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For many Kiwi mums, pregnancy and new motherhood are a time of overwhelming joy.<\/p>\n
But every year, for nearly 30,000 women, the months and even years become a battle with mental distress, psychosis, grief and, in the most devastating cases, end in suicide or the death of their children.<\/p>\n
Now, new reports have put a spotlight \u2013 and a cost \u2013 on what happens when those mothers don\u2019t get the help they need.<\/p>\n
One report, commissioned by Health New Zealand Te Whatu Ora \u2013 and largely kept secret until NZ Herald political editor Thomas Coughlan forced the publication \u2013 reveals a third of women experiencing significant maternal mental health distress are not getting the specialist care they are likely to need.<\/p>\n
Another report, commissioned by the Tindall Foundation, found the long-term social cost of mental distress among new parents is estimated at more than $2 billion a year.<\/p>\n
The numbers are staggering. But behind them are mothers like Kristy Maguire, who experienced postnatal psychosis after the birth of her baby, from whom she was then separated.<\/p>\n
She spoke to Coughlan, who tells The Detail that \u201cwhen you have women\u2019s health and mental health at the same time it\u2019s sort of like falling through two cracks at once\u201d.<\/p>\n
And, he says, it\u2019s not a new problem.<\/p>\n
\u201cIn reporting the story, I\u2019ve sort of found that at times when you look at the history of it going back sort of 10 to 20 years, it sort of felt like this has not necessarily been the first cab off the rank in terms of problems that health ministers going back generations haven\u2019t wanted to deal with.\u201d<\/p>\n
Coughlan says when reports commissioned to investigate those problems were finally completed, getting them into the public domain proved difficult.<\/p>\n
\u201cI was surprised at how long it took to get those reports out \u2026 There were four of them, and so they weren\u2019t all included in the same release.\u201d<\/p>\n
\u201cIt\u2019s bizarre because, in my view, the reports are sort of something that should have been proactively released when they returned. Most of them returned to ministers in 2023, late 2023, and they\u2019re the sort of thing that I would expect to have been released proactively sometime in 2024.<\/p>\n
\u201cBut most of them were only released after we requested them under the [Official Information Act]. They were declined and then proactively released. So yeah, there\u2019s a wee bit of feet dragging and that I guess is indicative of just the wider health system not exactly falling over itself to remedy these very real issues.\u201d<\/p>\n
The scale of the problem is stark, he says, with around 15 percent of mothers estimated to experience significant mental health distress during the perinatal period.<\/p>\n
Around a third of those women are not getting the support they need, in part because of where they live.<\/p>\n
\u201cIt varies a lot by region, and this is \u2026 one of the reasons why Health New Zealand was created back during the Labour government\u2019s health reforms, to end this postcode lottery of care, and maternal mental health is just like so many other conditions, where where you live can have a big impact on the quality of care that you receive.\u201d<\/p>\n
Only Auckland and Christchurch have mother-and-baby units, where women can receive inpatient mental health care without being separated from their newborns, which Coughlan says is considered best practice internationally for treatment and improvement. But those facilities don\u2019t exist elsewhere.<\/p>\n
The old district health board boundaries, he says, are still influencing access to specialist care.<\/p>\n
\u201cWe still have these 18 district health boards which kind of live on in zombie form inside Health New Zealand and what these four reports revealed is that where someone lives \u2013 their old DHB boundaries \u2013 can have a big impact on whether they are able to get care.\u201d<\/p>\n
For Tauranga mother Kristy Maguire, the consequences were terrifying.<\/p>\n
After a caesarean section, she began experiencing symptoms of postnatal psychosis.<\/p>\n
Coughlan says she described her world as beginning to feel like the film The Truman Show \u2013 as though everyone around her knew something she didn\u2019t, and \u201cin which everyone was in on some sort of secret that she wasn\u2019t let in on\u201d.<\/p>\n
\u201cThe smell of gas could convince her that her house was about to explode. She would grab her baby and bolt for the door.\u201d<\/p>\n
Eventually she was sectioned under the Mental Health Act, and separated from her newborn. It was a trauma.<\/p>\n
\u201cIt\u2019s not best practice \u2026 she was taken into a unit which doesn\u2019t best meet the needs of a new mother who was going through what Kristy was going through.\u201d<\/p>\n
She\u2019s since become an advocate for mother-and-baby units, and a significant change to the law was passed a few months ago.<\/p>\n
\u201cIt\u2019s written in the Mental Health Act now that \u2026 in the first instance our mothers should be kept with their newborn children when they\u2019re receiving care, so that\u2019s a really big change and hopefully when it\u2019s rolled out it means better care for so many people,\u201d says Coughlan.<\/p>\n
