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Avoidable Deaths and the failure to commission Maternal Mental Health Services

Barry Sheerman, MP for Huddersfield, in raising an Early Day Motion in Parliament is raising awareness of the recent NSPCC report and the lack of Perinatal Mental Health Services.

The key task is to raise awareness so that sufferers of PND and their Carers “Know what to ask for?”

Barry Sheerman and Chris Bingley talked live on BBC Radio Leeds with Liz Green about their work in raising public awareness of PND issues and in campaigning to raise awareness in Parliament.

When asked by Liz Green about the difference their campaign work is making Chris highlighted the work of The Maternal Mental Health Alliance and the recent Royal College of GP’s announcement that:

Maternal Mental Health will be a Clinical Priority from 2014 to 2017. This is a clear example of how charities, health care professionals and the royal college can work together and make a difference.

GP’s, HV’s and MW’s take note, changes are coming and you will get the training, information and tools you so badly need and deserve!

Whilst Leeds has its own Mother and Baby Unit and specialist perinatal mental health services, across the rest of Yorkshire and the UK services are chronically inadequate, if they exist at all.

http://www.leedspft.nhs.uk/our_services/Perinatal_Mental_Health/Mother_and_Baby_Unit

The Patients Association Investigation into PCTs Commissioning of PND Services – Sunday Times 6/3/2011

We are supporting the NSPCC call to action for the improvements urgently needed in the provision of maternal mental health services across the UK.

 

1. Mother and Baby Units – “Informed Consent”

At the end of the Coroner’s Inquest into the death of Joanne Bingley he issued a “Statement of fact” that included “arguably Informed Consent has not been obtained in line with general medical council guidelines”.

Joanne Bingley Coroners Statement – highlighted version

Despite being a nurse, having been hospitalized twice with breastfeeding problems Joanne (and her husband) where never told of the Specialist Perinatal Services that should have been treating her.  

According to the NHS publication “Birth to Five Years” all mothers suffering from very severe postnatal depression or puerperal psychosis should be offered treatment in a mother and baby unit, unless there is a valid clinical reason for not doing so.

 

2. Equitable access to Specialist Perinatal Mental Health Services – Integrated Care Networks

This latest report from the NSPCC confirms that to end the current postcode lottery of care there is an urgent need to ensure:

 ALL MENTAL HEALTH TRUSTS CONFORM TO NICE CARE QUALITY STANDARDS.  

 

3. Training & Education – Implementing the Lessons Learned

The Mid-Staffordshire enquiry is just one of many “Independent Reports” raising issue that many NHS trusts are failing to comply with care quality standards, failing to adhere to professional standards of care and are operating unlawfully.

The NHS Constitution places legal duties on NHS trusts and their directors to provide services that comply with NICE care quality standards and that they implement the “Lessons Learned” from independent investigations.

Two years after his wife’s death and the Independent Investigation recommendations stating the need for specialist care, a Care Quality Commission investigation found patients still being treated by staff with no specialist training or experience in perinatal psychiatry, a breach of NHS guidelines.”

Mandatory training and accreditation must form part of the provision of the “Universal Service” with health care professionals and Volunteer Carers having access to accredited training providers. 

 

4. The Whole Family Approach – Support for dads and the legacy for those left behind

The crucial role “Carers” play, whether dads, partners, family members or friends, is recognized by the NHS on their NHS Choices website:

http://www.nhs.uk/carersdirect/guide/rights/pages/carers-rights.aspx

http://www.nhs.uk/CarersDirect/guide/assessments/Pages/Carersassessments.aspx

http://www.nhs.uk/carersdirect/guide/mental-health/pages/care-programme-approach.aspx

But the NHS currently does not commission or provide any support for Dads supporting those suffering from postnatal depression or for Dads who suffer from postnatal depression. 

Ask Why – Does the NHS not provide support and information to Dads?

Following my wife’s death nobody contacted me from the Mental Health Crisis Team that had been treating her. But the clinical records detail how the Crisis Team Manger contacted the Health Visitors advising them NOT TO MAKE CONTACT FOR 6 TO 8 WEEKS as I had the support of my family. Whilst at the same time the Crisis Team Manager discussed ensuring support was provided to members of staff.

Thankfully the Health Visitors ignored that advice and left a hand-written letter offering their condolences and telling me to contact them at any time I needed their help or support.

 

5. The True Costs of Failure – The Impacts on Society and the Wider Community

For mothers suffering from Postnatal Depression the National Institute for Health and Clinical Excellence (NICE) has defined what good quality care is but access to such care for women in the UK remains a postcode lottery and mental illness continues to be the leading cause of maternal death in the UK. 

