CITY OF WHITTLESEA Perinatal Mental Health Services | 1

KEY MESSAGES

• Theperinatalperiodisthetimeinawoman’slifewhensheismostlikelytoexperienceamentalhealthdisorder.

• TherearesignificantgapsinaccesstomentalhealthservicesintheCityofWhittleseaforwomeninperinatalperiodandnoMotherBabyUnitsorPerinatalEmotionalHealthProgramsfundedintheNorthernGrowthCorridor.

• InvestmentinperinatalservicesintheNorthernGrowthCorridormustbeconsideredasapriority.

• Planningforspecialistperinatalservicesdoesnotcurrentlygiveadequateconsiderationtopopulationgrowth,birthsdata,andpopulationriskfactors.

• TheNorthernHealthcatchmentincludesthreeofthestate’ssixgrowthareas:Hume,WhittleseaandMitchellwhosepopulationispredictedtogrowby17percent(69,000people)inthenextfiveyearsalone,andbyover58percent(morethan228,000people)by2031.1Theageprofileoftheseareasispredominantlyyoungfamiliesandthebirthrateishigh.

• Thedemographicsofthecatchmentarecorrelatedwithahigherriskofpoorermentalhealthoutcomes,includingperinatalhealth.

• Genderimpactstheexperienceofmentalhealthandmentalillness.Domesticviolenceandsexualabusesignificantlyimpactsmentalhealthandwomenhaveincreasedrisktotheirmentalhealthduringpregnancyandfollowingchildbirth.2

• Earlyinterventioninperinatalmentalhealthhasdemonstratedsocialandeconomicbenefits.3(PWCNWMH)

• ReviewsandauditreportsoverthepastdecadehavehighlightedthelackofhealthsystemcapacitytomeettheneedsofyoungfamiliesintheNorthernGrowthCorridor.4,5,6,7,8Thereisnoevidencetosuggesttherehasbeenanyprogresstoaddresstheseservicecapacityissues.

OUR NEW MUMS NEED ACCESS TO PERINATAL MENTAL HEALTH SERVICES

During a pregnancy and the year after giving birth is the time in a women’s life when she is most likely to experience a mental health disorder. Yet despite more than 3000 births in the City of Whittlesea each year, our mums have very little access to perinatal and postnatal services. Urgent government funding is needed to establish these services and support our new mums during this very exciting, but challenging part of their life.

We require urgent government investment to:

Commitment 1. Increase funding for the Perinatal Maternal Health Service at the Northern Hospital and expand the service to provide postnatal follow up beyond six weeks.

Commitment 2. Provide outreach perinatal support services for new parents.

TheyidentifiedsignificantgapsinservicesforwomeninthetransitiontoparenthoodandbarrierstoaccesstherangeofspecialistservicesattheAustinincluding:

• ParentInfantResearchInstitute(PIRI)Evidence-based Programsforparents,• Parentinfantinpatientprogram.

ThenursesalsoreportedlimitedcapacityoftheParentInfantMentalHealthInitiativetoprovidesecondaryconsultationservices.

TheNorthernAreaMentalHealthServiceattheNorthernHospitalhasrecentlyestablishedaPerinatalMentalHealthService.Ithashoweverlimitedfundingandthescopeofitspracticeislimitedtoassessmentandconsultation.ItisasmallteamofConsultantPsychiatrist,PsychiatryRegistrarandaRegisteredNurse.Theyseepeopleasoutpatients(referredfromantenatalclinics)andinpatientonthematernitywards.Duetothelimitedcapacityoftheteamtheyunfortunatelydonotcurrentlyprovidepost-natalfollowupbeyondsixweeks.

TheCommunityOutreachPerinatalSupportService(COPSS)wasacounsellingandsupportprogramfornewandexpectantparentsatriskofmildtomoderateperinataldepression.Theserviceprovidedamixoffacetoface,onlineanddigitalsupportservicestailoredtoindividualneedsandpreferences.EasternMelbournePHNfundingforthisserviceacrosstheEasternandNorthernregionsofMelbournehasrecentlyceasedandavacuumcurrentlyexistsinservices.

