How has Perinatal Mental Healthcare in Wales changed, as a result of COVID-19? A medical student’s perspective – Eleanor Openshaw

As many as 1 in 5 women will experience mental health problems during their pregnancy or during the postpartum period. The Saving Lives, Improving Mothers’ Care Report by MMBRACE-UK, run in 2021, reported that maternal suicide was the leading cause of direct death within the year after pregnancy.

COVID-19 significantly disrupted the services offered by the Perinatal Mental Health Team (PNMHT) in Cardiff and Vale University Health Board (CAVUHB), when they were needed more than ever. As a result, the team had to quickly rethink their methods of delivering care. Emerging telemedicine and tele-mental healthcare have played a huge role in supporting patients suffering from mental illness during pregnancy, across the pandemic, but how successful has this been?

While some aspects of obstetric care could not be performed remotely, many of the services offered by the PNMHT were able to transition to remote working. Since lockdown restrictions have eased, the support and care offered by the PNMHT is now offered both in person and via telemedicine. This is known as a ‘hybrid’ model of working.

Throughout my time in the perinatal mental health department, I reviewed 18 casenotes, as well as partaking in and shadowing many remote consultations, to see first-hand how this new hybrid method of working had impacted care. Out of 18 casenotes, 14 of the patients received a video consultation or telephone appointment initially from the PNMHT consultant obstetrician. These patients had presented post-pandemic; indicating that telemedicine is still widely being used within the team. Importantly, a patient is still able to specify if they would prefer a face-to-face appointment with team, protecting their autonomy.

The key benefits of the system, both from my time in the PNMHT in Cardiff and also anecdotally, from patients include:

• Accessibility – can easily be done from home
• Avoiding the spread of disease in vulnerable patients
• Some patients (for example, agoraphobic or anxious) reported preferring anonymity of telephone/remote consultations
• Still allows for rapport to be built and has not impacted quality of care
  

Some of the drawbacks noted were:

• Digital divide – not everyone has access to a phone or computer
• Connection problems, hence communication problems (though rare in the CAVUHB catchment)
• Increasing social isolation
• Difficult to create a confidential space in patient’s home e.g if partner is abusive

With the COVID-19 pandemic obstructing access to care, telemedicine has played a huge role in providing high-quality perinatal mental healthcare. Its emergence has brought a lot of optimism and has left a lasting impact on the PNMHT in Cardiff and Vale. With lockdown restrictions eased, keeping this ‘hybrid’ model of working, with both remote and in-person assessments, has multiple benefits. Moving forward, perinatal mental health care should continue utilising technology to its advantage and modernising the way the healthcare is delivered to patients in Cardiff and Vale.

Eleanor Openshaw – Final Year Medical Student at Cardiff University

Supported by the Royal College of Psychiatrists, Wales. With special thanks to Dr Marion Beard, Professor Alka Ahuja MBE and Oliver John.