Back in June 2011 I was employed as a perinatal mental health nurse, and was working in partnership with midwives, child health nurses, GPs, Indigenous health workers, allied health staff and obstetricians to provide and develop easy, smooth pathways to mental health care for pregnant women and new mums who needed a bit of extra support.
At the time I was invited to submit this article to O&G Magazine regarding perinatal mental health.
One of the closing paragraphs of the article was this:
It would be fair to say that availability of specialist perinatal mental health service in Australia has been patchy. In some health districts, perinatal mental health services have evolved without specific funding, often emerging as a component of consultation liaison mental health. However, until recently there hasn’t been a coordinated approach to perinatal mental health at a national level. This should be addressed, in part at least, by Federal, State and Territory Governments using National Perinatal Depression Initiative funding to seed specific services and models of service delivery at various urban and regional centres. In Queensland, for example, there will a dozen or so ‘perinatal mental health clinical nurse consultants’ seeded in a number of strategic locations around the state, with the hope/intent of developing sustainable referral pathways and contributing to workforce training and development in this area.
Boy, did I get that wrong.
There were a dozen or so perinatal mental health clinical nurse consultants in Queensland Health up until June 2013. Now there are three: two on the northern side of Brisbane and one in Toowoomba. Apparently (if the grapevine is correct) there are funded perinatal mental health positions in Townsville and Gold Coast too, it’s just that they’re both empty at the moment. That leaves two out of sixteen Queensland Hospital and Health Services currently with access to a perinatal mental health nurse.
This is just as I feared back in March 2013 (see: The National Perinatal Depression Initiative and a Canary in a Coal Mine?).
For the many health districts that have lost the specialist perinatal mental health nurse, the only alternative is to ask the woman to use phone support or see their GP instead.
But there are problems with both the phone support and the GP option.
Look, I have nothing but admiration for GPs – they’re at the frontline of primary health care and tend to be a very versatile bunch. But, let’s face it: most GPs are as busy as a one-armed Sydney taxi-driver with an ice-cream and an itch. It’s a big ask for the GP and the pregnant woman/new mum to make the time and head space available for ventilating, understanding and re-packaging strong emotions.
When I’m meeting with somebody who is experiencing symptoms of depression, anxiety or other mental health difficulties, it usually takes me an hour or so to feel that I have provided an outlet for the distress, and gained an understanding of what strategies and services we should use to support the person.
Maybe I have just have slow ears.
Maybe GPs can hear, understand and sensitively respond to those complex stories of loss, grief, trauma and unmet expectations quicker than I can.
Or maybe, just maybe, the families that have lost easy access to a specialist perinatal mental health nurse have lost easy access to support.
In a cruel double-whammy, at the same time perinatal mental health nurse positions in Queensland were disappearing, the national perinatal mental health telephone support line was also becoming less accessible. Since midway through 2013 PANDA’s National Perinatal Depression Helpline has had to cut-back on available hours to 10:00am to 5:00pm Monday to Friday. This time last year it was 9:00am to 9:00pm Monday to Friday. Earlier this year the Million Mums in May campaign was hoping to get funding for PANDA to offer a 24 hour, 7 day-per-week service.
When perinatal mental health services on the ground are being cut in various places around the country, wouldn’t that be a good time to expand and promote the accessibility of the national helpline? Unfortunately, the opposite has occurred.
It is not all doom and gloom: if parents live within cooee of a St John of God Raphael Centre or near of the long-established state-run perinatal mental health services (usually in capital cities), access to support is still pretty good.
However, coverage is patchy: Australia’s “National” Perinatal Depression Initiative is anything but national. The “national” part is a myth.
Access to specialist perinatal mental health services in Australia is a postcode lottery and, as with all lotteries, there are a lot of losing tickets.
As always, your feedback and comments are welcome below.
As there have been no formal announcements/media releases about perinatal mental health services contracting, I have had to rely on first-hand knowledge and, to a lesser extent, hearsay via “the grapevine”.
If there any factual errors as at November 2013 please let me know. Naturally, i would like to make any necessary correction(s) as soon as practical.
Paul McNamara, 28th November 2013
Thank you for bringing the public’s attention to this absolute crisis of mental health funding.
Thanks for raising this important issue for families at a foundational time in their life stage. As we know Perinatal Mental Illness (or distress) affects everyone in the family. Here in Victoria the Perinatal Emotional Health Program (PEHP) programs (originally funded under the NPDI) are still on quarterly funding commitments as I understand it. In Geelong we have great GPs but as mentioned they are very busy but usually refer to PIMH services for the specialised counselling/ debriefing and even more thorough assessments required to unravel exactly what might be going on for families. The community are lucky to have both a PEHP service and a Raphael Centre here in Geelong but I can assure readers both of these services are very busy. I know some families also access the PANDA helpline so it is a shame to hear the hours have been cut back. Keep up the good work Paul in raising the profile of the need and hopefully drawing it to the attention of those who have the power to make the necessary funding decisions.
In a grim postscript to the above, it has been announced that Australia’s federal government is pulling funding from the NPDI: