Black mothers twice as likely as white mothers to be hospitalised with perinatal mental illness

Black mothers are over twice as likely to be admitted to hospital with perinatal mental illnesses than their white counterparts, a Guardian analysis of NHS figures shows, with the racial disparity being described as “horrifying”.

There were 777 admissions to NHS England hospitals of people with a primary diagnosis for puerperal mental disorders – occurring in the six weeks after childbirth – between 2020 and 2023. Of these, black women made up 12%, despite accounting for only 5% of deliveries in the same period. They were also more than twice as likely to be admitted to hospital than their white counterparts, according to the analysis.

Several factors contributed to the ethnic disparities, including “structural inequality, with women from ethnic minorities on average being worse off socioeconomically, difficulties accessing services, and cultural attitudes towards mental illness”, said Dr Katie Merwick, a senior clinical research fellow and honorary consultant psychiatrist with NHS Lothian.

Dr Rosena Allin-Khan, the Labour MP for Tooting, said the disparities were “hugely concerning”, and that “every new mother deserves the very best support when having a child”.

She added: “We know all too well that black women face worse outcomes in maternal health, and it is horrifying to see these play out in maternal mental health services too.

“It is imperative that women are able to access services within the community so that support can be received early. After 14 years of Tory mismanagement of our NHS causing sky-high waiting lists, it is unsurprising that many women are struggling to access community support.”

For black patients, there were 0.91 hospital admissions per 1,000 birth deliveries for perinatal mental illnesses, compared with 0.43 admissions per 1,000 for their white counterparts.

The figures showed black women were more than three times more likely than their white counterparts to be admitted to hospital for severe instances of perinatal mental illness and behavioural disorders associated with the six weeks immediately after childbirth.

For severe puerperal mental health admissions, there were 0.7 admissions per 1,000 deliveries for black patients, compared with 0.2 admissions per 1,000 deliveries for white patients. Patients from Asian and mixed-race backgrounds also had an increased risk of hospital admissions; 0.25 per 1,000 deliveries for Asian patients and 0.54 admissions per 1,000 deliveries for mixed race patients.

The hospital admissions the Guardian analysed ranged from mild to severe mental and behaviour disorders, and included puerperal mental disorders, which can include postpartum psychosis.

Up to 1,200 new mothers across England and Wales experience postpartum psychosis each year, according to the Royal College of Psychiatrists.

Postpartum psychosis is seen as a medical emergency that can cause depression, confusion, hallucinations and delusions, and – when left untreated – can lead to grave consequences. The illness most commonly presents itself in the fortnight after childbirth.

The figures further reveal the stark racial disparities in maternal healthcare, with black women being almost four times more likely to die in childbirth than their white counterparts.

A record 57,000 new and expectant mothers received specialist support for mental health problems in 2023, according to NHS England.

Birte Harlev-Lam, the executive director midwife of the Royal College of Midwives, said: “The provision of perinatal mental health services across the UK and particularly in areas of high social deprivation, where often women need the most support, for too long has been a postcode lottery. Action is also needed nationally with a multi-agency approach to better support black, Asian and minority ethic women who are suffering with perinatal mental health issues.

“There needs to be more joint working between clinicians so that issues are spotted earlier, better training – and the time to undertake such training – and specialist midwives to meet the increasingly complex needs of these women and families. Mental ill-health ranks with physical factors as one of the leading causes of maternal deaths in the UK, and yet this is not reflected in the resources allocated to it.”

An NHS spokesperson said: “The NHS is committed to supporting women with mental health issues – every part of England now has a specialist perinatal mental health team and we have recently opened 39 maternal mental health services, with almost nine in 10 women reporting they are receiving mental health support during pregnancy.

“However, we know there is more to do, including to address racial disparities, and we will continue to work closely with NHS Trusts to ensure safer, more personalised and equitable maternity care for all women, babies and families.

“If you are pregnant or have given birth recently and are struggling with your mental health then please ask your GP or other services for support – the NHS is here to help.”