Erin Sutherland: Falling Through The Cracks

The news over the last couple of days has been filled with reports of the tragic death of 10 month old Chloe Sutherland who was killed by her mother Erin back in February. 

Erin had been treated for postnatal depression before but was unable to access the help she asked for because Chloe was more than 6 months old and, The High Court in Edinburgh heard, postnatal depression is not considered a factor after 6 months.

Erin was previously diagnosed with postnatal depression following the birth of her older daughter back in 2006. Her symptoms worsened when the child was 8 months old and this led to an admission for treatment as an in-patient.

Recognising the symptoms, Erin sought help from her GP in December last year who rightfully contacted the perinatal mental health team only to be told there was no support they could offer her due to the fact her baby was older than 6 months.

It seems no consideration was given to Erin’s risk factors when making this decision. Her last episode had been when her older child was 8 months old yet she had managed to receive support. The fact that she had required an admission for treatment would indicate a significant risk during a subsequent pregnancy and a need for an increased level of support and monitoring following this. 

Postnatal depression is often not apparent until around 6 months but it is very dangerous to assume that women can not be affected by the condition later than this. There is much evidence from women who have begun to experience the symptoms up to 12 months after giving birth. Erin was concerned about her mental health and asked for help, which she was refused because she didn’t fit into the box assigned for women who have just had a baby.

If it was identified that Erin didn’t meet the criteria for the perinatal mental health team why was she not referred on to general adult outpatient services? Why was the door just closed in her face?  The mother and baby unit in Livingston can provide inpatient psychiatric care up until the baby is 12 months old, why was no referral made for assessment? There is also a Lothian Perinatal Mental Health Community Team who could have advised.

We practice a “no blame” culture in the NHS but are we in danger of failing to take responsibility for our actions, or inactions, because of this? 

Professionals caring for parents during pregnancy, childbirth and beyond need to be aware of the support available in their area, which can, admittedly be a lottery as there is a distinct shortage of beds in mother and baby units in the UK.  Research shows that women can be affected by PND up to a year after giving birth but depression is by no means limited to childbirth. It takes many forms but the common denominator is that it will not go away spontaneously. People who present with mental ill health need support, understanding and, in a lot of cases, treatment. 

We are taught to ask women how they feel, assess mood etc, but do we know what to do beyond that? How many of you reading this are fully aware of what services are on offer in your area?

Erin asked for help but none was given. She was alone and vulnerable dealing with a mental illness which ultimately cost the life of her daughter. Ironically Erin is now being detained in hospital under a treatment order, hopefully receiving the support she needed several months ago but what now?

A system which denies help to a woman because she doesn’t meet a criteria which is flawed anyway will continue to fail the most vulnerable and put their lives as well as those of their children at risk unless it is changed. If women are only beginning to describe symptoms of postnatal depression at 6 months then they need access to specialist support at that point and beyond. There is a distinct lack of provision for women with mental ill health, in particular beds on mother and baby units, which could well have contributed to the decision to limit access to the perinatal mental health team to women who’s babies are less than 6 months old but where does that leave women such as Erin? 

Only 3% of Clinical Commissioning Groups (CCG’s) have a perinatal mental health strategy. Of the 97% with no strategy 60% have no plans to put one in place. There are whole areas where GP’s, midwives and health visitors have no training or time to dedicate to this service which means women are not getting the help and support they need. This has a devastating impact on the well-being of the child and family and in the most extreme circumstances will result in tragedy and loss of life. 

The resources for these services need to be provided urgently, our government needs to stop paying lip service to perinatal mental health and actually make good on these promises of investment instead of making cuts to an already depleted service. 

How many more women, children and babies need to lose their lives before things change? “Lessons learned” are all well and good but I for one am tired of reading about them.