MaternalandChildHealthNurseshaveindicatedtheydonothavethespecialistcapacitytosupportwomenwhoareexperiencingmentalhealthcrisisorsuicidalthoughts.TheonlyreferraloptioninthisinstancemaybetheNorthernHospitalEDthebusiestinthestate.1

INVESTMENT IN PERINATAL MENTAL HEALTH HAS PROVEN SOCIAL AND ECONOMIC BENEFITSAreportundertakenbyPricewaterhouseCoopers(PWC)demonstratessignificantcostsavingsfromearlyinterventioninperinataldepression.13ThePerinatalEmotionalHealthProgram(PEHP)withinMaternityServicesatSunshineHospitalidentifieswomenrequiringassessmentandearlyinterventionintheantenatalandpost-partumperiodandprovidesaccessiblementalhealthcare(antenatalanduptooneyearfollowingbirth).Evaluation of Sunshine PEHP demonstrated:

• High Level of Need for the Service• Clinical EffectivenessPreandposttreatmentdatarevealed asignificantclinicalimprovementinpatientsymptoms ofdepression(59percent),anxiety(79percent)andstress (63percent).andareductioninthoughtsofself-harmfrom 48percentto25percent.• Reduced Costs Incurred by the HospitalAveragereduction ofstayby1.7daysstay=saving$2635perpatientperstay or$806,310p.a.basedon306admissionsin2014.16

THE BACKLOG IN HEALTH SERVICES FOR YOUNG FAMILIES IN THE NORTHERN GROWTH CORRIDOR

TheNorthernHealthcatchmentincludesthreeofthestate’ssixgrowthareas:Hume,WhittleseaandMitchellwithpredictedpopulationgrowthof17percent(69,000people)inthenextfiveyears,andover58percent(morethan228,000people)by2031.1Inthe2017ReporttoParliamentEffectively planning for population growth,VAGOidentifiedtheVictorianGovernmentisstrugglingtodeliveradequatehealthservicesforyoungfamiliesinnewgrowthareas,includingMitchellandWhittlesea.5TheindependentTravis Review: Increasing the capacity of the Victorian public hospital system for better patient outcomes—highlighted“hospitalslocatedinthegreenfieldgrowthareashadthelargestgapsbetweendemandandsupplyofhospitalbeds.Thenortherngrowthcorridorhadthelargestgapbetweendemandandsupply.”4

VAGOhighlighteda68percentincreaseinthenumberofbirthsinpublichospitalstowomenresidinginthenortherngrowthcorridor(Whittlesea,MitchellandHumeLGAs)over10years.IncontrastthenumberofbirthsinpublichospitalsacrossVictoriaincreasedbyonly24percent.5IntheirrecentlyreleaseddiscussionpaperGrowing Victoria’s Potential: The opportunities and challenges of Victoria’s population growth,InfrastructureVictoriaacknowledgethegovernmentisstrugglingtodeliveradequatehealthservicesforyoungfamiliesinnewgrowthareas,includingMitchellandWhittlesea.14

2 | CITY OF WHITTLESEA Perinatal Mental Health Services

PERINATAL MENTAL HEALTH

Theperinatalperiod,whichincludesthetimefromconceptiontooneyearpostpartum,isthetimeinawoman’slifewhensheismostlikelytoexperienceamentalhealthdisorder.Perinatalanxietyanddepressionistheresultofbiological,sociologicalandpsychologicalfactors.Itcanbenewinonsetortherecurrenceofapre-existingillness.

