Exploring perinatal mental health with Smart About Health’s Dr Laura David

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Lucinda Quigley: Hi there, I’m Lucinda Quigley Head of Working Parents and Executive Coach at Talking Talent.

Laura David: And hello, I’m Dr. Laura David. I’m an NHS GP and the founder of Smart About Health. This podcast is all about helping you tackle challenging and to-do areas of health and wellbeing in the workplace.

Lucinda: And it’s produced by Talking Talent in partnership with Smart About Health. Today we’re going to be talking about the subject of perinatal mental health. So today we’re going to be talking about the subject of perinatal mental health. Laura, let’s start off with looking at actually understanding a bit more about what do we mean by perinatal mental health, in your experience.

Laura: So, we can think of perinatal mental health as being an overarching term for mental health issues that occur in the antenatal period. So when a couple is expecting and in the short period of time after birth, and then the more long-term experience after birth. And we would often classify perinatal mental health or postnatal mental health issues as being up to two years after someone’s had a baby. And that’s really important actually to think about when we talk about diagnosis and think about delayed diagnosis and how things don’t always surface immediately. When we think about perinatal mental health issues they may be preexisting. So they may be something that somebody’s already dealt with in their lifetime or is dealing with, or they may be new, and they may be new during pregnancy, after birth, or in that postnatal period up to two years.

They may be things that we’ve all heard of, like depression, postnatal depression, probably all heard of that terminology. it will also encompass aspects like anxiety. So perinatal anxiety, perinatal OCD, so obsessive-compulsive disorder, is something that’s actually more common than we think when we think about perinatal mental health.

We’re also thinking about some of the other potentially more serious perinatal mental health disorders like psychosis, which is actually, albeit rare, it’s an emergency and it’s an important thing that people need to know about and to know that they need help immediately if they’re experiencing psychosis. This isn’t the purpose of this podcast, but just to explain really briefly, that psychosis involves out-of-body experiences, hallucinations have really invasive thoughts potentially about harming yourself, harming your baby, not being able to keep your baby safe. So there are significant safety issues that can arise with those people who’ve experienced psychosis. One really good thing to know about psychosis is that it’s completely treatable and most women completely recover from psychosis. But there have been quite a number of documentaries around perinatal mental health and women and baby units, for example, and people may be experiencing psychosis or severe depression.

Actually, perinatal mental health issues are very common, much more common than we think. The statistics are that up to one in five women, new mothers or expectant mothers, may experience perinatal mental health issues and think about the most common ones, which are the anxiety first and foremost, and depression. And actually, it’s not just women that are affected. It could be partners and husbands, fathers. We know that the statistics say up to one in 10 men may be experiencing perinatal mental health issues as well and this is almost certainly underreported, because I can count on my hands as a GP how many times I’ve seen a father come in and talk to me about their perinatal mental health. It’s so stigmatized and it’s not widely available, this knowledge that can happen to partners as well. There’s a lot of work that needs to be done to make sure fathers and partners are supported as well as the person who’s given birth as well.

Lucinda: Yeah we’ve talked haven’t we before in other podcasts, around the challenges for different groups of people, either socially or culturally around having conversations and this idea that we know that a lot of perinatal mental health challenges are undiagnosed. But we also know in the statistics that black women particularly are more likely to suffer from perinatal mental health challenges. And I think that’s important to recognize as well, both for individuals and for employers.

Laura: Absolutely. I think we just need to consider that there are different experiences across the world in different groups, And in fact, in our society and the Western culture, perinatal mental health issues are the commonest complication around birth and having a baby. And in the developing world still unfortunately, maternal death is one of the biggest risk factors of having a baby. And we need to think about all of the other issues that compound some of the experiences of different groups when they’re having a baby or building a family.

Lucinda: So I think as part of the main reason why we wanted to tackle this subject is about actually encouraging more people to have conversations and to be comfortable in the knowledge that lots of people are affected by perinatal mental health challenges. And as you said earlier, it is a spectrum, so we hear the term baby blues quite commonly. Can you just explain a little bit more about what do we mean by baby blues, and how prevalent is that, and why does it happen?

