Perinatal mental health: how to ask and how to help

Abstract

Key content The 2015 Mothers and Babies: Reducing Risk through Audits and Confidential Enquiries (MBRRACE) report states that death from psychiatric disorders is now one of the leading causes of maternal death, surpassing haemorrhage, pre‐eclampsia and genital tract sepsis. Perinatal mental health is stigmatising to women and professionals alike, leading to reluctance to discuss the topic and under‐ or misdiagnosis. Often clinicians may feel apprehensive in broaching the subject for fear of asking questions insensitively or perhaps not knowing what to do with the information divulged. Learning objectives To understand ‘how to ask’ women about mental health: by normalising and raising awareness of perinatal mental health, providing examples of open screening questions, recapping psychiatric history and mental state examination, and performing a risk assessment. To understand ‘how to help’ women with their mental health: by guideline‐driven advice at first contact for mild anxiety and low mood, deciding on level of risk and the direction and urgency of referral. Ethical issues There is no evidence that discussing mental health or suicidal ideation leads to an increased risk of self‐harm or suicide, and in fact it is known to decrease the rate of completed suicide.