Treatments

Barriers to help-seeking

Many parents experience psychological barriers to asking for mental health support or treatment during the perinatal period. They might not want to admit they are struggling because there is a stigma associated with admitting to having mental health concerns during this time. Society especially in some cultures can place unrealistic expectations on new parents to associate this time solely with positive feelings.

Some people worry they may be perceived as a bad parent or unable to care for their baby. They may fear departmental authorities becoming involved or that their children could be taken away from them. In Australia, this is an especially significant barrier within indigenous communities who have experienced children’s removal by authorities over several generations.

In reality if a parent seeks professional support, they can expect to be recognised as a responsible and caring parent who wants the best for themselves, their baby and their family. In cases where a need for social services support is identified home-based support programs are usually offered to the family.

Early intervention in perinatal mood, anxiety and trauma disorders is helpful for recovery. While acknowledging the barriers, parents are encouraged to start help-seeking as soon as possible, if they are concerned about their mental health or wellbeing. Early help-seeking or advice from a professional is also useful for partners, carers and significant others if they notice a new parent is struggling and has not been able to access help themselves.

Asking a health professional, such as a GP whether they are experienced in working with new parents’ mental health is a good way to start a conversation and gauge whether the professional could be helpful. The GP or Child and Family Health Nurse will be aware of relevant services to assist.

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Emotional support

Emotional support most commonly involves a partner, family or friends. The most useful support comes from those who take time to listen to parents’ distress or worries and validate their feelings and experiences. Responding to a parent’s concerns without judgement, unwanted advice or trying to ‘fix’ things can be really helpful.

A parent who is feeling stuck and negative may also find it helpful to hear from others that there is hope for the future and that recovery is possible.

It can be useful to have people on board whose opinions are trusted. Trusted people may encourage a new parent to seek professional treatment if they are worried about them.

Parents may find only a small number of people in their network who provide helpful emotional support. It is sometimes a shock if people don’t meet expectations for emotional support. It can take time to find people who are good listeners and also have time to listen. If a personal network isn’t supportive, non-directive or person-centered counselling styles can be an invaluable source of emotional support too.

Other supportive forums may include new parents’ groups and online groups such as the Gidget Virtual Village. Join the Facebook Group now

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Professional care and treatment options

The mental health system can seem complicated and overwhelming to someone who is already struggling. Medical professionals who can provide initial help with new parents’ concerns about their mental health include:

• Child and Family Health Nurse
• GP
• Midwife
• Obstetrician

These people can provide some initial assessment, information and support around perinatal mood disturbances.

If more specialised support is needed, a parent may be referred to additional services.

Referral types

The type of referral may depend on whether the parent’s distress appears mild, moderate or severe. These are some of the options:

• Perinatal psychologist or counsellor.
• Psychiatrist.
• Mental Health Social Worker.
• Specialist support groups or a specialist telephone support service.
• Online support tools.
• A mother-baby unit (MBU) within a hospital.

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Psychological and counselling support

There are different practitioners offering counselling including: psychotherapists, psychologists, psychiatrists and mental health social workers.

If a parent is referred to one of these, they may need to navigate the Medicare system. GPs are available to help with this and can complete a Mental Health Care Plan in conjunction with a patient. This plan means that with eligible psychologists and counsellors, a parent can claim part of the cost back from Medicare (called a rebate) for six or 10 sessions. Not all counselling services are eligible for the Medicare rebate, so parents need to check with the service before starting.

There are some community services that provide free or low-cost counselling. There also may be free psychological support available under Medicare bulk-billing through some services (including Gidget Foundation Australia). If a new parent is struggling to identify suitable and accessible support, it is important that a professional help them to explore options.

For people in rural and remote areas or people with accessibility barriers, there is an increasing number of counselling services that can provide support via software such as Skype, Zoom or over the phone such as our Start Talking Telehealth program.

Psychological and counselling support varies according to different practitioners and therapeutic styles. Doctors can provide referrals to counsellors or psychologists but it can also be useful to ask for word-of-mouth recommendations. It is common for people to work together for a few sessions to see if they “click”.

What to expect

Taking into account different styles and individuals here is a list of what to expect in a counselling appointment:

• The opportunity to build rapport, trust and experience a safe place to discuss difficult thoughts and feelings.
• Exploration of emotional triggers and responses to different situations.
• Examining familiar patterns in relationships – how and when these are helpful and unhelpful and how to improve them.
• Exploring the impact of past experiences with one’s own parents or other caregivers and how it influences their own parenting style.
• A way to monitor and assess a new parent’s mental health including asking about thoughts of suicide and/or harm to self and others.
• Identifying negative thought patterns, a person has about themselves as a parent and working on strategies to manage these.
• Helping with any scary or intrusive repetitive thoughts a parent may be having.
• Identifying coping skills and building resilience.
• Helping to increase confidence in parenting.
• Discuss other resources and supports that might be helpful.
• Discussing relationship with yourself, baby and others.
• Practical strategies and tools to manage anxiety.
• Sessions that include the partner.

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Medication

Medication is an option that GPs and perinatal psychiatrists can prescribe for their patients. For some parents in the perinatal period, medication can form an important part of their treatment plan and can be especially effective in conjunction with counselling.

However, it is common and understandable for parents to have reservations about taking medications.

One common concern is about possible physical effects on a baby if taking medication while pregnant or breastfeeding. There are a number of medications that are deemed low-risk during these times. Always remind your health provider if you are pregnant or breastfeeding.  Other common psychological barriers to taking medication include general stigma around mental health and fear about being viewed as a less capable parent. Doctors should be able to acknowledge these and allow the parent a central role in decisions about treatment. A doctor’s role is to provide balanced and up-to-date information and advice.

There are different types of medications used in the perinatal period, depending on the mental health issue. Anti-depressants are the most common form which can be used to treat both depression and anxiety. Other medications such as antipsychotics may be used in severe cases or as an adjunct (in lower dose) in less severe cases.

Specialist doctors such as perinatal psychiatrists work with the latest research and can advise on the risks and benefits of taking medication for each individual. They can help a new parent decide what is best for them and their baby.

Anyone taking medication in the perinatal period should not change or stop their medication abruptly without consulting a doctor as this can make a person unwell.

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Specialist advice resources

The following services can provide specialist advice on medicines for parents who are pregnant or breastfeeding:

• NSW – Mothersafe at Royal Hospital for Women: 1800 647 848‍
• VICTORIA – Monash Medical Centre, Mr Rodney Whyte: (03) 9594 2361‍
• PERTH – Obstetric Medicines Information Service: (08) 6458 2723
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For general advice nationally (not specific to perinatal patients):

• NPS MedicineWise - 1300 633 424 OR local pharmacies

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Date of Last Review: April 2021