Laura: Baby blues is really common. We think about one in three or one in four women are affected after birth. It’s a hormonal shift. Of course, we can all imagine, there are these huge hormonal changes that happen when you have a baby. It’s usually short-lived, it usually goes away in the first few weeks. I certainly had baby blues, with my first…

Lucinda: Me too.

Laura: It’s so common and I just remember crying all the time but not feeling sad. I think this is one of the big differences is that I didn’t feel overwhelmingly sad. Just to remind people that this often happens very shortly after birth in the first few days. I just remember feeling really tearful and not really being able to control my emotions and I remember phoning up to buy a gift for somebody and blubbing to the woman over the phone and sort of trying to make sure that she’d actually got the right address through my tears, but it goes away quite quickly.

And I would say people start feeling back to their previous selves quite quickly with baby blues. So thinking of it as a short-lived hormonal shift in hormonal changes after birth. With postnatal depression, I’m just going to focus on postnatal depression, anxiety really here, being the most common scenarios that people may find themselves in. It may not happen immediately after birth. We think that the peak of onset is around eight weeks after having your baby, but it may be much later, or it may be that these issues weren’t recognized or weren’t sort of brought to the forefront until much later on. That can be even after a year or going back to work. Sometimes it’s often a retrospective diagnosis thinking, okay, yes, I think that’s what I was going through. That happens a lot with perinatal mental health issues.

But it may be that there is that crossover. As I said at the beginning, that if you have had antenatal, so in your pregnancy, you’ve had either new-onset anxiety or depression, or you’ve had existing anxiety and depression, which may have worsened during the pregnancy. Of course, you know that pregnancy is anxiety-inducing experience, there are so many things that you think of, and you need to do, and potentially things that may be being monitored. So that may be that it does overlap with that baby blues in those first few weeks because there are already existing issues going on.

So what about working parents, Lucinda? This is really important that working parents are aware for both men, women, everyone in your organization, that perinatal mental health exists. In your line of work, what are you seeing?

Lucinda: Yeah, thanks, Laura. So, I think the key thing for me, you know we’ve talked about this a little bit already, is normalizing perinatal mental health and the experiences that people can have. I think firstly from the parent’s point of view to know that there are lots and lots of people who are experiencing mental health challenges, and it’s really normal and understandable with, as you say, the hormone changes and the breadth of things that you have to think about, all the new things that you’re trying to manage – you know, things like feeding the baby, whether that’s successful or not – that can be really challenging for new parents. And just the stress of trying to keep this new little bundle alive!

As we think about working parents, particularly the reality then of moving into a situation where you’re having to think about returning to work. And for a lot of first-time parents, in particular, they feel real pressure to return to work in the way that they left. So to go back to being the person they were before they had their baby, and I’m sure there are lots of people that can identify with that. I certainly felt that way after my first child. So there were these pressures that we placed on ourselves because, in reality, we don’t talk about this stuff enough. We don’t talk about the fact that it’s hard to go back to work after having a child and that we put pressure on ourselves and that actually, we might not want to leave our children straight away. We might want to have a couple of more months at home. So, I think one of the challenges is that there’s lots of unsaid stuff around, you know, being, being a working parent, both for mums and for dads, whatever your situation.

And then it’s this expectation piece, the pressure that we put on ourselves, the expectation, as I’ve said that it’s all going to be like it was before and that we’re just going to manage and get on with things. One of the commonest things I hear from people who are returning to work is well everybody else is doing it, so I just need to get on with it. Of course, that’s true lots of people do it, but we don’t talk enough about how hard it is for parents to go back to work and to start this new phase of their career as a working parent, where they’re trying to be an amazing parent to their child, which they’ve recently bought into the world. But also try to continue their career and often trying to do it exactly as they did it before.

So for me, there’s this really important factor of acknowledging that this is tough for parents when they return to work. Interestingly Talking Talent did some research at the beginning of this year that showed that even parents who have teenagers still talk about the return to work as being the hardest point of their career. So, that’s really important to know and acknowledge. But also, if we know it’s harder then what can we do about it? What can we do to support people, talk to people, and also empower the parents themselves to seek help when they really need help? I think those are the key things that are important for me.

