Perinatal Mental Health: Opportunities and Challenges for Psychiatry

Abstract

Objective: Developments in public mental health policy in Australia and a renewed focus on the preventative importance of the early postnatal years have recently brought perinatal mental health to the fore. The present paper aims to explore the meaning of ‘perinatal mental health’ and its relevance to psychiatry, and to examine the opportunities and challenges currently facing Australian psychiatrists in the provision of services in the perinatal period. Methods: The definition of ‘perinatal mental health’ is discussed and the impact of maternal mental illness arising in the ‘perinatal’ period on offspring outcomes and early intervention endeavours are reviewed. Recent Australian developments in public health policy are outlined. Results: The use of the term ‘perinatal’ highlights the importance of considering the mental health needs of both parents and infants from conception and through the developmentally critical first 2 years of life. The relevance of a perinatal approach is supported by a literature demonstrating that maternal mental illness arising at this time can adversely affect offspring mental health outcomes. Early intervention programmes targeted at well-defined ‘high risk’ families in the perinatal period may be of value in terms of reducing this morbidity but remain to be replicated. Although the 2nd National Mental Health Plan and other recent Australian health policy initiatives support the belief that good mental health care in the perinatal period is critical to the mental health of future generations, such care provision remains fragmented and often difficult to access. Innovative developments in public health policy and models of service provision are beginning to address these shortcomings. Conclusions: An understanding of the conceptual and empirical underpinnings of ‘perinatal mental health’ is essential if there is to be a shift towards an integrated approach to mental health service provision and better access for vulnerable families at this time. As psychiatrists, we have much to contribute to early identification and intervention strategies and the integration of these services with those provided by primary health-care professionals in the perinatal period.