Wide disparities: why black mothers are at greater risk of perinatal mental illness in England

Perinatal mental illness affects almost a third (27%) of new and expectant mothers in England and covers a range of conditions including postnatal depression and postnatal psychosis. A Guardian analysis of NHS figures has shown that for cases of perinatal mental illness resulting in hospital admissions, black patients are more than twice as likely to be admitted as their white counterparts.

Part of the reason black mothers are at higher risk for perinatal mental illness is because black people are at higher risk for mental illness in general.

In England, black people are more than four times more likely to be detained under the Mental Health Act and more than 10 times more likely to be subject to a community treatment order.

Dr Lade Smith, president of the Royal College of Psychiatrists, said this was because factors such as poverty, housing insecurity and discrimination increase the likelihood of all mental disorders.

He added: If you’re black, you’re at greater risk of social disadvantage and that means you’re also more likely to have a mental illness.

Sandra Igwe, founder of the Motherhood Group, an organization dedicated to supporting black maternal health, said stigmas surrounding mental health, as well as racism, could play a role in the disparity.

The Motherhood Group hosts support groups, workshops and works with NHS trusts to provide cultural competence training for Black maternal health care.

Many of the mothers we work with have shared how they often feel invisible, unheard and misunderstood by health care providers, Igwe said. There can be cultural stigmas surrounding mental health that make it difficult to seek help.

Black women also disproportionately experience stressors such as the weight of systemic racism. All of this adds to the already overwhelming transition to motherhood.

There also needs to be more open and honest dialogue to break down the stigmas that persist in our communities. We need to normalize talking about maternal mental health and seeking help. Black mothers should feel empowered and supported, not ashamed and alone.

Dr Katie Marwick, senior clinical researcher at the University of Edinburgh and honorary consultant psychiatrist at NHS Lothian, whose research areas include perinatal mental illness and psychiatry, said the increased frequency of admissions to black women within six weeks of giving birth was driven by stigma. but also the fact that women from ethnic minority backgrounds are less likely to access community perinatal services and are therefore more likely to present at a time of crisis.

It is well established that psychotic disorders are more common in people who have immigrated to Europe, or their children, particularly black people, Marwick said.

This does not reflect an increased risk of psychosis in people of this ethnicity wherever they live, it has to do with the change of country and may be driven by language barriers and social disadvantage. Although the perinatal period has been understudied to date, it is plausible that there is also an increased risk of psychotic illness for Black women during this time period.

He added that this could be due to access to services. Ethnic minority women may not be aware of services or avoid accessing them and this is sometimes linked to experiencing negative attitudes or cultural insensitivity from professionals and feeling dismissed, she said.

All of these factors could cause women to present later to services with more severe symptoms.

Dr Nicole Votruba, senior researcher at Nuffield’s Department of Women’s and Reproductive Health, said the research showed that large disparities persisted between women from minority ethnic groups in accessing and receiving mental health care perinatal in the UK, and which may be related to socio-economic factors. and the stigma.

She added: Stigma is a major barrier, meaning women may not be able to seek or receive the support they need, or not in the way they need it. For example, women may be afraid to disclose their mental health struggles for fear of appearing incompetent as a mother. And socio-economic inequalities and cultural and language barriers often reinforce the gap in mental health care for women from minority ethnic groups.

The Women’s Health Strategy for England has highlighted the need to tackle these inequalities. We need to better understand what is happening in a woman’s journey from the onset of her mental health problems to her admission to hospital.

How can we support women from ethnic minority groups to access perinatal mental health care in their communities? How can we develop community services that are culturally sensitive, to support women early and help prevent the onset of more serious perinatal mental illness.