Laura: Absolutely. I think a few things that you mentioned there really key to pick up on is that, and I think this is not entirely exclusive to first-time parents. Every time and any time that you bring a life into the world, is that your identity shifts, and this is a really big part of what I see is as a driver potentially for perinatal mental health challenges, is that what you said about going back to work and resuming that same position, or maybe you’ve been promoted while you’ve been off and you’ve actually got more expectations. We talk about confidence, your confidence may shift if you have been off work for a significant period of time.

If you’ve had a mental health challenge, your confidence may well be lower and that is potentially, as a feature of depression, is that you may be feeling worthless or hopeless or not worthy. You maybe have thoughts about the future that don’t feel good. You may not be able to think about the future. You may lack hope. And a lot of these features can overlap with your new identity when you’re going back to work. So of course, it’s really important for workplaces to acknowledge if there have been any perinatal mental health difficulties for both. If there are two people in the relationship for both parties, and again, I’ll go back to fathers because I think that they often, in many cases will go back to work first and they will be experiencing sleep deprivation and all the difficulties that are going on at home that are challenging, albeit in most cases, rewarding. There’s a lot of change going on at home for them as well and conversations need to be had, but it’s really important that we think about the identity shift.

For me personally, and I’m going to talk about my personal experience of perinatal depression, anxiety, but that shift in identity, who were we when we left to go on our maternity leave or our paternity leave or parental leave? And who are we now? For some people, that can feel quite different and quite unsettling. It doesn’t mean that if you’re, you know, recognizing that there has been a shift in identity that you’ve got a perinatal mental health issue, but it may be a factor that’s really important to this equation. Certainly, for me, it was very much about that loss of identity of who am I? Am I still a doctor, because I’m now on maternity leave? It’s still me.

A lot of people are very defined by their careers. I’m not saying that’s a good thing or a bad thing, but it may be that before you left on your parental leave that that was very much central in your life, and now you’ve stopped, you’ve slowed down, you’ve resumed a different position. How does that feel? That can feel quite confusing for people. So, acknowledging for yourself that that is a shift that you might be experiencing. Also, for the employer, the manager who’s going to welcome that person back from their leave at some stage and really needs to find out the best way to support that person. Again, things that you’ve said before about assumptions, not to assume certain things either about their maternity or paternity leave or about what their needs are when they come back to work.

Lucinda: Yeah, we’ll talk about that, how you can support people, won’t we, a bit later on. I’m just keen to explore this bit around, maybe not why it happens, but what are the triggers? Because we’ve talked about the fact that there’s the hormone shift. We’ve talked about the additional stress may be of returning to work. Of course, there are other challenges that parents can sort of manage, that will find hard to manage out there in those first sorts of six, maybe months to a year, maybe isolation. If people have been isolated without much support, maybe people who’ve not had parents near them or in a different country. We know that’s really been a challenge over the last couple of years. Are there any other sort of reasons why this happens, I suppose, is the thing that I wanted to ask. What should we know about why this happens?

Laura: Yeah I think with any mental health issue, especially when we’re talking about depression and anxiety, it really is multiple factors involved in why these things happen. If we think about some of the other mental health disorders, like bipolar or psychosis, maybe it looks slightly different in terms of the causation, but one is it can happen completely out of the blue. I suppose that’s a really important message is that you may not have a family history. You may not have had a stressful life. You might not have experienced trauma. Your birth may have gone well… And you can still get a perinatal mental health issue, especially these common ones like depression and anxiety. The other things that I mentioned there are some of the factors that may be involved, which are things like strong family history of mental health challenges, especially depression. We often look back to family members and see that there are other people in the immediate family who are experiencing mental health issues. Of course, mental health is multifactorial anyway, so thinking about stress, thinking about the social aspects, what’s going on for somebody, what’s going on in their immediate support circle. Absolutely, as you’ve explained, lack of support is certainly an influencing factor.

Lucinda: What about a traumatic birth? Because that’s something that I think particularly from a work perspective if people are aware that someone’s had a traumatic birth and then maybe, not necessarily, but there may be more chance of them experiencing mental health challenges.

