The National Perinatal Depression Initiative and a Canary in a Coal Mine?

Author’s Statement of the Obvious Clarification

As mentioned previously (here & here) I do not represent any organisation(s) on this website. See the lack of organisational branding? That’s the clue. This website is part of my professional use of social media, as defined here. I have read and respect the social media guidelines specifically for Australian nurses (here & here). This website is informed by the Mindframe guidelines (here). Unusually for this website, specific workplace events will be mentioned in this post. Naturally, no attacks are made on people, procedures or policies – that would be stupid and rude. This post just collates some info that a lot of people already know regarding a specific clinical/educative role, and adds an opinion on the value of continuing that role. I’m not revealing secret nuclear launch codes or anything.

Weird Week at Work

urlOn Friday 1st March I was advised that the perinatal mental health role I currently work in would be discontinued at the end of the month. It wasn’t about me/my performance: the service is going though a major restructure that includes the loss of many positions.

Letting people know that the position was closing down was an important first step. There was a lot of disappointment expressed by the referrers (midwives, child health nurses, social workers, psychologists, GPs and obstetricians) and the referred (pregnant women and new mums). Expectations and referral pathways needed to be re-orientated as soon as possible.

Naturally, I was disappointed too. I’m lucky though – losing the position didn’t mean I was becoming unemployed. I could return to my old job in mental health consultation liaison [“What’s that?”, you ask. Think “general hospital mental health”. More about that in a future blog].

urlDuring the week I kept mimicking cricketer Jason Gillespie’s response after he was dropped from the Australian Test Team; in a TV interview he deadpanned, “At least I have my other career to fall-back on: pizza delivery.”

Then, late in the afternoon on Friday 8th March, I was told the decision to abolish the position had been reversed. I have no idea about any of the behind-the-scenes negotiations that went on and, as an ongoing employee, am not really in a position to speculate. That said, it would be rude not to acknowledge the support the position has received from heaps of people both locally and further-afield, including Kaylene Turnbull of the Queensland Nurses Union.

Canary in a Coal Mine?

However, I do wonder how boisterous celebrations about the position receiving a reprieve should be. When the loss of the position was announced I had the dreadful feeling (dreadful as in full of dread) that this resource reduction was like the canary in a coal mine for an Australia-wide health initiative. There are dozens of mental health nurse positions dotted around the country that face uncertainty about funding via the National Perinatal Depression Initiative1 (NPDI) beyond June 30th.

Nobody I’ve spoken to knows whether established services catering for the mental health needs of pregnant women, new mums, and their families will remain in existence beyond the current financial year.

Nurses can generally pick-up work, so don’t worry too much about us – we’re a fairly resilient bunch.

What worries me is whether the established services that provide a proactive approach to perinatal mental health will survive. This is a model of care that has been facilitated often (not exclusively) by mental health nurses under the NPDI.

National Perinatal Depression Initiative (NPDI)

Under NPDI funding mental health nurses have played a very significant role in providing direct clinical support to pregnant women and new mothers (examples herehere). Although certainly not the only profession contributing to perinatal mental health services, mental health nurses are the largest cohort of clinical service providers in this speciality. Added to that, mental health nurses have contributed to community awareness and destigmatisation activities (example here), and research and data collection (example here). These mental health nurses also promote the value of routine, universal screening, and educate, support and build the mental health skills and capacity of other clinicians such as GPs, Midwives, Child Health Nurses and Obstetricians (example here). All of these roles that mental health nurses have contributed to are in keeping with the objectives of the NPDI.

NPDIobjectives.001-001

If we support mum we’re also supporting baby. We get ‘two for the price of one’. To reinforce this financial argument, a Deloitte Access Economics report2 estimated that perinatal depression cost the Australian economy around $430 million in 2012. Furthermore, a report3 launched by the Minister for Mental Health, Mark Butler, during postnatal depression week4 revealed that not treating perinatal depression and anxiety would add an additional $500 million to Australia’s financial burden.

However, the real costs are more poignant, more important, than the costs measured in dollar terms. Conditions like depression and anxiety can rob parents of some of the joy of having a baby, and sometimes rob babies of the comfort of having parents who can fully engage with them as they develop in those crucial early months of life. Saddest of all is the ultimate cost: a Queensland report5 has revealed that suicide is the most prominent cause of death in women who died more that 42 days and less than one year after giving birth.