Theseproblemshavethepotentialtocauseharmtobothmotherandbaby.Itisimportantthatwomenareprovidedwithaccesstotimely,appropriateservicespost-assessment,ongoingpsychosocialsupportandappropriatetreatments.9

• Depressionisexperiencedbyuptooneintenwomen (10percent)duringpregnancyandoneinsevenwomen (16percent)intheyearfollowingbirth.Theratesof anxietydisordersarelikelytobeevenhigherandmany womenarelikelytoexperiencebothdepressionand anxietydisordersconcurrently.• Severementalillnessessuchasschizophreniaand bipolardisorder,whilstlesscommon,requireintegrated multidisciplinarycareduringtheperinatalperiod.11• Suicideisoneoftheleadingcausesofmaternaldeathsin Australia.10

Alloftheseconditionshavethepotentialtohaveanegativeimpactonmaternalandinfantoutcomes.Thisismorelikelytooccurwhenamentalhealthconditioniscombinedwithseriousormultipleadversepsychosocialcircumstances.11Recognitionandmanagementofpostnataldepressionrequiresacomprehensiveplantoaddressthecompletespectrumofmaternalsocialandpsychologicalhealth,whichwouldincludenotonlydepressionbutalsootherkeyissuessuchasdomesticviolence,drug&alcoholdependenceandeconomicdisadvantage.12

PERINATAL SERVICES AND GAPS KeyrecommendationsfromtheVictorianParliamentaryInquiryintoPerinatalServicesin2018highlightedtheneedforspecialistperinatalmentalhealthservices.MotherandbabyunitshavebeenestablishedinsixhealthservicesacrossmetropolitanandregionalVictoriaforwomenexperiencingseriousmentalillnessintheperinatalperiod.ThesearelocatedatAustinHospital,MonashMedicalCentre,WerribeeMercyHospital,LatrobeRegionalHospital,BallaratHealthServicesandBendigoHealth.Perinatalemotionalhealthprogramsarealsoprovidedbysevenregionalhealthservices.The2017–18StateBudgetsecuredapproximately$6millionongoingfundingforperinatalmentalhealthservicesinVictoria.Thesespecialistservicesarenotaccessibletofamiliesinthenortherngrowthcorridor.ConsultationwithEnhancedMaternalandChildHealthNursesandNorthernAreaMentalHealthService(NAMHS)illustratestheinequityofhealthserviceaccessinthenortherngrowthcorridor,andtheimpactsonlocalfamilies.EnhancedMCHNursesidentifyarangeoffactorsrelatedtothegrowthcontextandindividualfactors,suchasfamilyviolence,poverty,lowEnglishproficiencyandsocialisolationthatcontributetowomen’sandinfant’sriskofpoormentalhealthoutcomes.Perinatalanxietyanddepressionhasbeenshowntoimpactmaternalchildattachmentandcontributetorelationshipstress.

CITY OF WHITTLESEA Perinatal Mental Health Services | 3

1 NH2018,NorthernHealthAnnualReport2017/18 https://www.nh.org.au/wp-content/uploads/2018/09/Northern-Health-Annual-

Report-2017-18-Final.pdf2 DHHS2015Victorias-10-year-mental-health-planhttps://www2.health.vic.gov.

au/about/publications/policiesandguidelines/victorias-10-year-mental-health-plan

4 Travis2015,Travis Review: Increasing the capacity of the Victorian public hospital system for better patient outcomesFinalreport,June2015Retrievedfromhttps://www.bettercare.vic.gov.au/~/media/BetterCare/Files/Resources/Travis%20review

5 VictorianAuditorGeneral’sOffice(VAGO)2017,EffectivelyPlanningforPopulationGrowthhttps://www.audit.vic.gov.au/sites/default/files/2017-08/20170823-Effectively-Planning-for-Population-Growth.pdf

6 VictorianAuditorGeneral’sOffice(VAGO)2019aAccess to Mental Health Services Independent assurance report to ParliamentPPno19,Session2018–19Retrievedfromhttps://www.audit.vic.gov.au/sites/default/files/2019-03/20190321-Mental-Health-Access.pdf

7 Bell,T.,Mendoza,J.,Stretton,A.,andSalvador-Carulla,L.(2018).EMPHN Integrated Mental Health and AOD Service Atlas (East and North East Melbourne) – Final report.ConNetica,SunshineCoastQld.Retrievedfromhttps://www.emphn.org.au/images/uploads/files/20180516-Final-Atlas-Report-EMPHN_July-2018-1.pdf

8 DHHSNorthern GrowthCorridor Services Plan(unpublished)9 RANZCOG2018,MentalHealthCareinthePerinatalPeriodRoyalAustralian