Laura: Definitely. I mean, birth trauma is directly linked to postnatal mental health challenges. But to frame that in a sense that trauma is such an individual experience, and somebody could have on paper a really traumatic birth. Somebody who’s reading that paper might say, oh my goodness that was so shocking, surely that person must have some consequences from it. And actually, it doesn’t always work like that. So trauma is such an individualized experience. It’s often also based on previous trauma as well, if you’ve had any of those in the past. But certainly, a traumatic birth could be a stimulant for developing postnatal issues in the mental health area. Snd of course, physical issues as well, and things like previous experiences. So if you’ve had miscarriages, if there have been any complications in your pregnancy, so any pregnancy that’s involved a lot of monitoring, and there’s been anxiety or premature birth. These can all be risk factors for developing postnatal, depression or anxiety, or other issues. So, it’s quite broad potential issues that can crop up for people. And it’s not always correlating with your experience and then you get the postnatal depression or anxiety. It may come out of the blue, or it may be that actually, you’ve had those experiences that we would consider difficult and actually, there aren’t any consequences from it.

Lucinda: Yeah. I think for me what I’m reflecting on as you’re talking is this idea that one of the things that I talked to my working parents a lot, or expectant parents a lot, about is this idea of control and the fact that when you’re pregnant, particularly if you’re a pregnant person, then there’s a lot of things that you lose control off, including physically. Then if your expectations around the arrival of your child don’t go to plan, that could be one of the things that potentially triggers it, I suppose. It doesn’t have to be, I think, what I was hearing you say is it doesn’t have to be trauma in the traditional sense. It could be trauma in that the birth plan didn’t go to plan, or you didn’t get the birth that you wanted, or even if there was a situation where you had to be put in an ambulance and everything turned out okay, but even just that on its own. So, I think there’s something about again with all of these topics we talk about making sure that you understand the individual story and how that might be affecting them. Yeah.

Laura: Birth stories, and I’ll come and speak about my story, but I think birth stories are really important. It’s not always something you’re going to go and talk about with your boss or with your manager, but it may be a really important factor. And actually, the more we talk about birth stories the more normal it feels. And to recognize that the last two years have been difficult for people. They may not have been able to do certain things with the people they want to around the birth. Things may not have gone the way that they’ve planned it and I think being able to reflect on your birthing experience can often be a really therapeutic piece of the puzzle and that isn’t done that well, I must say.

In the NHS, there is limited opportunity. There’s not always that support. So, I’m not saying that’s an excuse. It’s all about the NHS, but I’m just saying that there are potentially other angles that people can pursue to find that connection with somebody that they want to talk about their birth experience with. It could be a professional, it could be a colleague, it could be a friend.

The more we talk about birth stories and birth experiences the more we can process them together as a society, and we can if realize that not everything always goes to plan, that there sometimes is a need for certain interventions to make sure that everything’s okay. But collectively we can start to talk about birth stories, birth experiences, and then subsequently, has there been any issues that have come up after the birth or in the pregnancy? So these are all really important aspects that can be spoken about in the workplace. It’s not necessarily a private thing that we have to shy away from. And it might be a really important part of somebody’s journey that they want to talk about. You can ask me about my personal story, I think, is that right?

Lucinda: Yeah. But because I know that you’re happy to talk about it and I do think that part of these podcasts is about normalizing as we’ve said. So, I think it would be good to hear your experience. And then maybe also talk about what people can or when should your learnings and also obviously as a GP, is when should people ask for help as well?

Laura: Yeah. I’m really happy to share. I’ve always said we do a lot of work around perinatal mental health to try and bring it to the forefront, help people understand when they need help, why they might need help, that it’s okay to need help. We can’t always have this you know, dreamy experience of, you know, having the baby, everything’s going fine, and we’re all happy, and we immediately love and connect with our baby, and everyone’s one big happy family. It doesn’t always work out that way and it’s okay. You can get through. My story, my experience is that actually perinatal depression, which I’ve just alluded to before, hit me completely by surprise.

