Shepparton family feels the gaps in regional perinatal mental healthcare

Melissa says her story is an example of why the Goulburn Valley is in desperate need of preventative support for expecting and new parents with perinatal mental health problems, such as an early parenting centre — a call echoed by experts and politicians.

When she fell pregnant, Melissa went to lengths to find a health service that wouldn’t treat her as ‘high risk’ because she lives with mental illness.

“I wanted things to be as uncomplicated and non-judgmental as possible,” she said.

Melissa chose to go drug-free for the birth of Ollie and she did a hypnobirthing course in preparation, which helped reduce fear, pain and anxiety while she laboured.

In March 2021 she gave birth to Ollie and all went as planned.

“It was awesome … he didn’t need any help, he knew he was coming,” she said.

While most physical aspects of her pregnancy were uncomplicated, Melissa, who lives with borderline personality disorder, says her mental health declined rapidly after conceiving.

Her general practitioner and psychologist couldn’t offer the specialist treatment she knew she needed.

“They didn’t know how to help me,” she said.

Melissa’s experience is not uncommon, according Dr Alice Dwyer, a perinatal and infant psychiatrist and secretary of the Royal Australian and New Zealand College of Psychiatrists’ special interest group in perinatal and infant psychiatry in NSW.

Dr Dwyer said general practitioners and psychologists did a great job carrying the bulk of outpatient care.

“But they reach a threshold where they might not know what to do next,” she said.

“The big problem is the missing middle ‒ those who need more than a GP and psych, need more than Medicare can provide, but who don’t meet criteria for the public teams.”

Reaching a crisis point and three months’ pregnant, Melissa didn’t feel safe, so she called a hospital psychiatric helpline and was told home was a better place for her than the mental health unit.

A few months later her husband, Nathan, drove her to hospital because Melissa was scared she might hurt herself.

“Again, they told us the best place to be was at home …They were really stretched,” she said.

Melissa had to fight to get a referral to see a psychiatrist specialising in perinatal depression, she said, and when she finally had one, the waiting list was more than three months.

“I would have had Ollie by the time I had my first appointment,” Melissa said.

When the desperate mother-to-be finally got an appointment with a perinatal psychiatrist it was a fluke.

“I had a complete breakdown the week before Christmas in 2020, I just fell off the deep end,” Melissa said.

“I was like, ‘I need medication, I need something, I don’t feel safe.’ I was thinking all these terrible thoughts.”

Melissa got a referral to another perinatal psychiatrist, who happened to be doing his own Christmas leave cover.

“He spoke to me on the phone, talked me off the ledge and I’ve been seeing him ever since,” she said.

It is common to be unable to get access to a psychiatrist in a period of perinatal vulnerability, according to Dr Dwyer.

One service attempting to support those parents in ‘the missing middle’ is Perinatal Anxiety and Depression Australia, a free telephone counselling service Melissa engaged with several times during the past two years.

PANDA doesn’t offer psychiatric care, it helps with referrals to appropriate services and offers counselling over the phone.

The number of calls PANDA receives annually has more than doubled since 2019 — from 19,000 to 42,000 in 2021.

PANDA chief executive and clinical psychologist Julie Borninkhof said the service also saw an increase in new callers and a change in their profiles.

“We weren’t just supporting people as those child maternal health support systems were falling away later in bub’s first year, we were supporting people in the first month of their baby’s life,” Ms Borninkhof said.

One in 10 women and one in 20 men struggle with antenatal depression and more than one in seven new mums and up to one in 10 new dads experience postnatal depression, according to PANDA.

But that is an under-reported number, in Ms Borninkhof view, and she doesn’t expect the high demand for PANDA’s services to decline.

“(The rates) are not about COVID-19, they’re about people understanding more readily that it’s okay to ask for help,” she said.

Melissa said PANDA was helpful, although she often spent a long time in a queue on hold during peak times, and it needed to be a 24-hour service.

Ms Borninkhof said PANDA’s service had been “more reactive than proactive in supporting people”.

Although it did the best it could in tough circumstances, it has always been the chief executive’s vision to see PANDA become a 24-hour service.

“We know the needs of parents don’t go to sleep at night,” Ms Borninkhof said.

Melissa’s mental health didn’t improve in the first months of Ollie’s life and, in July 2021 her midwife, Quinn McPherson, helped her get a spot in Bendigo hospital’s five-bed mental health unit for mothers and infants.

Securing the bed was another stroke of luck in Melissa’s journey.

Quinn made multiple fruitless calls to support services as her midwife, eventually connecting with PANDA’s health professionals line and gaining some momentum.

“This woman on the phone was wonderful ... she said, ‘At the Bendigo (parent infant) unit right now there’s a woman being discharged — there’s a free bed. Snap it up right now.”

It marked a turning point for Melissa, Nathan and Ollie.

“The things I took from Bendigo were that a family solution was needed,” Melissa said.

“There were changes Nath and I could make about how we parent Ollie, to share the load and take care of ourselves.”

Nathan wasn’t able to stay in the hospital unit, and with no care available at the time they needed it in Shepparton, the distance between home and Bendigo was painful.

"It was the isolation that was the hardest part, having them have to go away,“ Nathan said.

Both Melissa and Nathan wish they’d had access to a support service such as an early parenting unit earlier in their journey.

EPCs aim to strengthen parent-child relationships and offer support with infant sleep, child behaviour and breastfeeding.

Offering a community-based model of care, where parents aren’t admitted as patients, EPCs offer day stays, intensive five-day stays and group-based programs.

Melissa and Nathan both say they prefer to approach problems together as a team but couldn’t find services that allowed them to do so.

“There’s not a whole lot of preventative programs out there ... before it gets to that extreme point,” Nathan said.

“And Mel’s been at the point where she doesn’t want to be here anymore, and somehow it’s not ‘bad enough’. And that’s quite frustrating.

“There’s definitely a point where I can’t give the kind of support I’d like to give her, and I can’t give her the support she needs, either.”

Melissa is still seeing a perinatal psychiatrist, who she says helped save her life, and who encourages her and Nathan to approach the challenges of childrearing as a team.

Together, they’ve found equilibrium.

“(My psychiatrist) said to me his favourite saying is ‘A baby cannot exist without a mother and a father, and a mother and a father cannot exist without a baby’ — they’re not isolated things, so I don’t know why we treat them in isolation,” Melissa said.

“A family unit, where mother, baby, and father can come in together, would be immensely beneficial.”

PANDA National Perinatal Mental Health Helpline: 1300 726 306, 9am to 7.30pm, Monday to Friday.

Lifeline: 131 114 or www.lifeline.org.au

Suicide Callback Service: 1300 659 467 or www.suicidecallbackservice.org.au