A Review of Maternal Mental Health Support in Canada
Photo by Marcin Jozwiak on Unsplash
Life with a Baby has commissioned Maternal Mental Health: Is Canada Doing Enough?, a review of maternal mental health support across the country.
In her blog on November 23, 2020, Claire Zlobin, founder of Life With a Baby (LWAB) demonstrates concern about the inequity of provision of maternal mental support in Canada. She says, “First, our healthcare system resources are not equally accessible, distributed or even available. What is standard in one province may be entirely unavailable in the next; resources may be abundant in one municipality, while less is offered just a few kilometres away.”
Unable to find the supports she needed during severe postpartum depression, Claire Zlobin built her own peer support group, Life With a Baby, in 2008. The Life With a Baby Foundation Foundation last year commissioned a report by Catriona L. Hippman, PhD., a Certified Generic Counselor, Clinical Assistant Professor of the Faculty of Medicine at UBC, and Research Fellow with the Reproductive & Infant Psychiatry programs at BC Children’s Hospital.
The review used a scoring methodology with a score range of 0-8 based on the following criteria.
· Provincial guideline/strategy/policies in place – 2 points; if no provincial guidelines, check if there are regional guidelines – (1 point)
· If universal perinatal mental health screening is recommended – 1 point
· If there is a published pathway to perinatal mental health care – 1 point
· If perinatal depression screening (not just education) is integrated into prenatal record – 1 point
· If perinatal screening (not just education) is integrated into postpartum record – 1 point
· If specialty perinatal mental health clinical services are publicly available – 1 point
· If there is any evidence of cross-cultural considerations included in perinatal mental health guidelines/resources – 1 point
British Columbia and Saskatchewan were the only provinces/territories to receive a full 8 points. A number of the jurisdictions had scores as low as 1.
British Columbia’s results included:
· Provincial & Regional Guidelines
o Yes. Provincial guidelines last updated in 2014; currently under review for revision.
o All regions were required to create a plan for perinatal care.
· Universal Screening
o Completed Prenatal (28-32 weeks) and Postnatal ( 6-16 weeks) using EPDS.
· Pathways to Care
o Reproductive Mental Health guidelines; included in Perinatal Services BC Maternity Care Pathway.
o Screening at 28-32 weeks using EPDS, with associated recommendations regarding score interpretation, education about postpartum depression (PPD) at multiple time points.
o Maternity care pathway also currently in the process of revision.
· Perinatal Medical History Integration?
o Antepartum clinical path: EPDS, score, date, and follow-up yes/no included in record.
o Postpartum clinical path record: included in Section 3; Maternal assessment – emotional status and mental health, Section 4: education/anticipatory guidance – postpartum blues/depression.
· Specialty Clinical Services
o Yes, including: Ronal McDonald House BC & Yukon program, BC Women’s, St Pau’s, Richmond, Royal Columbian, Surrey Memorial, Victoria General, Kamloops Perinatal Support Services
· Cross-Cultural Considerations
o Aboriginal care guideline co-created with Aboriginal community.
The Yukon, unfortunately, is not as well provided, with a score of 4:
· Provincial & Regional Guidelines
o No, although they might have informally adopted BC’s guidelines.
o Also interestingly, the Yukon Mental Wellness Strategy (2016-2026), published by Yukon Health and Social Services, does include the following in its guiding principles: “We will review and adjust our mental wellness services and supports to ensure a focus on collaborative and integrated delivery and capacity development, and to ensure service delivery across a continuum of promotion, prevention, assessment, intervention, aftercare and self-support throughout the life span. This includes prenatal.”
· Universal Screening
o Yes, by virtue of using BC’s protocols for antenatal and postnatal records.
· Pathways to Care
o Nothing specific to the Yukon, however, adopting BC forms qualifies with the associated guidance information.
o Additionally, postpartum depression is specifically mentioned as a topic for postpartum care provided in home visits by community health nurses: “Each Yukon family will be offered a home visit where a Community Health nurse will come to your home to support you and your new little family. This is a great opportunity to get support with breastfeeding, baby blues, postpartum depression, sleeping, nutrition, growth and development. The nurse will talk about what the next few weeks will look like for a family with a new baby.” In addition to these home visits, Whitehorse Health Center nurses are available to families with new babies by phone call or drop in during regular office hours. The site also has a PPD info sheet for download.
· Perinatal Medical Record Integration
o Yukon uses the same records protocol as BC.
· Specialty Clinical Services
o No – except potentially through psychologist at CMHA Yukon Canadian Mental Health Association, Yukon Division.
o Since closure of Many Rivers Counselling and Support Services (August 2019), access to even non-specialist services has been reduced.
· Cross-Cultural Considerations
o None on record.
The report recommends national coordination: “…we believe there needs to be a Federal focus on creating a national perinatal mental health strategy to address gaps in the framework and execution of maternal mental health prevention, diagnosis, treatment, and support.” The report feels that this should be supported by equipping “provinces with the mandate and funding to design a universal perinatal support strategy in their region”, supported by grassroots action, in a collaborative effort to address the issue: “a top-down, bottom-up” combined strategy.