It happened with my second daughter. It wasn’t with my first baby, where I had the baby blues and then I think I was fine afterward. It kind of went away and you think, okay, well you’ve done it once, the second time it’s going to be easier. Although having two kids is obviously hard work you think, well, I’m experienced, I know how to do this, I know how to do that, so everything’s going to be much easier this time. And perhaps you’ve been told that by relatives, friends, or society that yeah, you’ve been there, done that, bought the t-shirt it’s all good. Actually, as a doctor really it threw me because, and I’m not saying this is correct in any way, but a lot of the messaging you get as a doctor is, well, these things can happen to your patients, but they can’t really happen to doctors. Of course, that’s the most ridiculous thing. If you hear it, people are probably confused by me saying that, but that’s the messaging that often doctors receive is that your patients come first, that what you tell your patients might not necessarily apply to you.

Look, I realized that through my work in the wellbeing sector, that of course it does apply, and it should be self-care, and self-recognition of what’s going on is essential. But it really took me a while to understand what was going on for myself. Partly it was around the identity shift. I’d gone from working, I’d been managing to work and have my other daughter and go back to work and everything was fine. I felt quite lost at the point when, and it didn’t happen immediately after birth I must say. I did have difficulty with breastfeeding. That didn’t help. I did have a slightly complicated pregnancy. I don’t think that helped. I had a cesarean. I’m not sure if that helps or not. Obviously, it’s a major operation, gotta put that out there.

Lucinda: Absolutely.

Laura: You’re expected to carry on. You can’t just rest and recover after that of course. But I suppose those kinds of things, you just take it on the chin in a way. I started to feel quite bad after about two, three months and I couldn’t sleep. You could say, okay, look, nobody sees from the babies there. But actually, I really couldn’t sleep in the sense that she would sleep. I mean, she wasn’t a great sleeper and that was another issue as well which compounded things. But when she was asleep, I couldn’t sleep.

My mind was racing. I could also hear her crying when she wasn’t crying. You’re so switched on. I knew it wasn’t real, but I was always listening. I was always hyper-aware of what was going on. It really ended up being almost like a crisis for me and my family, where I just felt really miserable, really low. I didn’t want to go out. I didn’t want to see my friends. I didn’t have any real symptoms of disconnect from my second daughter or my first daughter. But I know that that is something that can happen. People can feel disconnected from their baby. They may feel like I don’t love my baby – that’s a really hard thing to say and to think, but some people do feel that way. You may feel that you haven’t bonded or that having a baby has been a difficult and negative experience.

It ended up actually really affecting my husband as well because of course, he doesn’t want to see me in distress and doesn’t want me to feel like there’s no way out, what am I going to do? How am I going to feel? How long am I going to feel this way? And it ended up being that he was really down as well, and he had to take a significant period of time off work too and there was nobody at work that he could talk to. I think the message that I try and give when it comes to my experience is one, your identity may really shift, it may actually prevent you from seeking help. Eventually, I did seek help from a really good source. It was really difficult for me to go to see my own doctor because, of course, I know all the doctors around me. That also held me back, I think, in terms of getting help. I sought help independently outside that.

But what I would say as well is when you’re going to see your doctor at your six-to-eight-week check, which is just something we have here in the UK, I am aware that it’s not always the same globally. But you have an opportunity to speak to your doctor and hopefully, it’s done in the right way that you’re given that space, that separate space from what’s going on with your baby, which is often felt to be the primary intervention at this stage. But it is a time to speak openly with your doctor and hopefully, they will use the right language to make you feel comfortable, and open questions to help you talk about it. And I always say to my patients now that even if you’re feeling fine, which is great, and I don’t want anyone to feel like feeling fine, they shouldn’t be feeling fine. Of course, if you’re feeling fine, fantastic! But it may come later, and to really be aware that perinatal mental health issues are very common and that there are signs that you should be aware of, and you should be aware of them in your partner as well.

If you’re a grandma or grandpa or an auntie and uncle to be aware of them in your loved one, and to really approach it with kindness and approach it with the right language. Using inflammatory comments like this is just part and parcel, this is to be expected, sleep when the baby sleeps. These aren’t realistic comments, they are things that I think are quite unhelpful.

And use the opportunity to speak to your doctor. Eventually, I did seek help and, and eventually, I got better. I feel like I got better. Of course, there are times in my life when I feel like, oh my goodness. I remind myself. I feel like I’m reminding myself as that person who was me in those early days, but I feel better. You work through it and often for me, I found my purpose again, as well as being a mother, was to work on my business and develop the business. That really helped me to recover. Exercise also helped me to recover. Speaking to professionals helped me to recover.