I am proud to be one of the many Australian mental health nurses who have been developing services and supports to prevent these enormous costs, and meet the objectives of the NPDI. I can’t think of a single reason for discontinuing any of these important mental health nursing positions. In fact, it would be great to have a few more resources available so we could reach-out to dads and Aboriginal and Torres Strait Islander families a bit better than we already do.

Sharing these personal reflections online isn’t because I’m looking for a job – like Jason Gillespie I have one to fall back on. This blog post is simply about promoting mental health nursing’s contribution to the success of Australia’s National Perinatal Depression Initiative, with the hope that it will be extended and expanded beyond June 30th.

Please Note

Talking and thinking about suicide can be distressing. Australians can access support via:

Lifeline – 13 11 14
Suicide Call Back Service – 1300 659 467
MindHealthConnect www.mindhealthconnect.org.au

phone_hotline-40Outside of Australia and not sure where to get support? Google usually displays a red telephone icon and your country’s suicide support phone number when searching for a suicide-related topic.

 References/More Info

1. National Perinatal Depression Initiative

http://www.health.gov.au/internet/main/publishing.nsf/content/mental-perinat

2. Deloitte Access Economics report

http://www.panda.org.au/images/stories/PDFs/PANDA_Exec_Summ_Deloitte_Web.pdf

3. Price Waterhouse Cooper report

http://twitdoc.com/upload/meta4rn/bb.pdf

4. Mark Butler media release

http://www.beyondblue.org.au/index.aspx?link_id=105.1441&tmp=FileDownload&fid=2545

5. Queensland Maternal and Perinatal Quality Council Report 2011:

http://realchoices.org.au/wp-content/uploads/2012/05/QLD-report-2011.pdf

Paul McNamara, 10th March 2013

8 thoughts on “The National Perinatal Depression Initiative and a Canary in a Coal Mine?

  1. Julie Ferguson

    What a great blog Paul and so true. The other important aspect of the work we do is also to help mothers be available to their other children and help repair the often damaged relationships because of earlier episodes of depression. Their is a great paper by Andre Greeb a French psychoanalyst about “The dead Mother”. His talks about the long term impact of a child losing their mother to depression and how hard it is to reconnect with her even once she is well without a supportive therapeutic intervention. We are not just working with mother’s and their babies we are helping reduce the loing term effects of depression in the perinatal period for the whole family.
    Coninue on the great work we should all be passionately trying to save these important positions for the long term health of our nation.
    Best wishes,
    Julie Ferguson NP Perinatal & Infant Mental health

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  2. Shirley

    Paul, I’m pleased that you will continue to keep your position. It really is concerning that these positions are at risk . So many people need extra support during the perinatal phase, crucial to have services available.We only touch the tip of the iceberg as it is, reducing services would be stepping back.into the past

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  3. Susan Fleming

    Dear Paul, that’s promising news and I’m sure credit should go to you for your tireless work and support in this area. Regards Susan.

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  4. tiffzimmermann (RN/RM)

    Perinatal mental health nurses are vitally important… we are fortunate that we have Helen Mayo House in SA, and the hospital which I work at has perinatal mental health nurse-midwifes (yes, you heard it, midwives who are also mental health nurses employed as part of the maternity service)… but in FNQ these services are lacking, and the need for perinatal mental health nurses vital to ensure the best possible outcomes for women and their babies… Fingers crossed that this essential service stays (and expands!).

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  5. Pingback: Thinking Health Communication? Think Mobile. | meta4RN

  6. Paul McNamara Post author

    A belated postscript: on 1st July 2013 about eight Perinatal Mental Health Nurse positions in Queensland were dissolved. This included the Perinatal Mental Health Nurse position hosted by the Cairns and Hinterland Hospital and Health Service (ie: the role I was in).

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  7. missywombat (@missywombat)

    Paul, I’m sorry to hear of all of those lost positions. Our team in the NT is hanging on but we have no idea what our future is. The sad thing is if we are forced to disband we actually lose a tiny team that has done an awful lot of good at relatively little expense. My Perinatal MH work is the most rewarding and effective work I have ever done as a doctor. It would be a terrible shame to lose that.

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