The Spectrum

It's the end of the second Maternal Mental Health Awareness Week, organised by the Perinatal Mental Health Partnership. Last year, there were campaigns and live events all over the UK which you can read about here. This year, themes and campaigns about Maternal Mental Health seem to have exploded all over the internet. Instagram saw at least 5 campaigns running throughout the week, ChannelMum did a Facebook Live with Dr Andy Mayers and BBC5Live revisited its Mum Takeover. When I first became interested in maternal mental health around ten years ago, it was still largely hidden and very misunderstood. While stigma and misunderstanding remain, it is reassuring to see so many experiences being shared this week and, even more so, the huge waves of support over social media. 

It's got me reflecting on what maternal mental health means to me, and why it's so important that we talk about it. What is mental health anyway? Yesterday I attended Tea for PND, organised by Jo of Lobella Loves. It is essentially a peer support group for women who have had difficulties with their mental health during pregnancy and parenthood. Jo recently relaunched her Depression Wears Lippy campaign for Maternal Mental Health Awareness Week  to challenge assumptions made about how those with mental health problems 'should' look. She also invites mental health professionals to attend each meet up, and I was delighted to attend. 

I was left thinking about the different ways in which mental health is presented - and how even with such a lot of awareness raising going on, there are still so many assumptions made about mental health. 

One of the things we talked about yesterday was how there’s a multi-layered barrier to get through when you try and reach out and get help. There’s the barrier of recognising that you might be finding things hard to deal with, and even then knowing where to go to get help can be a minefield. There’s the added barrier of sometimes then not getting the support you need. This was very clearly demonstrated in my poll this week, showing 67% of those who responded did not feel they got the support they needed (71% also felt it took too long to get help, and only 41% of those who responded felt it had helped). There’s also the barrier of getting through your own stigma about mental health. Having to get past the idea that you ‘should be coping’ or facing questions like ‘aren’t you over that yet?’ I sometimes wonder if we’re dealing with a huge epidemic of perfectionism at the moment. There's a sense that we must appear to be coping at all times, and the pressures placed on us are only increasing. What used to be peripheral is now seen as essential - and as we invite people into our homes via social media there's also a sense sometimes that we've nowhere left to relax. Any indication that we’re not meeting the absolute ideal translates as ‘I’m failing’ (rather than, these standards are unhelpful). And then there's the fear for parents of what will happen if they do disclose their mental health struggles - the most common fear being that your children will be removed from you. When we talk about mental health, it is still often packaged neatly. We can talk about post natal depression, but not suicide in parents. We can talk about anxiety, but not psychosis. We can talk about recovery and hope, but not relapse. We can talk about parenting, but not about what happens when our capacity to parent is challenged. There is still much that is left unspoken. 

So I wanted to talk about spectrums. Often when we talk about mental health we talk about diagnoses or conditions. There are labels attached and meaning behind those labels. Of course diagnosis has its place and some people find it immensely helpful- not only having an indication that what they're going through has a name and is shared by others. But also because having a diagnosis can make it easier to access support if you are placed on a certain ‘care pathway’ (a protocol which outlines the support you should be receiving and from whom).

But when we focus only on diagnosis it all becomes a bit black and white and we forget about the nuance of mental health. We all have mental health, it’s just that it’s not always problematic. But depression, for example, usually doesn’t just hit one day, often it builds up over time- at what point do you officially become ‘depressed’? People who have diagnosed mental health problems may have a self care toolkit in place to support themselves and prevent relapse- but again, we all have these toolkit’s to a greater or lesser extent. And we’ve all experienced down days, and worries, and obsessions - it’s just that they can become more disruptive to some people and at some times. Even psychosis, which can be very misunderstood, is something many of us have had tastes of at a much lower intensity- we all have delusions at times, we just don’t have the urge to act on them. And many people experience unusual visual and auditory hallucinations, particularly when tired or under the influence. We become much more vulnerable to experiencing mental health problems in the period just after having a baby, so it's no surprise that this spectrum can feel a little shorter for a while - moving from feeling on an even keel to feeling overwhelmed sometimes on a daily basis. 

When these become diagnosable symptoms, of course these have a greater impact on our lives. Someone at yesterday's meeting wondered ‘will I ever get better?’ But while not all of us have been through mental health crises, all of us need to pay attention to our mental health in some way to remain ‘well’. Plus, for those experiencing perinatal mental health difficulties, there is the added complication of the often dramatic change to your identity which naturally happens when you become a parent. So the process of feeling ‘better’ may also involve saying goodbye to ‘old you’ and integrating all of the new parts of you that have been discovered since becoming a parent.

Mental health can appear complicated, and mysterious. But  knowing that they exist on a spectrum can help us understand and relate to them, can help us feel less isolated when we're going through them.