CollegeofRANZCOGhttps://ranzcog.edu.au/RANZCOG_SITE/media/RANZCOG-MEDIA/Women%27s%20Health/Statement%20and%20guidelines/Clinical-Obstetrics/Mental-health-care-in-the-perinatal-period-(C-Obs-48).pdf?ext=.pdf

10 Ellwood2016FactCheck:Is suicide one of the leading causes of maternal death in Australia?https://theconversation.com/factcheck-is-suicide-one-of-the-leading-causes-of-maternal-death-in-australia-65336

11 AustinM-P,HighetNandtheExpertWorkingGroup(2017)Mental Health Care in the Perinatal Period: Australian Clinical Practice Guideline.Melbourne:CentreofPerinatalExcellence.https://www.cope.org.au/wp-content/uploads/2018/05/COPE-Perinatal-MH-Guideline_Final-2018.pdf

12 RANZCOG2018,MentalHealthCareinthePerinatalPeriodRoyalAustralianCollegeofRANZCOGhttps://ranzcog.edu.au/RANZCOG_SITE/media/RANZCOG-MEDIA/Women%27s%20Health/Statement%20and%20guidelines/Clinical-Obstetrics/Mental-health-care-in-the-perinatal-period-(C-Obs-48).pdf?ext=.pdf

13 BeyondBlue2014,Valuing perinatal health The consequences of not treating perinatal depression and anxietyhttps://www.beyondblue.org.au/docs/default-source/8.-perinatal-documents/bw0079-report-valuing-perintal-health.pdf?sfvrsn=2

14 InfrastructureVictoria,2019GrowingVictoria’sPotential:The opportunities and challenges of Victoria’s population growthRetrievedhttps://www.infrastructurevictoria.com.au/wp-content/uploads/2019/04/Growing-Victorias-Potential-April-2019.pdf

15 CrimeStatisticsAgencyVictoria,(CSAV)2018, Family Incident Data for period July 2017-March 2018–customrequest

16 MelbourneHealth2015Implementing a Perinatal Emotional Health Program in a Metropolitan Melbourne Maternity Hospital

https://www.anmfvic.asn.au/~/media/files/anmf/presentations/anmc%202015/2b%20frances%20bilbao%20jenny%20tenni%20nicole%20highet.pdf

POPULATION PROFILE, GROWTH AND BIRTHS.CityofWhittleseahasayoungageprofilewithahigherproportionofchildrenandyoungpeopleandwomenintheperinatalperiod.Thereissignificantculturalandlinguisticdiversity,withalmosthalfofthepopulationoftheCityofWhittleseaspeakingalanguageotherthanEnglishathome(44percent)andmorethanathirdofthepopulationbeingbornoverseas(35.5percent).TheCityofWhittleseahasthesecondlargestpopulationofAboriginalandTorresStraitIslandersinMetropolitanMelbourne.

TheCityofWhittleseahasahighproportionofgroupsatriskofpoormentalhealthoutcomes.Growthareasuburbswithinthemunicipalityattractyoungandlowerincomefamiliesduetohousingaffordabilityissuesininnermetropolitanareas.TheLGAhasoneofthehighestratesoffamilyviolenceintheNorthernMetropolitanRegionofMelbourne(1,428.9per100,000ofpopulation,comparedtoVictoria1,176),andchildrenarerecordedaspresentatamuchhigherratethanothermunicipalities(436.7per100,000ofpopulation,comparedtoVictoria323.2).15

MaternalandchildhealthservicesdatahighlightsthehighproportionofVictorianbabiesbornoverthepastsevenyearsintheCityofWhittlesea

Births 2012/2013 2013/2014 2014/2015 2015/2016 2016/2017 2017/18 2018/19

CityofWhittlesea 3047 3135 3116 3363 3397 3264 3254

Victoria 77197 77427 77668 79336 78407 79010

% 3.95 4.05 4.01 4.24 4.33 4.11

FOR MORE INFORMATION

Michele PurtleSenior Advocacy Advisor

9217 2242 Michele.Purtle@whittlesea.vic.gov.au whittlesea.vic.gov.au

Prepared October 2019