Hiding in Plain Sight: How AI calls will help solve the maternal mental health crisis in the UK
by Gabriel Hellen, Senior Analyst at Yokeru
For many pregnant women, the idea of experiencing mental health issues is seldom their most immediate thought when tasked with having a child, but with 20% of new mothers experiencing some type of perinatal mood and anxiety disorder (PMAD), it is a battle that too many women face.
At the crux of this battle, perinatal depression (PND) is the most common and disruptive enemy: with a prevalence of 7.4-14.8% in the antenatal period, and 7.4%-12.8% in the postnatal period, maternal mental health is an enduring issue in which symptoms that emerge following conception can linger for years after birth. However, despite its regularity and the serious adverse effects on mother and infant, only an estimated 3% of all cases of perinatal depression achieve a full recovery.
So, the questions this raises seem clear: what is the reality of care that is currently available to mothers, what is stopping them from accessing it, and what needs to change to improve the rate of recovery in the future?
N.I.C.E. Protocol, N.O. Provision
The existing treatment and care provided for women with perinatal mental health problems is managed through a combination of universal and specialist services around the country.
Universal care is mandated through The National Institute of Clinical Excellence (NICE), with guidance suggesting that all pregnant women be routinely asked diagnostic ‘Whooley’ or ‘Edinburgh Postnatal Depression Scale’ (EPDS) questions pertaining to their mental health by primary care officials (midwives, health visitors, GPs etc.) in their first antenatal visits and subsequent postnatal check-ups. If mild/moderate symptoms are detected, patients are referred to their GP for further therapy/treatment. If, however, severe symptoms are detected/if the mother has any pre-existing mental health history, patients will be referred to secondary specialist services: specialist community mental health teams and inpatient mother and baby psychiatric units (MBUs) that are in place for more complex or serious conditions.
At face value, screening for PND and provision of care seems intuitive and accessible; mothers are questioned about their mental state at regular health check-ups and referred to professionals if treatment is warranted. Why then, when asked in a survey, had 30% of new mums with perinatal mental health problems never talked about it with a professional? What is preventing access to care, and why do so many PND sufferers go undetected?
Hiding in plain sight
The reality of care for PND sufferers in the UK is a bleak one. A high proportion of perinatal mental health problems go undetected, with issues such as depression and anxiety reaching non-detection rates of 50% or more. This means that, despite the numerous opportunities for identification provided by routine perinatal health check-ups (midwives see mothers roughly 13 times before birth; health visitors have roughly 5 postnatal check-ups), the majority of women dealing with PND suffer silently.
There is a clear lack of consistent, comprehensive care that incorporates the recommended mental health questions necessary for effective screening. Indeed, in a recent survey, 41% of new mothers said that their midwife or health visitor had never asked them about depression in their most recent pregnancy. Furthermore, 62% of women said that they did not have a health visitor to go to or did not feel they could talk to them if they had a problem. These alarming figures imply an underlying lack of proactive identification of vulnerable mothers even in hospital settings, and further highlight an important reality: at-risk mothers often have no-one to voice their problems with or turn to for help in these situations.
Negative Stigmas, No Information
The poor rate of identification is also supplemented by a lack of awareness of the symptoms of postnatal depression in patients, and the negative stigmas associated with seeking treatment.
In a survey of 2,000 mums who had suffered from postnatal depression, 49% of them had not sought professional treatment, with 60% citing how they felt as though their condition was not serious enough to need professional help, and a further 12% feeling as if they did not have enough information to ‘know what to do about it.’ Evidently, new mothers are not provided with necessary medical insights surrounding mental health problems, causing them to downplay the severity of their personal issues and not seek treatment. Moreover, this lack of basic information manifests in negative stigmas surrounding seeking treatment, as 33% of mothers were ‘too scared to tell anyone because [they] didn’t know what the implications would be for [them] and/or [their] child.’
The culmination of factors affecting identification of at-risk mothers in the UK leads to one vital point: the sheer number of mothers who suffer silently, who lack the means or information to come forward with their issues, is worrying and unacceptable. Though plans are in place to improve capability of perinatal mental health services in the UK, such as a £365 million-backed NHS Five Year Forward View implementation plan, the path to improving rate of recovery seems clear: there is a need for informed, proactive, consistent outreach for individuals throughout the entire perinatal period, with an emphasis placed on improving universal knowledge of maternal mental health issues to help remove stigmas and improve identification and referral of patients.
How AI calls can help
The adoption of AI calls can help improve identification and monitoring of at-risk mothers by shifting the focus from reactive, to proactive, care.
AI calls offer a new way to talk to individuals, at a mass scale, using only the landline or mobile phone. In under an hour, AI platforms can survey an entire community to identify X or Y problem. This has numerous applications for improving maternal mental health.
The use of advanced human-like voice in AI calls allow for the effective spread of crucial information surrounding the symptoms of postnatal depression. By offering standardised information (what are the symptoms, how to recognise them, how to seek help), AI calls can help educate mothers in an un-intrusive way, simultaneously removing stigmas associated with the disorder and seeking treatment. Furthermore, AI calls can ask NICE-recommended ‘Whooley’ or ‘EPDS’ questions to help improve detection rates of the disease. By improving understanding and awareness of postnatal depression, AI calls can help bolster the number of women in treatment.
The efficiency of AI calls can also help to alleviate the burden of care from Primary Care Officials. Though necessary for sensitive, face-to-face treatment, midwives and health visitors simply don’t have the resources for consistent monitoring of behaviour in the months leading up to pregnancy and the ensuing years after. Bi-weekly AI calls would help to track behaviour as long as necessary, offering resources to the patient to reach out to whenever necessary.
Whilst AI calls are not a replacement for the sensitive, face-to-face therapy necessary for those suffering from PND, the emergence of this technology can provide us with a cost-efficient, un-intrusive way of educating PND sufferers and improving the number of women that receive professional treatment.