The purpose of sharing the story is to normalize it, but also to help people realize things aren’t always textbook. Some things may creep up on you and it’s okay to seek help when you need it.

From your perspective Lucinda, how does this relate to the emotional challenges, and how this affects parental wellbeing in the workplace or outside the workplace? This is our whole life, right, we’re a working parent so we have to think about not losing sight of wellbeing when it comes to being a working parent.

Lucinda: Yeah so I think the reality is, as we know, that working parents have very busy lives and particularly the last couple of years has been a real intensity to that with everything that we’ve been managing. I think the really important message from what we heard from you is the fact that there are always going to be good days and bad days as a working parent right. You’re still going to have sleepless nights, some children don’t sleep well until they’re five or six, or maybe never. You’re going to have days where it’s really hard. And I suppose it’s knowing that, but then also being aware that if you are experiencing regular insomnia, the things that you’ve talked about, the sadness, that it is important. I think heightened emotions, if that stuff is recurring, then that’s when it’s important to seek help. And that within the workplace it is important to be open and honest about some of the challenges that you might be experiencing.

If you can’t be open and honest with your manager, then finding someone else, maybe that’s someone in occupational health or going through your employee assistance program, if you have one and seeking help through them is really, really important. And also, I think even if you’re not experiencing perinatal mental health issues, being able to talk about the challenges that you might be experiencing, so whether that is managing childcare and that’s been difficult for you, maybe your circumstances at home have changed and that’s giving you added pressure.

It’s really important, one way in which I think working parents can really support their own mental health and wellbeing is around making sure that they’re putting the right boundaries in place to ensure that their balance is sustainable. So making sure they’re not trying to do everything. They’re not trying to be the perfect employee, they’re not trying to be the perfect parent, because that’s not sustainable and we know that. But how can you really focus on doing the things that are important to you that make you feel good and also really making sure you’re having those conversations with work around what you can achieve and also what are they expecting you to achieve at the same time.

And I also just want to say around the return-to-work piece, because we know that this is a challenge, as we said earlier, is that it is really important to recognize that return to work is a transition. It’s a process. The reality is, as I said, I was one of them, expect to flick open the laptop on your first day back at work and everything to be as it was before. But we know that for most working parents, it takes three to six months to feel like you’re actually back up and running and managing. Have some self-compassion with that, manage your own expectations about what you can achieve, and get the support from work and your managers to really help you manage your work/life blend and sustainability, I think is really important.

Laura: I totally agree. I think it’s really important for both the individual and the workplace to recognize that this is a transition, whether it’s coming back to work after two weeks or two years. Of course, there are different needs associated with that potentially, but having a child, having a new child, whether it’s your tenth child or first child, is going to be a change for that individual. And thinking about the needs of that individual as they navigate this new lifestyle and the challenges that come up with that lifestyle. I think having a supportive team around you and hopefully, you will be enabled to go back to whichever position, and whichever level of seniority, or a role that you’re taking on, and be promoted and get to wherever you want to go. But to you remember that it is a transition and to those who are supported in that transition, they’re going to be much more likely to want to stay and want to work and be productive and be happy in the workplace and feel fulfilled in both their home life and their work life.

So ensuring that that transition is recognized and there’s a process to it is going to be a really positive experience for everybody. And then that translates into that go back to that concept of mentoring and if you’ve gone through it, and you’ve had a good experience, then what about the next person in your team that goes off on parental leave? How can you benefit them? How could you perhaps be somebody they could speak to, that option for peer-to-peer support, as well as that hierarchical support as well.

Lucinda: Really talking about creating good culture, aren’t we here? That culture of being able to have open and honest conversations, but is supportive of working parents and the challenges they face. Let’s talk about clients and employees specifically shall we, and what they can do to support people. So, in your experience, if you know that you’re welcoming someone back who has experienced perinatal or postnatal depression, or mental health challenges, what will help support them back into the workplace do you think?

