The Big Interview: Dr Alain Gregoire tells VIEW why he campaigns for better maternal mental health services

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Dr Alain Gregoire, chair of the Maternal Mental Health Alliance

Dr Alain Gregoire, chair of the Maternal Mental Health Alliance in the United Kingdom, tells VIEW editor Brian Pelan why the organisation is committed to campaigning for better perinatal mental health services for mothers and infants

Question: Why did you help create the Maternal Mental Health Alliance? (MMHA)?

Answer: It started with just a few corridor conversations with friends and colleagues who were also involved in the field and seemed to me, after 25 to 30 years of working in the field, and in my own little way of trying to get services to develop across the United Kingdom. It occurred to me that the only way we were going to make the rapid progress that women and families needed was to bring together all the organisations involved and speak with one voice and bang the table together so to speak.

Q: What were the biggest challenges you faced?

A: The biggest challenges when we started was that nobody took perinatal mental health seriously apart from people who were already working  in perinatal mental health and sufferers. Our colleagues in mental health services, both adult and child thought this was a trivial marginal issue. Politicians had no interest whatsoever and were not prepared to make any sort of investment. I think we’ve come a long way in achieving things but there’s a lot further to go.

Q: What are the links between mums who are depressed during pregnancy and the future development of their children?

A: This is obviously a really sensitive issue because an inevitable aspect of parenting is that one is desperate to do the best possible job for one’s children and one inevitably feels guilty about the slightest thing that we get wrong. It’s an inevitably that during the most difficult job we ever do, we do get things wrong and there is a pervasive stigmatised attitude towards mental health that it’s somehow our fault if we have a mental health problem. Statistically speaking there’s no doubt there’s an impact. Individually there are so many other factors that come into play… it’s by no means inevitable, but the risk is increased of children having emotional behavioural, intellectual, learning challenges as they grow up, and it’s certain that parental mental health problems are associated with a higher risk of mental health problems in older children.

Q: What are the economic costs of perinatal mental illness?

A: The London School of Economics  conducted a study in 2014 which we commissioned from them using money from Comic Relief. What they found was the cost to the public purse was about £8.1 billion for each
one-year cohort of births in the UK.

Q: Is the work of the MMHA aimed at improving mental  wellbeing for future generations?

A: Absolutely. Perinatal mental health is about the health and wellbeing of mother but also the rest of the family and in  particular, the relationship between the mother and the baby. The infant is at that very young age where they are completely dependent on their wellbeing and their development, both mentally and physically, on their primary care giver, which usually in our society is mum, jointly sometimes with other parties, and obviously dads are important to this. Research is telling us, study after study, that this intergenerational effect of mental health in parents is one that passes not just across one generation but across several generations because of course their child may become a parent and their child is likely to be at somewhat greater risk of mental health problems, and that will impact on their children. So we have an opportunity here to break a cycle that has existed as far back as humans have existed. For the first time we have this unbelievably important knowledge, and we have the responsibility for future generations to act on it, and act on it now.

Q: Are Scandinavian countries much better at funding and supporting perinatal mental health services?

A: It’s not quite fair to say that Scandinavian countries have a better approach to perinatal mental health care. What they undoubtedly invest in generally is support for parents. That’s slightly different. Their support to parents is undoubtedly a greater investment than we make in this country and of course that overlaps with mental health care around this very critical time at the very beginning of parenthood and motherhood. Investing in supporting parents will have an impact on mental health. What we’re calling for specifically is improvements in the mental health care that women get from health services. Of course we also want to see better support for parents because that will have an impact, but that is a wider social issue than just healthcare that reaches into areas of government policy which include benefits, child support, housing, local authority responsibilities, and the protection of children. We do very badly compared to Scandinavian countries across those areas of social policy.

Q: What effects has the policy of austerity had on maternal mental health provision?

A:Undoubtedly austerity has had an impact on the NHS, particularly on expenditure in public health services and family health services. I’ve seen the figures for dramatic closure in children’s health centres and in health centre numbers. The impact of austerity has also affected the health service, even though the NHS is supposedly protected in real terms. Of course, the funding is static or decreasing when you take into account health inflation. When it comes to perinatal mental health services in England there’s actually been an increase in funding, partly as a result of our campaigning and the increase in awareness by politicians of the importance of this field. But in other areas of care which aren’t specialised perinatal services, professionals in services are really struggling to give the support to women that they need, and it’s very clear that women aren’t getting the care in most parts of the country that is defined as standard quality care by bodies such as the National Institute for Health and Care Excellence.

Q: Are women frightened to report mental health issues?

A: Yes. Right across the board, women are reluctant to talk about mental health problems, partly to do with the negative attitude towards mental health problems. It’s still commonplace in our society for people to perceive those with mental health problems as being somehow weak. We have these myths around mental health which makes it difficult for people to put their hand up and say ‘I’ve got a mental health problem’, but that is happening increasingly and slowly chipping way at those frankly damaging and harmful perceptions and views. And particularly in the perinatal period when there’s a young baby around, it’s very common for women with mental health problems to have fears about how they’re functioning as a parent, and how good a mum they are. They’re overly critical and they believe very commonly that other people will be critical of their parenting and will believe that they’re a bad mother, just as they often do, and in extreme cases that someone will come and take their baby away. The result of this is that the majority of women – seven out of 10 who are depressed – are reluctant to come forward, so that has got to change.

Q: What do you think of the situation in Northern Ireland, that apart from the Belfast Trust, that there are no Specialist Community Perinatal Mental Health Teams or that there is no mother and baby unit on the whole island of Ireland?

A: It’s utterly scandalous. In Northern Ireland, it can’t get worse. It can only get better, so how can you be anything but optimistic. And frankly it was the action of women that transformed living in Northern Ireland not that many years ago, and I think the women of Northern Ireland are a formidable force, and if they decide that they want to ensure there is better mental health care at the most important time in their lives, they will get it.

Q: Finally, are you optimistic or pessimistic about the MMHA campaign to improve maternal mental health services for mothers and infants?

A: I am completely optimistic. I’m a patient man, I can hang on, even though I think it should happen now.



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