Dr. Eithne N? Longphuirt:

On behalf of the Psychological Society of Ireland, I thank the Chairperson and members for the opportunity to address the sub-committee. I am Chair of the Psychological Society of Ireland’s special interest group in perinatal and infant mental health, SIGPIMH. I am accompanied by my colleague, Dr. Jillian Doyle, and she is a committee member of the special interest group.

Perinatal services are where the earliest interventions begin for mothers, care givers, and infants. These are the interventions that set the foundation for the mother-child relationship and, indeed, provide the blueprint for much of a child’s later emotional development. We know that investing early and smartly by supporting parents and family systems is likely one of the more cost-effective ways to promote mental health.

The focus on mothers, infants and relationships in the context of the broader family. Today, we will advocate for a broadening of the model of perinatal health in the following ways: to invite the infant into the perinatal services and the services into the world of the infant; to include those who have been largely excluded; to provide a continuum of care between perinatal and community services; and enable perinatal services to become trauma informed.

As the perinatal model of care takes root, psychologists increasingly recognise the need to provide services that cater to the needs of the mother-child dyad. Perinatal teams are at capacity in meeting the mental health needs of pregnant and postpartum people. We know that the first 1,000 days are the most significant in a child’s development and, therefore, we believe that each of the perinatal teams would benefit from an infant mental health practitioner. We also strongly advocate for the provision of mother and baby units that cater comprehensively for the needs of the mother, child and family.

We must move towards a model of combined care that alleviates the mental health burden on parents and encourages the global development of children. The current iteration of the perinatal services is not equipped to carry out work with babies. Services are in portacabins and in shared office spaces. We need to expand perinatal services so that both mothers and babies are supported, and clinicians have the appropriate tools to do the therapeutic work.

To date, no service has been developed for partners in the perinatal period. Evidence suggests an unmet treatment need for paternal depression and anxiety. Lack of support from the partner is one of the strongest predictors of postnatal depression in women. This is a service gap.

Teenagers are at high risk of developing perinatal mental health disorders. Due to their age this cohort cannot access perinatal services thus denying them access to timely and appropriate care. We advocate for the provision of psychological care to this cohort and believe that a working group could be formed to explore how best to provide this care.

Unsurprisingly, parents of premature infants in the neonatal intensive care unit, or NICU, are at high risk for depression, anxiety and acute traumatic stress with negative implications for parenting and infant development. Researchers recommend ongoing assessment of the perinatal mental health needs of parents as part of the network of services available in NICU. Adequate staff resourcing of the health and social care professionals team, as highlighted in the neonatal model of care, would help actualise perinatal and infant mental health across NICUs and paediatric intensive care units or PICUs in Ireland.

Primary care psychology services are ideally placed to meet the unique experiences of the perinatal period. The perinatal model of care advocates for primary care psychologists to prioritise pregnant women. Prioritisation has been impacted by restrictions on public health nurse screenings, which limits referrals, and by long waiting lists. We believe that investment in primary care psychology will ensure a continuity of care for women and families.

Finally, best practice tells us that care offered to women should be trauma informed. Trauma-informed care prioritises safety, choice, decision-making and control. Healthcare professionals also need to be supported via the provision of adequate staff, regular training and supervision about how to communicate with and care for women.

The Psychological Society of Ireland, PSI, recognises that operating from this value base will require significant systemic change. However, we believe that the benefits to women, infants, partners, healthcare staff and society will ultimately greatly outweigh the cost of change.

According to the eminent psychologist John Bowlby, “If a community values its children, it must cherish their parents”. In the PSI and our special interest group, we strongly believe that perinatal and infant mental health services offer a unique opportunity to cherish both parents and children in Ireland. We urge you, the leaders of our country, to invite in the infant, the mother and the family. As a State, we have birthed these perinatal services; now it is time to parent them and help them to reach their full potential.