We need to change the way we talk about mothers and mental illness

On the Āhurutia Te Rito | It takes a village report and the media coverage around it...

This post talks about maternal suicide and mental health. Please take care, even if you’ve healed from your post-natal or anti-natal depression, this may be hard to read.

Over the weekend an excellent report was released by the Helen Clark Foundation. Āhurutia Te Rito | It takes a village follows on from, and takes up the challenge of, the report released last year that revealed suicide was the leading cause of death during pregnancy and the postnatal period in Aotearoa, with wahine Māori three times more likely than non-Māori to die by suicide.

I’ve been writing about the maternal suicide rate for six years. For six years I’ve seen reports come and go and people say “not one more mum” and “this has to stop”. It never does. Nothing seems to change.

Holly Walker authored the (really good) report and says: "Our maternal suicide rate is seven times that of the UK, but there are no other statistically significant differences between the two countries in terms of maternal mortality. This suggests there is considerable scope for improved intervention."

It can get better. So why doesn’t it?

I am convinced that the reason why it never changes for the better is because the things we know would actually help mothers and birthing people who have antenatal and perinatal depression and anxiety are put in the too hard basket. The government, DHB and Ministry managers, and health professionals working for DHBs, set the narrative - and they ensure the narrative is on the individual not the system.

Take for example the comments by a clinical psychiatrist on Newshub Nation.

The psychiatrist is introduced as being on the “frontline” dealing with seriously ill mothers. The first thing she does in her interview is de-centre the mother - saying she likes to call maternal mental health services ‘perinatal health services’. I support the use of the term perinatal health services because not all birthing people are women, but I find it interesting that in this case the term is used to shift the focus to babies and partners (mostly cis men).

Don’t get me wrong, I get it. I know that those who work in this space want people to care about it and the patriarchal pecking order of importance in our society is:

• men - (birthing partners)

• babies

• everybody else

• mothers.

She then says: "I think it's really important to make the point that not all women who experience mental illness or have drug and alcohol problems are poor parents”. This, to me, sets the tone for the whole interview.

Immediately, after de-centreing struggling mums (except to say they might not be poor parents - imagine!) - the conversation becomes how impacted a baby is by their mother’s distress in pregnancy.

“They don’t cry!”, the reporter says in horror about our babies. “It changes the way they understand the world!” she says. “It really does,” the psychiatrist says.

She then talks about early intervention completely devoid of reference to mothers, while throwing out lines like “not just at the severe clinical end, there’s a lot more behavioural problems”. Just in case you thought that you might not be damaging your child forever by having even the smallest bit of depression and anxiety…

These comments are from the article that goes with the interview, it is titled: Perinatal distress can affect children and non-birthing parents - psychiatrist.

The psychiatrist says: “the long-term impact of depression and anxiety in parents means there are a lot more behaviour problems when the children are toddlers and it can impact a child's language and school readiness.”

And from the reporter - “Dr […] said it can also cause depression when the child is a teenager, so it is important to notice the warning signs and intervene early.”

It’s completely laughable that the interview suggests this topic is taboo after they’ve just talked about how mothers are probably irreparably damaging their babies into teenagehood from pregnancy. Gee, I wonder why mums don’t talk about their mental health? Where could the stigma come from? Why would people consider it taboo? It’s a complete mystery.

I felt sick watching the interview. I felt sick reading the article. And I shared on Instagram why. Overnight I had hundreds of messages from mums. Some had healed, others were still fighting to be alive.

Almost all of them talked about the pain that health professionals cause when they de-centre mothers and place so much blame onto mothers.

When I was very sick in pregnancy, every article that said “your baby can feel your stress from the womb” or “having depression means your child will have attachment issues” made me feel like my child would be better off without me.

I hunted down the reports later, when I was in a better space, and was astounded to see how over-egged they’d been. But back then I believed it all. Hook, line and sinker.

I was the problem. I was the one making my baby sick.

The psychiatrist’s comments - and the way this topic was covered (and is almost always covered) - does exactly that. It talks about mothers as if they’re not watching, not listening. It speaks over them. It shames them. It blames them.

I want to share some of the comments I was sent after sharing the interview. This is the message mums are getting:

“When I saw that interview I just thought, it’s too late. I’ve destroyed my baby already”.

“This is the message I got when I was struggling. That if I didn’t fix myself, my baby would be psychologically damaged forever. I couldn’t fix myself so the logical next view for me was that if I was dead, my baby would be better”.

“I’ve suffered with depression since I can remember. Sometimes my kids are the only things that keep me here and moving forward. If I’ve already irreparably fucked them up, what’s the point in trying?”

“I still remember being horrifically depressed as a young single pregnant woman, dealing with stalking and abuse from my ex-partner, and being told SO MANY TIMES…that I needed to “relax” because my emotions would negatively affect my baby. Not only did it make me feel even worse, and already like I was a terrible mother before my baby was even born, but it really cemented the fact that now that I was pregnant I didn’t matter anymore. I was just a vessel for a baby. I didn’t exist as a person anymore and was completely worthless outide of my ability to grow a baby”.

These are the stories I hear every day.

For so long, those of us who work supporting mums have been saying the same things. Things that are all through this new report: We need social housing prioritised for our mums. We have to, have to, have to urgently prioritise wāhine Māori in suicide prevention efforts. We need engaged midwives who aren’t burning out because they’re treated so poorly - because they’re the ones who can spot antenatal depression or anxiety or PND as it’s starting. We need ACC to cover birth injuries and birth trauma.

I mean one recommendation is: “Provide fast access to affordable, culturally appropriate therapeutic support to parents with early signs of distress, and guarantee immediate access to best practice specialist help if they become unwell.”

Can you imagine if we had that?

Can we all also see now why the focus is on the individual and how much they’re hurting their whole family instead of on the system itself? If we keep moving the conversation to mums and how they’re damaging their babies and their partners, we don’t have to get to the real shit.

The report says what so many in the system don’t want to talk about:

“At the societal level, the stressors that drive perinatal distress are structural and systemic, and tend to be the same things that drive wider forms of disadvantage. These include: poverty, racism, gender disadvantage, food insecurity, gender-based violence, poor housing, limited education, and weak social networks”.

These aren’t soundbites.

They involve all of us working together. They involve an actual government response, they involve accountability from DHBs and the Ministry of Health.

It shouldn’t be a surprise that the way to help our most isolated and vulnerable mums is to come together and all carry the burden that they are so often forced to carry alone.

I was interviewed about this report and I was asked: What would you say to a mum who was suffering?

I would of course tell her she is loved and I would try to help her. But I said I wanted to turn that question around…

Everyone has messages for The Mum. I want to give a message to everyone else: The friend of The Mum, the colleague of The Mum, the neighbour, the brother, the cousin, the grandmother, the parent of The Mum…God, the health professional who keeps talking over her!

You need to show up and fight for her life.

The way you speak about her matters. The way you speak about other mothers around her matters. Telling any mum who is sick that she’s harming her baby by being sick will not help her. It’s cruel.

She is fighting. She is tired. She is doing her best.

Are you fighting for her?
Are you doing your best for her?

Are you going to fight for systemic change for all?

Today, will you walk with the mum who is struggling?

Today, as a health professional, will you consider how your words will impact mothers?

Today, will you look at the way you talk about mental illness and ask yourself: How does this feel to someone who is trying to stay alive?

Will you make this fight your fight too?

What will you do?