The costs of just one “avoidable death” like Joe’s would cover the costs of providing all mums and dads with the information they require and the extra mother and baby unit beds needed.

The sad fact is there many such “avoidable deaths” costing the economy in excess of £300m, every year. 

The death of Joanne (Joe) Bingley caused horrific trauma to her husband, her family and her friends.

Following his wife’s death Chris was driven by his own grief and despair to protect his daughter from suffering the same fate as her mum in the future.

However, at the Coroner’s Inquest the true consequences and costs of the failure to prevent what was an “avoidable death” was brought home to him when the court was told of the many others affected.

People who witnessed Joe walking along the track and laying down into the path of the oncoming express train, seeing her body being torn apart by the train, her internal organs being spread across the tracks and the blood pool that resulted, as her upper torso was dragged along the tracks. 

  • The 7 year old child waiting on the Deighton station platform who needed counseling treatment
  • The 2 train drivers off work who needed counseling treatment
  • The members of public, off work who needed counseling treatment
  • All the other people (emergency services, rail workers, etc.) who had to deal with the incident

The estimated cost of the emergency response (£2m) and the economic costs of closing the Trans-Peninne train line for several hours (£20m) hardly feels relevant when compared to the widespread human cost.

All this suffering as a result of the NHS staff failing to obtain “informed consent”, failing to provide access to specialist perinatal health services and the Mother and Baby Unit in Leeds.

What would proper care cost?

Less than £20,000 per Mum

  • 25p for the JBMF information card for mums & dads (£176,000 per year for all mums) 
  • 5p for the JBMF Severe Postnatal Depression checklist /leaflet (£1,000  for all sufferers)
  • £318 per day for treatment in a Mother and Baby Unit £17,000 for the 56 days treatment to live!

 

KEY STATISTICS

Yorkshire UK Description Note
66,358 706,248 Live Births 2009 Office National Statistics  
       
133 1,412 High Risk mums who suffer Puerperal Psychosis a
1,991 21,187 Medium to High risk mums who suffer Severe Postnatal Depression b
2,124 22,599 Mums who should be offered MBU places according to NHS publications c
       
265 2,825 Planning guidance for MBU required treatments d
33 782 Current level of treatments MBU beds can provide  
       
100 630 High Risk mums at home, requiring specialist treatment  
1,991 21,187 Medium to High Risk mums at home, requiring specialist treatment  
2,091 21,817 High Risk mums at home due to lack of MBU beds requiring treatment  
       
67 67 Expected/Forecast deaths of Mums every year as a result of Mental Illness e
58 58 “Avoidable Deaths” given 86% are possible to diagnose and treat e

 

Basis and Source of Statistics – 2009 Live Birth Rates and the application of applicable ratios 

a)       2/1000 mums or 0.2%

b)       Normally 3% of mums but raises to 50% if mum has suffered previous mental illness like Joanne Bingley

c)       According to NHS publication Birth to 5 Years

d)       4/1000 mums or 0.4%

e)       Confidential Enquiries in Maternal Deaths (2012, 2009, 2006, 2003)

 

RELATED STORIES AND TOPICS 

Joanne Bingley Memorial Foundation – Handouts and Factsheets

http://www.joebingleymemorialfoundation.org.uk/jbmf-handouts-and-factsheets/

 

MIND – Understanding Postnatal Depression

http://www.mind.org.uk/mental_health_a-z/8007_postnatal_depression

 

When having a baby can cause you to ‘lose your mind’

By Clare Dolman, Trustee of Action on Postpartum Psychosis

http://www.bbc.co.uk/news/health-15969234

 

Action on Postpartum Psychosis – Map of MBUs

http://www.app-network.org/what-is-pp/getting-help/mbus/

 

10% of dads suffer from the effects of postnatal depression but for them the NHS provides no care.

http://www.telegraph.co.uk/health/healthnews/9226013/Fathers-just-as-likely-to-suffer-postnatal-depression.html

 

Fathers Reaching Out

Mark Williams, set-up Fathers Reaching Out which aims to help men who suffer from perinatal mental illness or who are left responsible for caring for mums suffering from perinatal mental illness

http://www.fathersreachingout.com/

 

Guidance for commissioners of perinatal mental health services – 2013

The new guidance fails to mentions the role of dads as carers, or that they too may suffer from postnatal depression and may need the support of mental health services.

http://www.jcpmh.info/library/resources/guidance-for-commissioners-for-perinatal-mental-health-services/