60.In the previous chapter we looked at the experience of becoming a new parent during the pandemic, and the loss of much of the support which is available to new parents. While becoming a parent should be a wonderful experience, it is also an enormously challenging one. The added complications of becoming a new parent under the current exceptional circumstances inevitably has consequences for parental mental health. We consider these issues, and what the Government can do to better support new parents, below.
61.According to the Royal College of Psychiatrists (RCPsych), around 10–15 in every 100 women are affected by depression and anxiety during pregnancy, with the same prevalence of women experiencing postnatal depression. Suicide is the leading cause of death for new mothers in the year after birth. Around 1 in every 1,000 women experiences postpartum psychosis, the most serious type of mental illness experienced after childbirth. Postnatal depression can also affect partners. At least 1 in 20 fathers suffered significant psychological distress at some point in their baby’s first year. Among the causes of postnatal depression listed by the NHS are having no close family or friends to support you and recent stressful life events.
62.The perinatal period can be extremely important for mothers and babies. The Royal College of Psychiatrists states that:
Poorly managed perinatal mental health problems can have lasting effects on maternal self-esteem, partner and family relationships, and the mental health and social adjustment of the child. […] Perinatal psychiatric disorder is also associated with an increased risk to both mortality and morbidity in mother and child.
Health services to support mothers with postnatal depression include specialised inpatient mother and baby units, specialised perinatal Community Mental Health Teams (CMHTs), maternity liaison services, adult mental health services including admission wards, community and crisis services, and clinical psychology services linked to maternity services.
63.Among the thousands of new parents from whom we heard, many spoke about the increased financial pressures that they found themselves in as a result of Covid-19. New parents plan their parental leave carefully to ensure that they can afford to take time off with their new child. In Chapter 2 we discussed the difficulties that parents can face affording to live on their statutory pay and the unpaid portion of their leave entitlement. Many parents have found this now impossible with some losing household income because of partners being placed on furlough or losing their jobs all together. Many also no longer have job security at the end of their leave. Dr Trudi Seneviratne, of the Royal College of Psychiatrists’ Faculty of Perinatal Psychiatry, told us that these concerns “feed into developing depression and anxiety”, but that mothers experiencing these problems are managed by primary care providers rather than engaging with dedicated mental health professionals. While improving mental health provision is one tool that could be used to support those who face this challenge, securing and improving the financial security of parents would, to Dr Seneviratne, be “welcome”. We appreciate that Covid-19 has hit many people financially, but the added stress for new parents at what is already a challenging time is clearly exacerbating mental health problems among new parents. One new mother told us:
I’m a first time Mum on maternity leave. My husband was made redundant 3 weeks ago, which whilst it’s lovely to spend quality time together as a new little family; the impact of Coronavirus and his future job outlook will mean that I may have to cut my maternity leave short, getting even less time to spend and bond with my son. The quality time together that I had envisioned going to baby groups and my son enjoying time with our family also hasn’t been possible as a result of the lockdown.
Another mother told us:
My maternity leave has been completely robbed off me and now to make things worse I’m also being told I could have no job to return to due to being made redundant. Worrying how I’m going to afford rent and bills.
64.We’ve heard from many parents who feel that the important one-to-one bonding time with their newborns or new child has been seriously affected due to the lack of childcare, formal or informal, for their other children. We’ve also heard from many struggling to adjust to life with a newborn or newly adopted child and all the challenges that come with that, as well as trying to home school others. Dr Alain Gregoire told us that mothers with more than three children were already at higher risk of mental health problems. One mother told us:
I’m having to home school my other two who are 12 and 7, this is taking the time away from my baby. In order for me to be able to home school I have had to give up breastfeeding. It was impossible to establish breastfeeding at the start as my other two children needed me to help them with work and other activities in the day meaning I didn’t have time to sit and cluster feed my baby, so he could establish my milk supply. This has made me deal with high anxiety and low moods as I feel I was forced to put him on formula so I could make sure my children are getting the support they needed.[…]. I feel like my maternity has been ruined and the one to one time I should have had with my baby is gone. This makes it very hard to bond with my baby as I feel I have let him down already.
Teaching children is a full-time job. Trying to do this on top of caring for a newborn is clearly putting a huge strain on many of the parents we heard from.
65.We heard how many of the important mental health services for pregnant and new mothers had not been available in the usual way during the lockdown. Dr Seneviratne also told us that even though services were trying very hard, women did not have the right level of support from both antenatal and postnatal services. The Institute for Health Visiting told us how the lockdown had imposed a level of isolation from sources of support and therefore exacerbated the ‘normal’ challenges of parenting. Dr Alain Gregoire told us:
[Becoming a new parent] is a time when we mentally struggle more than at any other time; it is also a time when the impact of those mental health difficulties is greater than at any other time in our lives, not just on us as individuals, but on the next generation. The level of support that is available is great, from all sectors—from healthcare, social care and the charitable sector—but all of those, particularly with Covid, are suffering enormously. Face-to-face support and sensitive, timely support is really important, and that has been seriously affected at the same time as the need has more than doubled.
A mother told us:
I’m a first-time mum, struggling with anxiety and depression. I was having bonding and socialisation difficulty with my baby and I and was attending group therapy which understandably had to be stopped, but my mental health has taken a decline since, despite phone consultations. I was getting much needed support in caring for myself and my baby which I feel is now gone, as a phone call is no real replacement. I grieve for the loss of this as I had gotten so much better and have declined again due to this lockdown.
Another new mother told us:
I am isolated with my baby. I am not able to attend any baby groups and classes […] [or] make [friends] with other parents which is important for support. My mental health has suffered, and I have not been able to seek support for postnatal depression as I would have done if there was not a lockdown. As a result, my mental health has got worse and I am concerned about going back to work without the time to fully recover with the support I need.
66.We’ve heard extremely concerning evidence that a tsunami of mental health referrals could be on their way as a result of Covid-19. The very specific challenges and isolation that new parents have experienced as a result of Covid-19 have very likely had a very serious impact on parental mental health. It is too soon to have empirical data to demonstrate the adverse effect on the mental health of new parents and their children, and we fear that it will come too late. We have however heard powerful evidence from those on the front line, and from the thousands of parents who contacted us, that the impact on the mental health of new parents is unprecedented. Dr Alain Gregoire told us that the Maternal Mental Health Alliance have reported “an enormous increase” in mental health problems among pregnant women and new mothers. In an unpublished survey of women using a pregnancy and post-natal app, he said that 60% of new mothers and 50% of pregnant women said that they were “a lot more anxious” than they would expect to be. Dr Gregoire said that this is more than double what they would normally expect.
Dr Seneviratne told us that colleagues across the country were reporting an increase in anxiety in both pregnant mothers and new parents. She told us:
We are worried that a tsunami of referrals for mental health difficulties may be on the way—that at the moment, people are perhaps in isolation and not presenting with their mental health problems, but more will be on the way.
Dr Cheryll Adams also told us that health visitors were reporting more depression among new mothers. She told us:
“I had a case yesterday of a specialist perinatal health visitor who had contacted one of her mums, just as a catch-up. This mum had always coped very well but had had depression with the first child and was coping with the second one. She had hit a really black point and the call was very well timed. If there was time to ring every mum, I suspect we would be finding a lot more problems and a lot of families needing more support.”
67.The negative impact of Covid-19 on the nation’s mental health has been widely acknowledged. However, becoming a new parent is already a vulnerable time for mental health. We have heard that the pandemic has seriously exacerbated mental health problems for new parents at a time when the health services and other support systems are unable to respond sufficiently. We’ve heard that the need for these services among new parents has probably doubled. Simply resuming services after lockdown is not going to help these parents ‘catch up’ with the support that they have so desperately needed.
68.Over the last generation the Government and Parliament have had clear scientific knowledge on the impact that poor parental mental health can have on the child. The First 1001 Days Movement, an alliance of over 120 charities and professional bodies spanning the children, family, mental health, maternity and baby sectors, told us how lockdown affected babies at a critical time in their development, when they are particularly vulnerable to family stress and anxiety. It said:
There is an urgent need to support babies and their families to prevent immediate and long-term harm. A wealth of evidence shows that exposure to significant stress in the womb or early life can have pervasive and lasting impacts on multiple domains of development. But importantly, the research also shows us that the risks of early trauma and adversity can be mitigated with the right support.
The NSPCC said:
Undetected and unsupported mental health problems can affect a parent’s ability to provide the responsive and sensitive support necessary for scaffolding their child and jeopardise the formation of a secure parent-infant bond.
Dr Alain Gregoire said:
The effect is not invariable, not unavoidable, not irreversible, but large. So you see a doubling overall of mental health problems in the offspring of women who are anxious or have increased anxiety during pregnancy. For those with a lot more anxiety, that is the sort of figure that we will expect to see in the next generation.
You are the first generation of legislators who have this scientific knowledge; […] So, there is a huge potential for acting and acting now, to prevent effects in 20- or 30-years’ time, as well as effects tomorrow.
69.The impact of parental mental health on young children is striking. The Government has been unable to protect everyone from the impact of this pandemic, and it is difficult to see how any Government could. However, there is clear scientific evidence that shows if new parents can be effectively supported through this crisis, this will also help protect the next generation from the impact of the pandemic.
70.A 2014 study by LSE on the costs of perinatal mental health problems attempted to quantify the economic costs of existing levels of mental health problems in new parents, including both the costs associated with the parent and the effects on children, examining the costs per case of depression, anxiety and postnatal psychosis. It put the total known cost of mental health problems per year’s births in the UK at £8.1 billion and a per-case cost of nearly £10,000 to the public sector alone.
Table 4: Total costs per case, in £ (of which public sector costs in £)
Total cost - mother
Total cost - child
Total cost - mother + child
An extra 13 weeks of Statutory Maternity Pay would cost £1,966 per person. When we put to the Minister, Paul Scully MP, the economic benefits of investing now, he responded:
What we are trying to do—which is why we are not looking at extending the provision of maternity pay at the moment—is to get the balance right between supporting as many parents as we can and supporting employers. […]
Employers are worrying about cash flow, which is everything to them at the moment, and we have to get the balance right on whether we want to have those jobs for the mothers and fathers to go back to.
71.We appreciate the importance of new parents having jobs to go back to. Indeed, financial pressures and concerns about job security in light of Covid-19 have added to the anxiety and stress of new and expectant parents. We also fully understand the gravity of the situation that businesses find themselves in. However, without robustly supporting new parents and dealing with a potential crisis in mental health, they won’t be fit to work, or at best won’t be as productive, which will also cost businesses.
72.On 22 May 2020, the Government announced a total of £4.2 million to be awarded to mental health charities, such as Samaritans, Young Minds and Bipolar UK, in addition to £5 million already made available to Mind and the Mental Health Consortia. While funding for mental health charities is welcome, the Minister was unable to confirm that any money will be directly targeted at new parents and whether it will meet their specific needs. Covid-19 has had a significant impact on the mental health of the whole nation. New and expectant parents have especially been put under tremendous strain during what is already an incredibly challenging time in their lives. It is extremely likely that there will be a significant increase in mental health referrals from new parents which the Government must ensure that the Health Service is fully prepared for. We are the first generation of legislators with the scientific knowledge of the impact that parental mental health has on the development, health and future outcomes of some of the most vulnerable in society: babies and young children. We must act on this knowledge. The Government should fund and provide additional professional and mental health support especially targeted at this cohort of parents, and their children, in addition to its wider plans to significantly expand mental health services provided by the NHS.
93 National Collaborating Centre for Mental Health, , 2018
94 Maternal Mental Health Alliance, , accessed 23 June 2020
95 Royal College of Psychiatrists, , accessed 23 June 2020
96 Fatherhood Institute ()
97 NHS, , accessed 23 June 2020
98 Royal College of Psychiatrists, , page 10
99 House of Commons Library, , 18 July 2018
100 Annex 2
101 Annex 2
104 Annex 1
105 Annex 1
106 Annex 1
107 Annex 1
109 Annex 1
110 Annex 1
112 Institute of Health Visiting
114 Annex 1
115 Annex 1
120 First 1001 Days Movement
123 Centre for Mental Health and London School of Economics, , 2014, p4 and p20, Table 7
124 13 X £151.20 per week.
126 Department of Health and Social Care, , 22 May 2020
Published: 6 July 2020