The RCPCH works to transform child health through knowledge, innovation and expertise. We have over 500 members in Wales and over 17,000 worldwide. The RCPCH is responsible for training and examining paediatricians. We also advocate on behalf of members, represent their views and draw upon their expertise to inform policy development and the maintenance of professional standards. For further information please contact Gethin Jones, External Affairs Manager for Wales: gethin.jones@rcpch.ac.uk or 029 2050 4211.
Our recent report, the State of Child Health (SOCH), presents the most recent data on child health from across the UK broken down by nation where possible and includes a comprehensive series of recommendations for Wales.
Recommendations
· The Welsh Government and NHS must ensure that every woman has access to appropriate perinatal mental health treatment and support.
· The Welsh Government should take immediate steps to embed statutory and comprehensive personal, social and health education programmes (including sex and relationships, social inclusion, bullying, drug and alcohol use and mental health) across all primary and secondary schools. The new curriculum for Wales should use the Health and Wellbeing Area of Learning experience to continue that approach and Estyn should inspect the provision of personal, social and health education programme within a robust framework.
· The Welsh Government should mandate that all maternity services achieve and maintain UNICEF UK Baby Friendly Initiative Accreditation by January 2019 to support and promote bonding as well as increase breastfeeding rates.
Perinatal mental health and child health
Perinatal mental health problems affect up to 20% of women at some point during pregnancy or in the year after childbirth. This is a major public health issue impacting on mothers, babies and their families[1]. Women affected respond well to treatment, but about half of all cases of perinatal depression and anxiety go undetected and many of those which are detected fail to receive evidence-based interventions[2].
A recent report found that on a UK level, almost a quarter of all maternal deaths between six weeks and a year after birth are related to mental health problems, and one in seven of the women who died in this period died by suicide[3]. Perinatal mental health problems do not only have negative repercussions for the women directly dealing with them, but also for the family life and development for the children involved, in terms of bonding, the wellbeing of the child, disruption to the early family life of a child and a host of other factors[4].
Maximising mental health and wellbeing for future generations
High quality personal, social and health education including sex and relationships education is essential to ensure that the next generation of parents have the knowledge and skills to make positive, healthy decisions and are equipped to understand how to manage their own well-being and minimise their children’s exposure to the adverse childhood experiences. It is positive that the new curriculum for Wales, due from September 2018, establishes health and wellbeing as one of the six Areas of Learning and Experience.
Integration
All healthcare professionals including paediatricians should receive training and support to identify mental health issues and offer the appropriate signposting and support. There is an opportunity with the creation of Health Education Wales to look at how this can be achieved.
Health inequalities
The 2015/16 report of the Chief Medical Officer for Wales[5] stated that infants, children and young people living in the most deprived areas of Wales have not benefited as greatly from the improvements in health of the last two decades, compared to those living in the least deprived areas. An estimated 200,000 Welsh children live in poverty and are more likely to experience negative health outcomes. Both universal and targeted services must be protected to reverse this. A ‘whole person’ approach is needed to ensure that mothers and pregnant women experiencing mental health problems should receive support to ensure that all other aspects of their health are addressed: being a healthy weight, breast feeding and stopping smoking all improve health outcomes for both mothers and infants. We advocate that all maternity services achieve UNICEF Baby Friendly Initiative standards to help improve bonding and offer new mums support, as well as increase breastfeeding rates and reduce health inequalities.
[1] The costs of perinatal mental health problems, A. Bauer, M. Parsonage, M. Knapp, V. Iemmi & B. Adelaja, http://www.centreformentalhealth.org.uk/costs-of-perinatal-mh-problems , October 2014.
[2] We are not aware of Wales-specific data. NSPCC Cymru, The National Centre for Mental Health and Mind Cymru are developing a project to investigate perinatal mental health services in Wales which will map out statutory and voluntary sectors services and whether statutory services in Wales are meeting national standards and recommendations.
[3] See MBRRACE-UK’s recently published report into maternal deaths, ‘Mothers and Babies: Reducing Risk through Audits and Confidential Enquiries across the UK’
[4] Further information on the impact of perinatal mental health problems see Mind Cymru’s Two in Mind project: https://www.twoinmind.org/for-professionals