Designate Funding in the 2017 Budget for Postnatal Depression Early Intervention

The Current Situation

• 1 in 8 women experience Antenatal Depression and 1 in 5 women experience Postnatal Depression. It is understood that women are experiencing significantly delayed and sometimes missed diagnosis (1) – estimated at around 63% of women with PND (2)
• These women are missed due to poor screening and referrals while under midwifery care (3 &4)
• Once diagnosed, General Practitioners (GP’s) are expected to manage a woman’s PND in their short 10-15 minute appointments at an estimated cost of $50 to the patient. Both the limited time and the cost of this appointment are barriers to a woman getting sufficient help for her mental illness.
• The only treatment/intervention currently available to assist women in their recovery from mild-moderate PND is to obtain medication through a paid appointment with their GP and private counselling. There is no Government-funded holistic programmes with proven outcomes of recovery from depression/anxiety available to women who have mild-moderate PND
• In most cases, counselling is only subsidised by the Government if an individual has a community services card and a diagnosis from their GP to apply for WINZ funding. This leaves a large portion of New Zealand women who are unable to afford counselling for PND and therefore, they are not adequately recovering from it

What are we needing funding for?

• Professional Development training of midwives in the onset, prevalence, identification, screening, treatment and intervention of AND/PND and when and whom to refer
• A service delivering early intervention assessments and recovery programmes with proven outcomes to women with AND/PND who do not fit Maternal Mental Health criteria in the Primary Health sector
• Subsidised (free) counselling for all women experiencing Antenatal or Postnatal Depression/Anxiety

Why is it needed?

Undiagnosed and untreated AND and PND has a significant impact on a woman, her partner and her child.
• For the woman and the child, depression has been associated with substance abuse, an increased risk for pregnancy-induced hypertension contributing to pre-eclampsia, gestational bleeding, diminished uterine artery blood flow and poor birth outcomes including foetal death, preterm birth and labour, small infants for gestational age, low birth weight, low Apgar scores and increased risk of neonatal special care and intensive care unit admission (4). She is more likely to develop chronic (ongoing) depression and anxiety the longer it continues untreated. It is more likely to increase in its severity and this puts her at greater risk of suicide. In fact, suicide is the leading cause of maternal deaths in New Zealand (5&6)
• The partner is at-risk of developing “partner depression” and their relationship is at-risk of breaking down/divorce the longer her depression is left undiagnosed and untreated (5&6)
• The unborn child is at risk of developing anxiety and cognitive, emotional and behavioural issues (4)
• In the first three years of life, a child to a mother with undiagnosed and untreated postnatal depression is more likely to experience insecure attachment. This means that the child is more at risk of developing learning difficulties, mental illness, addictions, delinquency, and is at greater risk of suicide as a child or later in life (7,8.9)
• Failing to provide prevention and early intervention assessment and recovery services to women at-risk or experiencing Antenatal or Postnatal Depression/Anxiety has a far greater cost to New Zealand than the cost of providing it (10)

We believe that the funding of early intervention services to women at-risk or experiencing Postnatal Depression is imperative and needs to be addressed urgently by designated funding in the 2017 budget.

References:

1. New Zealand Guidelines Group. (2008). Identification of Common Mental Disorders and Management of Depression in Primary Care [ONLINE] Available at: http://www.health.govt.nz
2. Mothers Helpers. (2015). Postnatal Depression in New Zealand and Feedback on Maternal Mental Health Services. [ONLINE] Available at: http://www.mothershelpers.org.nz
3. PANDA (2010). Australian Postnatal Depression Website Recognised As World’s Best . [ONLINE] Available at: http://www.panda.org.au/.
4. Jones, C. J. (2009). Emotional Disturbances During Pregnancy & Postpartum: A National Survey of Australian Midwives & An Educational Resource. Griffith University, Gold Coast.
5. Health Quality and Safety Commission New Zealand (2012). Report finds suicide remains leading cause of maternal death. [ONLINE] Available at: http://www.hqsc.govt.nz/.
6. Best Practice Journal (2009). Purpose and Introduction. [ONLINE] Available at: http://www.bpac.org.nz/.
7. Stein, A., Gath, D. H., Bucher, J., Bond, A., Day, A., Cooper, P. J., (1991). The relationship between post-natal depression and mother-child interaction. British Journal of Psychiatry. 158, 46-52
8. Fergusson, D.M., Horwood, L.J., Lynskey, M.T., (1995). The stability of disruptive childhood behaviors. Journal of Abnormal Child Psychology. 23 (3), pp.379-396
9. Ministry of Health (2012). Healthy Beginnings. [ONLINE] Available at: http://www.health.govt.nz
10. Mothers Helpers (2015). Mothers Helpers' Submission to the Ministry of Health. [ONLINE] Available at: http://www.mcagnz.org