Professor Muir Gray
2nd November 2001
Re: Outcomes of Meeting to discuss ‘Screening for Postnatal Depression’
It will not surprise you to be told that the papers circulated following this meeting of the National Screening Committee (NSC) have caused considerable anxiety amongst members of the health visiting profession. As a professional body particularly concerned with the health and wellbeing of children, we are very concerned that this guidance will lead to Health Authorities no longer supporting the development of services for mothers with or at risk of postnatal depression (PND).
In public health terms it is clear that increased resources must be directed at supporting parents at critical stages in their family lifecycle to ensure their children have the opportunities to develop not only physical but also social, emotional and mental wellbeing. Indeed an increasing research base has confirmed the very real impact that ante and postnatal depression can have on children and their families. An impact which could continue to influence children’s mental and social health for the rest of their lives. Experts on attachment, those working in the field of child protection and in child and adolescent mental health widely acknowledge the risks to children when their mothers experience postnatal depression.
In this context, whilst acknowledging and agreeing the findings of the NSC, we must question the recommendation that screening services for PND should not be supported, except in a research context. We expect it to lead to a reduction in the development of better services to support these women, despite the recommendations of the "National Service Framework for Mental Health", "Saving Lives" and "Supporting Families". Rather until we have more research into its use, it may be better to advise that the EPDS is used with care, acknowledging its shortcomings and in conjunction with the clinical interview and professional judgement. This is already recommended by many specialists in the field such as Lynne Murray, Peter Cooper and Sheelah Seeley. Research has demonstrated that clinical judgement (whatever that is) alone results in many cases of PND being missed. However when it is used in conjunction with the EPDS, the detection rate is much higher.
As a professional body, we are actively lobbying for more focused resources for training midwives, health visitors, community psychiatric nurses and general practitioners in the prevention, early detection, and management of PND. We advise a multi-disciplinary strategic approach, utilising a care pathway from the antenatal-booking clinic, through contact with primary, secondary or tertiary services. We would suggest that PND is so complex in its aetiology and has such varying progression that such an approach is a necessity. It would be very disappointing if the current focus on improving services for maternal health were not to continue. Our concern now is that purchasers, faced with supporting services for postnatal depression or some other service will feel justified in putting any development of services for PND on the ‘backburner’ until more research has taken place.
I attach a copy of the proceedings of our recent conference on PND, which I believe are of interest to this debate. I also attach a letter received from the pre and postnatal care team in Trafford, expressing their concerns at the outcome of the meeting of the NSC.
We do feel that further debate is necessary and welcome the intention of the NSC to convene a meeting of interested individuals in the spring. In the light of these comments, we would strongly urge the NSC to reconsider the recommendation to directors of public health regarding the use of the EPDS.