Laura: One is it’s really important that all organizations educate themselves about perinatal mental health issues. So there’s a wider angle around making sure that everybody’s prepared and everybody has some baseline knowledge of what could be going on for somebody else, and how common it is, and to expect that at some point in your career, especially as a manager, you will be welcoming somebody back who either has been diagnosed with or has undiagnosed perinatal mental health issues. That could be a woman. It could be a man. It could be anyone who has had a new child. So first of all, it’s about upskilling and making sure people are educated. Then, I think what really helps with anybody is, as you said, it’s a transition. So, you are going to have these conversations. If you’re not having them, this transition conversation, you’re really missing out on an important piece of this puzzle where somebody is coming back to a role, and they want to excel, and you want them to excel in this role. So making sure that there is time set aside for a transition, and that might start before that person gets back into their role. It’s okay to keep in touch with people while they’re on their parental leave. Depending on your relationship, you might have a really friendly relationship and actually, you might be keeping in touch on a regular basis, where it may be just more regular points put in the diary to see what’s going on for that person. So trying to understand what that experience was like for that individual. And if it comes to the forefront before the person comes back to work, they have had a diagnosis or they’re experiencing perinatal mental health problems, there needs to be almost like another plan that’s in place to make sure that their needs are being met and they can be supported, because just like we’ve talked about in some of the other podcasts as well, is that going back to work is going to be a huge transition in itself.

Even in the hybrid world if you’ve got older children, it’s still a big transition. But we’re thinking about somebody who actually is living through a mental health issue, and they may be needing very specific support. It may be that at that time you offer to involve HR or occupational health, thinking about working patterns, thinking about what their needs are in a very specific way. And hopefully, if you set the conversation up in a really open and honest and supportive way, then you would be met by somebody who’s willing to share what’s going on for them, what the challenges are that they’re experiencing. They may well have their own ideas about what can help or what’s helped already. Some of them may be things that you can do as a manager, some of them may be external to that.

I think one of the really key things to do is to look at any transition back to work. And that still counts for somebody that may be coming back from a short period of leave after a baby has been born is what’s going on for you? What challenges are you experiencing and how can we help at work? Of course, that person is in work, and they need to be able to work, so how can we make sure that this is as easy as possible transition, and then who in the organization can help if things aren’t going quite right? Because some people may go back to work and feel really overwhelmed, and as a manager, you might be somebody that they go to speak to you first. Is there anyone else? Is there an employee assistance program? Is there anyone else that they could talk to or be supported by? Are there mental health first aiders or wellbeing champions? Is there somebody in the team or the wider team that has been through this before that they could speak to? You and they may not have all the solutions, and I think that’s a really important piece.

Lucinda: Yeah.

Laura: But if you’re welcoming somebody back you should really make sure that you have a plan in place and also that that plan is followed up and there’s an ongoing dialogue, and it’s not just left as right, that’s it, you’ve come back to work now, get on with it.

Lucinda: And also, I think that it’s a good point to make that, that plan is flexible as well, because someone who is experiencing perinatal mental health challenges might want to have the eagerness to set a plan and to have something that they can work to. But when it comes to it, they might not feel that they can follow through on it, and that is certainly something that I’ve experienced in the past with supporting people that actually, when it comes to it, it’s just going to be too difficult and therefore there does need to be that flexibility, doesn’t there and continual communication. Yeah, and reality around it. Yeah.

Laura: So, from your perspective Lucinda, if a manager or somebody in a supportive role is worried about somebody, they suspect that they might be experiencing postnatal depression or something similar, what kind of tips could you give to those people?

Lucinda: It’s a really tricky one, isn’t it? I think as a manager, and it’s that kind of almost awareness of what’s going on with your people. It’s a really good skill to have, isn’t it? Obviously, performance and business objectives are the main aims. But having that awareness of actually what’s going on with your people, how are they? How are they functioning, really functioning? And that they’re not doing the classic swan, of sort of appearing okay on top and then battling furiously underneath, which we know a lot of working parents do.

I think, as a manager, if you suspect someone is struggling, it’s important to know that this isn’t all on you. It’s not all about you having all of the answers but having a bit of a toolkit to manage those situations. So you mentioned earlier, Laura, knowing what the internal resources are. So what is on offer through your EAP? What are the contacts in occupational health?

