and communities is a toxic combination. That’s why this Bill will make it a requirement that 95% of the women who need these services should be able to access them within 75 miles - figures recommended to me by experts at the Royal College of Psychiatrists, who strongly support this Bill.

This distance element is innovative, and I appreciate that it might raise an eyebrow or two. Actually, it’s just a different way of conceptualising the rights that already exist. For years, patients have had the legal right to access NHS treatment for physical illness within a maximum period of 18 weeks. Unfortunately this 18-week target would not be relevant to acute perinatal mental illness, where as I have explained the problem is both the shortage and location of services. That’s why this Bill thinks slightly differently and uses distance rather than time as its basis. This is novel for the NHS, but innovation is no bad thing, and I ask if we can enshrine a time-based right in law with no ill effects, then why not a distance-based one? This is certainly not unheard of - in the United States, Kentucky, Illinois and Minnesota have laws about the maximum distance that patients should have to travel for care.

Moreover, the financial implications of this Bill are actually positive. The LSE and Centre for Mental Health’s evaluation estimated the cost of providing the 60-80 beds that NHS England and NICE say are needed to be approximately £7 million.

I’m pleased to say that this Government has already earmarked extra funding for perinatal services more generally. In the March 2015 budget a pledge was made to spend £75m over five years on improving perinatal mental health. However, no detail has been forthcoming about what this actually means in practice. This Bill is therefore complementary to existing government spending plans, but importantly will serve to both compel NHS England to act and specifically will focus their attention on these much-needed Mother and Baby Units.

When I’ve spoken to colleagues about this Bill, some have cautioned that it could lead to legal action being taken if these services are meant to be available but aren’t. I’m pleased to say that these concerns are not founded; the Royal College of Psychiatrists informs me that they are not aware of the similar Scottish law leading to any such cases - they say it has, however, had the desired effect of raising awareness amongst commissioners of the need to provide these services.

Another question that I’ve been asked is why these services are a special case deserving of their own Bill. But there is a particularly strong argument for action in this case. As we know, the Government has set the laudable objective of giving mental health parity of esteem with physical health. Unfortunately, this reflects the fact that mental healthcare has lagged behind physical healthcare for so long. Perinatal mental healthcare has lagged behind other areas of mental healthcare, and so has been doubly disadvantaged in many ways. I think that this - and the consequences of not getting this care right for mothers and babies - justifies this Bill and the novel approach it takes. As for whether this legislation will set a precedent, that is ultimately within Parliament’s control.

In summary, this Bill reflects current NICE guidance, and will result in better outcomes for the mothers and infants concerned. There is robust evidence to suggest that this will save both the NHS and society money in the long run.

We have a moral duty to make sure that new mothers with severe mental illness get the care and I commend this Bill to the House.