Hidden Half

Why is the campaign called “Hidden Half”?

Our research found that nearly half of new mothers’ mental health problems did not get picked up by a doctor or other health professional. The “hidden half” is the half of new mothers who experience mental health problems and don’t get any help or treatment.

What changes is NCT asking for as part of the Hidden Half campaign?

The aim of the Hidden Half campaign is to improve the postnatal check-up, carried out at about 6-8 weeks after the birth, normally by a GP. We want every new mother experiencing mental health problems to get the help they need, quickly.

We’re calling for more funding for the six-week check so that GP practices can give every new mother a full appointment for the maternal six-week check. Additionally, we want to see better guidance and maternal mental health training for doctors, so they’re better equipped to discuss emotional wellbeing with new mothers.

How much extra funding will be needed?

We estimate the cost at about £20 million, which is a drop in the ocean compared with the NHS budget and the damage and costs of untreated maternal mental health problems.

Why is the six-week check currently ineffective at picking up mental health problems?

Our research showed that nearly half of new mothers’ mental health problems did not get picked up by a doctor or other health professional. The six-week check is a key opportunity to identify these problems, but many women said their appointment was rushed and some ended up with less than 3 minutes to discuss their own health, often because their six-week check was squeezed in with a check on their baby.

Many new mothers find it difficult to disclose emotional problems, so an unhurried discussion is vital. Mothers report feeling ashamed of how they are feeling and need to be made to feel comfortable and safe about discussing their mental wellbeing.

Why is it currently being rushed?

GPs are increasingly being put under overwhelming pressure and are having to make up for gaps in specialist services, health visiting and social care without extra funding. Doctors do not receive any specific funding for the six-week check and fitting in a full appointment is becoming harder.

How will more funding help to improve the six-week check

Currently GPs have to fit the six-week check into their routine workload. In overworked surgeries the maternal check often gets compressed and any discussion of the mother’s mental health can be rushed. Funding directly for the six-week check, will enable doctors to plan their workload and staffing so they have time to give every mother a full and unrushed appointment..

Is the six-week check always done by a doctor?

At 6-8 weeks, every new mother should be seen by a health professional for a formal health check. This coincides with the time when the baby should be checked physically, normally by a GP and the GP will often do the mother’s six-week check at the same time as the baby check.

GPs have an ongoing role in care beyond the postnatal period, so they generally do the six-week check postnatal check. If there are any problems that need supervision by a doctor or referral to specialist medical services, the GP can make any necessary referral and can coordinate the care.

The six-week check is in addition to any checks done by Health Visitors and other health professionals. New mothers are normally visited by a Health Visitor soon after the baby is born and may also be visited or invited to visit the Health Visitor at other times.

Why have we chosen the six-week check as the solution to identifying mothers with postnatal mental illness? What about checks by health visitors and midwives?

The six-week check is a really important safety net. While woman have many healthcare appointments during pregnancy, the six-week postnatal check may be the last routine appointment she has with a health professional that focuses on her health, as opposed to the baby’s. Given women’s reluctance to actively seek help for mental health problems, if they are not picked up at the six-week check, there is a significant chance of them remaining undiagnosed.

Why is the campaign only talking about postnatal mental illness in women, when fathers can suffer from mental health problems too?

We’ve worked consistently to combat the misconception that postnatal illness only affects women, including a media campaign: #dadsindistress. Our Hidden Half campaign is focussing on one part of the problem (postnatal mental illness in women) so that we can press for specific measures to combat the low rate of identification of this particular problem. By focusing on one issue, we can make clear specific recommendations that we hope can bring about a real and positive change for the women suffering.

What about the women who suffer from emotional problems during pregnancy, rather than postnatally?

Our public information emphasises that both men and women can experience mental health problems antenatally and postnatally.

We have identified the six-week check as a key opportunity to identify mental health problems. It is vital that health professionals ask about mental health at all appointments but, as the last routine appointment focusing on a mother’s health that many women have with a GP practice, the six-week check is a key opportunity and needs to be effective.

Is the Hidden Half campaign relevant in the whole of the UK?

Our research suggests that the problem of under-identification of mental health problems applies across the UK and that new mothers across the four nations often find that their six week check is rushed. While healthcare systems vary between the four nations of the UK, because health is devolved to national governments in each of England, Wales, Scotland and Northern Ireland, low identification of maternal mental illness is a common problem across the four nations.

Why are you asking supporters in Wales, Scotland and Northern Ireland to email their MP, if healthcare is not run by the UK government?

MPs do not directly control health systems in the UK as they are run by local bodies: in England, by the UK government and by local commissioning groups and in Wales, Scotland and Northern Ireland, by the relevant national government. We are asking supporters to email MPs, wherever they live in the UK, with a request that MPs press the national government in the relevant country for change. Our Email MP tool gives supporters a quick way of emailing their MP - by inputting their postcode onto the form, the system generates an email relevant to the country they live in, asking their MP to contact the Minster for health in that country. In this way, we hope to put this issue on the agenda for MPs and for all four national governments across the UK.