But I think more importantly on top of that, it’s being able to approach that person to firstly maybe ask them, you know, what support they might need, because bear in mind, they might not have had acknowledgment themselves that they’re struggling. So, it’s a difficult line to toe, but the message that you want to give that person is that you’re there to support them. So, whatever they’re experiencing, that you are there to support them without judgment and that you are there to listen to them, and that you’re keen to know how you can support them. So, tell me what I can do as your manager, tell me what support you would like. So, that’s the supporting and the acknowledging and then the listening as well, being able to listen to someone because you might find then that they open up and actually they just need to be listened to or heard. And that is an amazing gift to give someone particularly in the workplace, and we know people do struggle to talk about these things in a professional setting.

And then it’s linking them up with the right people, as we said, what, or who can help them. And sometimes it’s also acknowledging that maybe you’re not the right person for them to talk to. They won’t open up to you for whatever reason and that’s okay as well. It’s about giving them links to other people. We know through our research that the two things that managers can really help working parents with when they return are their network, so supporting them with building their network, and confidence. So just also having that in the back of your mind, I think when you’re supporting parents back into the business is really important.

Laura: Absolutely. I think there are really good business cases as well for the wellbeing conversations happening. Not just thinking about any business outputs and productivity, because they’re all linked together and there were some nice studies done by Gallup actually who looked at where wellbeing conversations were put into the appraisal and put into regular conversation that productivity and engagement such as workplace satisfaction went up to two and a half times where companies were not having these conversations.

Lucinda: Yeah.

Laura: It may be a disempowering position to be in. One thing that I’d like people to think about is we’re not expecting a manager to be able to diagnose postnatal depression. But one thing that can happen is that going back to work, there may be an underlying something that’s going on for that individual, that worsens when they come back. Often postnatal depression, for example, is not diagnosed potentially before people then enter another transition in their life and they look back and go okay, look, I can recognize what was going on for myself, but actually, it’s got worse now, it’s surfaced now and the workplace may be the trigger, but it could also be a position where people can get that support.

Thinking about how to open up those conversations can be quite difficult. But if you think about just asking somebody’s something really open, like tell me a bit more about your experience of having a baby, or how has your year been while you’ve been off, if you’ve been off for a year, six months, three months, whatever it is just really open to find out what’s going on for that person. One thing that comes up for us a lot when we do manager training around difficult conversations is that that individual may not initially feel comfortable opening up to you and that’s okay. It’s not anything that you’ve necessarily done wrong. I mean, there are ways that you should set it up for potential success, but it may be that the trust isn’t there yet. I like to allude that to being a doctor and having a patient come in. We got this concept that there may be something missing. What’s the unspoken elephant in the room that somebody hasn’t really necessarily brought? They come to you to talk about one thing but actually, there’s something else niggling that they really want to talk to you about. But they need to build up the trust and confidence in you first, in that if you’re a new doctor to them or you haven’t already got that rapport, something that’s quite personal might not come to the forefront initially.

So to think about this as a continuous conversation, that you can go back and revisit it, that it’s actually a really supportive thing to do, not to just write it off and say, well, they didn’t tell me anything so they must be fine to keep revisiting it and also to remember, and to maybe have this sort of preamble that we know coming back to work, it can be really stressful. Having recently had it had a new baby and navigating this period of time, it would be useful to have regular check-ins and see what comes up. And look, if somebody is completely fine and they genuinely are, they’re happy then great, celebrate it.

Lucinda: Yeah, absolutely. So, I think the message there isn’t there Laura, that this open and honest conversation is never going to be a bad thing ultimately. You may just be able to support someone who’s having a really difficult time and support them through that in the work setting to allow them to continue their career in a positive way. It’s such a big topic, isn’t it? There’s so much to talk about, but I think that’s all we’ve got time for today. So thank you so much. It’s, as ever been really interesting to talk to you, and thank you for bringing all your knowledge and insight today.

Laura: Well, thank you very much, Lucinda. Always a pleasure to speak to you as well and we continue to work together on all of these projects. Just to mention to everyone that we’ve got two other podcasts out in this series, one is on menopause and the other is on parental anxiety. So we hope you can join us for those as well.

Lucinda: Absolutely. Thanks for listening today.