For some other mothers, the system has failed in a different and profoundly painful way.<\/p>\n
After Serra Clark experienced a stillbirth, her midwife told her a referral would automatically be made to maternal mental health services. It wasn\u2019t.<\/p>\n
\u201cIn the eyes of the health system, to access that mental health support you have to have what they call, you know, in the bureaucratic language, a live baby in your care,\u201d says Coughlan.<\/p>\n
\u201cThat\u2019s clearly a massive crack in the public health system because it\u2019s a time in your life when you clearly need and deserve mental health support but the rules that were put around who gets mental health support and who doesn\u2019t mean that you don\u2019t get the support at a time when you arguably need it more than you might ever need it in your life.\u201d<\/p>\n
There is now a new pathway for bereaved parents experiencing stillbirth, but Coughlan says changes and progress have been painfully slow.<\/p>\n
In another devastating report by Coughlan, he covered Kristen Taylor\u2019s death by suicide during the pandemic period, after a difficult pregnancy and birth and a deterioration in her mental health.<\/p>\n
Her husband, Alastair Taylor, has since become a fierce advocate for better maternal mental health services.<\/p>\n
Coughlan says over 15 months, Taylor recalled his wife making eight or nine attempts to take her own life.<\/p>\n
And he says the mental health care she received was nowhere near good enough, with conditions inside the inpatient facility also deeply concerning.<\/p>\n
\u201cAlastair described going to a mental health inpatient facility in the Hutt \u2013 they live in the Wellington region \u2013 and he described it as being unfit for his dogs to spend time in, let alone his wife who\u2019s just given birth.\u201d<\/p>\n
The Tindall Foundation commissioned research into the long-term social cost of parental mental distress.<\/p>\n
Paulien Fa\u2019atafa, the tangata tiriti co-lead of Te Hokinga Mai and the initial project lead on the report, says the figure \u2013 more than $2b a year \u2013 is staggering, but it isn\u2019t surprising.<\/p>\n
\u201cWe know 29,000 women every year have some level of distress, so I think the $2b puts a number to it, but in community we\u2019ve known this for so long and this report is really a chance to just start showing what lack of action is doing, cumulatively, for lots and lots of mums each generation.\u201d<\/p>\n
And she has one message she wants to make absolutely clear: \u201cThis is never the fault of mothers.\u201d<\/p>\n
The $2b figure captures the long-term social costs of clinically diagnosed mental distress, such as depression, anxiety, or postpartum psychosis, and she says that number may be considerably larger when it includes people who may be experiencing \u201ca huge amount of stress\u201d, but don\u2019t have a diagnosis.<\/p>\n
\u201cThat number could be up to $4.3b, which the researchers still estimated was conservative.<\/p>\n
\u201cIt\u2019s mind-blowing, this number, and cumulative \u2013 because every year we don\u2019t do something differently, that $4.3b is added on to the next 57,000 mums who have babies.\u201d<\/p>\n
The consequences don\u2019t stop with the mother, with Fa\u2019atafa saying 65 percent of the $2b cost sits with the child.<\/p>\n
And the impacts can stretch across decades.<\/p>\n
\u201cThey happen over 25 years, so if mum doesn\u2019t receive the support that she needs while she\u2019s in distress then there can be ongoing impacts for the child, and that can be in health, that can be in education and \u2026 also be with kind of increased interactions with Oranga Tamariki and justice and future productivity for the child.\u201d<\/p>\n
But she says asking for help isn\u2019t always easy \u2013 there is stigma and fear, and for some mothers, disclosing that they are struggling can feel like putting their family at risk.<\/p>\n
\u201cIt\u2019s still a huge problem; there is lots of stigma placed on mums when they say that they\u2019re not coping or that they\u2019re not doing well, and you know lots of the services and supports from our government agencies that are meant to support mums and birthing parents and wh\u0101nau actually can make life really hard.<\/p>\n
\u201cMums with custody arrangements in family court can end up losing their child because they\u2019ve disclosed a mental illness, or if they are interacting with Oranga Tamariki, the fear of losing their child because you\u2019re saying you\u2019re unwell actually stops many mums from reaching out for help.\u201d<\/p>\n
And even when they do reach out, there may be nowhere to send them.<\/p>\n
\u201cThat is the other end, you know, when you do reach out for help because the clinical services and the hospital-based services are under so much pressure, there actually needs to be really, really severe [need] before mums can engage with some of those services.<\/p>\n
\u201cCommunity is already there doing it, they\u2019re just having to do it for free, so if you funded them so they could do it well and be supported to do it, we think you could see immediate benefit.\u201d<\/p>\n
Fa\u2019atafa says \u201cit\u2019s not a matter of whether you can afford to invest in community and in prevention and in supporting wh\u0101nau for wellbeing, it\u2019s whether we can afford not to\u201d.<\/p>\n
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