Towards a National Perinatal Mental Health Strategy – Call to Action

The Canadian Perinatal Mental Health Collaborative – National Coalition is calling on the federal government to introduce a Bill in the House of Commons to support the development a National Perinatal Mental Health Strategy.

The National Coalition is a united group of perinatal mental health advocates including individuals with lived experience and their families, clinicians, researchers, non profit, charity, and private sector organizations.

By bringing together the voices of all Canadians, the National Perinatal Mental Health Strategy would accelerate action on the federal government’s commitment to ensuring timely access to perinatal mental health services.

Unlike the United Kingdom, Australia, and the US, Canada does not have a comprehensive national strategy to guide how health care practitioners should assess, diagnose, treat, and provide follow-up to individuals suffering from perinatal mental illness. 

Perinatal mental illness is the most common disorder affecting pregnant and postpartum people affecting 1 in 4 birthing persons yet only 1 in 10 of those affected have access to evidence-based treatment in Canada. Suicide is the 4th leading cause of maternal death in Canada. Children of untreated individuals have a higher risk of developing a mental health disorder perpetuating the cycle of mental illness.

Common barriers to perinatal mental health care include stigma, lack of training and lack of timely access to equitable and culturally-appropriate services.

95% of health care providers in Canada surveyed report perinatal mental health services in Canada to be inadequate.

The cost of not effectively treating people with perinatal mental illness is $3 billion annually in Canada.

Programs and policies in Canada have not kept up with best practices, research, or the overarching science. Services currently available to those experiencing a perinatal mental illness in Canada are largely inadequate.

Addressing the psychosocial needs of families to enhance ongoing mental, maternal and child health disparities is a major public health issue. 

There is a need for a national strategy to ensure Canadians are receiving timely access to diagnosis and treatment as recommended by clinical practice guidelines. 

Background:

• Perinatal mental illness refers to the range of issues a birthing person or partner can face during pregnancy and in the year after giving birth. This includes prenatal and/or postpartum anxiety, depression, post traumatic stress disorder, panic disorder, obsessive compulsive disorder, bipolar disorder, and psychosis.

• The Government of Canada’s 2018/2019 survey on Maternal Mental Health showed that an average of 23% of Canadian women experienced postpartum depression alone. 

• Indigenous mothers are 20% more likely to suffer from prenatal and postpartum depression than white, Caucasian mothers in Canada. 

• In the US, 40% of Black mothers will suffer from postpartum depression and Black mothers are four times more at risk of maternal mortality than white mothers. Ten percent of fathers experience perinatal mental health issues.

Impact:

• Perinatal mental illness can have dire consequences across the family. Untreated perinatal mental health issues can lead to chronic depression. Suicide is the 4th leading cause of maternal death in Canada. 

• Maternal mental health is the single greatest determinant of a child’s health over the life course. Perinatal mental illness negatively impacts parental-infant attachment and can impair the child’s cognitive and psychosocial development. 

• The risk factors of perinatal mental illness are well understood. Early intervention at the pregnancy stage can prevent the onset of postpartum depression and anxiety. With the right treatment and support, perinatal mental illness is curable. Low-intensity interventions such as cognitive behavioural therapy (CBT) are highly effective for mild to moderate issues. Medication and psychotherapy can resolve even the most severe cases.

What Health Care Providers Are Saying: 

• With the goal to learn about screening and treatment practices across Canada to identify gaps as well as what’s working in different jurisdictions, the CPMHC created a first-of-its-kind national online survey (reviewed and approved by the Conjoint Faculties Research Ethics Board [CFREB] at the University of Calgary) to understand the state of perinatal mental health care in Canada. Four hundred and thirty-five health care practitioners participated.

CPMHC Survey Findings:

• 95.8% of health care practitioners believe that perinatal mental health services are insufficient in Canada.  
• 87% of health care practitioners in Canada do not have mandated screening for perinatal mental illness at their workplace. 
• When people are screened and have symptoms indicative of needing intervention, 27% of health care practitioners indicated that patients were able to access their referral within a month, 31% waited between 1-2 months, while 42% had to wait for >2 months for access. 
• Perinatal mental health services differ across health regions. More than half of health care practitioners surveyed (57.3%) reported that they have not received specialized training in perinatal mental health or were unsure if they received specialized training. 
• 87% of practitioners believe people from diverse backgrounds encounter barriers to accessing perinatal services. These include language, cultural and cost barriers. 
• 69% of practitioners reported that COVID-19 has complicated access to care, including reduced in-person visits and overall services.

• In Recommendations 18 and 19 of its 2021 Police Brief: COVID-19 and Early Childhood Mental Health: Fostering Systems Change and Resilience, the Mental Health Commission of Canada and the Canadian Paediatric Society recommend policy and decision makers “conduct an SGBA+ of gaps in perinatal mental health, health, and social services, ensuring long-term follow up, virtual service, and in-person service coverage that works and is culturally appropriate” and that they “utilize gaps in perinatal mental health coverage as a basis for action and for systems and quality improvement on the impending national perinatal mental health strategy.” The Policy Brief was reviewed by the Canadian Academy of Child and Adolescent Psychiatry, and the Public Health Agency of Canada.

The survey findings underscore a critical need for a National Perinatal Mental Health Strategy to address gaps in case identification and treatment. The CPMHC – National Coalition is calling on the government to work with key stakeholders to develop a strategy that ensures accessible and culturally safe treatment of people experiencing perinatal mental illness.