TODAY |

It’s early afternoon in the South Auckland suburb of Manurewa and Nezy Hukui is folding dozens of little dresses and shirts into piles that swallow up her couch.

“There’s another basket of washing in the room,” she says. “I moved it before you came, just to tidy things up a bit.”

Nezy’s lips are tinted red, her black hair is shiny and smooth. Photos of her smiling kids sit on the mantel, and washed pots in the kitchen point to last night’s cooked dinner.

On the surface, she is a mum with everything under control.

“Just last year I was suicidal,” she says.  

“People would say, ‘think of your children, think of how they’re going to be’. I didn’t. I couldn’t.  And it’s not that I don’t want to, it’s just that it wasn’t coming to me, like the emotions, you know?”

The 31-year-old mum of two is battling depression that started halfway through the pregnancy of her second child and has persisted for three years.

“For the first year of having depression, I think my [older] son was away from school for at least six weeks, because I just couldn’t do it. I couldn’t take him. I’d wake up and that’s it. The day was a write-off.”

Most people have heard the term postnatal depression, but according to experts there’s actually a collection of disorders the can affect both mothers and fathers. 

Perinatal Mood and Anxiety Disorder (PMAD) encompasses depression, anxiety, psychosis, obsessive compulsive disorder, and post traumatic stress disorder which start during pregnancy or soon after the birth of a child. Often a parent will be struggling with more than one on the list.

About 1 in 4 mothers will be affected by Perinatal Mood and Anxiety Disorders  - about 15,000 New Zealand mums.

Getting help is a postcode lottery. Most of the country’s District Health Boards have a pool of maternal mental health funding, but the exact amount, how it is spent, and who they treat, is up to each DHB to decide.

Mothers around New Zealand describe the difficulty of getting help, a lack of services, long wait times, and misinformation about safe treatments, no matter where they live.

Parents and health professionals also agree that while there’s a plethora of information about how to care for an infant, there’s little education for new parents on the risks of perinatal disorders.

Stigma adds yet another layer of complexity. Racked with guilt and shame, some mothers hide their symptoms and attempt to battle it alone.

Ministry of Health figures show 4388 women were seen by Maternal Mental Health teams across all DHBs in the last year, meaning 70% didn’t.

Last year, multiple submissions to the Mental Health Inquiry described a “neglected” maternal mental health system. One Plunket nurse said her DHB recently started accepting only severe cases of perinatal depression for treatment.

“A mother must have suicidal ideas before she will be accepted,” she said in the submission.

“I had one mother attempt to commit suicide whilst waiting [for help] ... Very scary stuff when you are out in the field and feel helpless.”

“If you had asked me about mental illness prior to this, I would have been like ‘what’s that?’” Nezy says.

“For me, mental illness didn’t exist.”

Originally from the Philippines, Nezy hid her struggles for as long as she could, only telling her husband who supported her immensely. She’s recently begun speaking to friends about it, but hasn’t told her parents.

“In our culture, having a mental illness is automatically ‘you’re crazy’.”

Like most mental health issues, the causes of perinatal disorders are a mix of biology and environment, and those with a history of mental illness are at a significantly higher risk of developing perinatal depression.

New Zealand research also shows Asian women and women from lower socio-economic households are at a higher risk of experiencing perinatal disorders.

For Nezy, it began with an unusually low mood while she was pregnant in 2016. She hadn’t experienced anything like it with her first child.

Her doctor said it was a part of pregnancy, her hormones all over the place, so it was best to wait until she’d given birth to see if she felt better.

But her mood got worse, and by the time she’d given birth to her daughter, Nezy felt like she was living in a black hole.

“I was just going through the motion without any feeling,” she says.

“I was out of touch with everything that was happening.”

Nezy also struggled with uncontrollable rage, a symptom of anxiety which was mostly directed at her then eight-year-old son.

“Every little thing that he would do, every little noise that he would make, would send me off straight away.”

Despite antenatal classes and midwife visits, Nezy hadn’t heard of perinatal disorders, so her symptoms felt wrong and shameful.

She desperately wanted to be a “good” mum, but dark thoughts, insomnia and intense irritability made it impossible to bond with her baby.

Nezy wasn’t coping and would spend, whatever moments she could, locked away in her bedroom alone. When her midwife asked how she was feeling, she lied and said things were fine.

“I felt like if I answered that something was wrong, they would take my baby away... I didn’t say anything that would cause trouble.”

Parents hiding their struggles is surprisingly common. It speaks to the social pressures on mothers and stigma of mental illness.

survey in 2017 found that 46% of mothers experiencing poor mental health in pregnancy or after childbirth did not tell health professionals because they feared they would be considered incapable of looking after their baby.

For Nezy, it eventually became too much to keep in. At her daughter’s three-month vaccinations, she broke down in tears in front of the nurse.

The nurse immediately suspected Nezy was suffering with perinatal depression and sent her to the doctor, but it took eight months before Nezy was referred to the specialist care she needed.  

The delay, Nezy says, came down to the doctor's lack of knowledge and understanding about her condition, not a lack of caring. But she believes it was the delay that has meant her depression has continued for so long.

A survey last year by the Maternal Care Action Group NZ found nearly half of women surveyed with perinatal depression experienced some delay in diagnosis and treatment. A third of them experienced severe delays of nine months or more.

The delays can be caused by missed perinatal screenings, or health professionals dismissing symptoms.

According to the Ministry of Health, screening for depression should be completed at various stages of pregnancy by the lead maternity carer, often a midwife. Plunket or Tamariki Ora nurses are then meant to screen mothers at the 4-6 weeks check up after birth. But both midwives and Plunket admit that these checks don’t always happen.

“The doctor just didn’t know what to do with me”, Nezy says.

She was sent for blood tests, offered medication, and referred to a thyroid specialist. Nezy’s baby was nearly a year old when she was finally referred to Maternal Mental Health at Counties Manukau DHB.

“If I got the help I needed sooner, I would probably be a lot better now.”

Nezy takes daily medication and attends counselling each week. It’s helping, but she has a long way to go.

“It took one year and three months before I felt something for my daughter. I remember that day, and I broke down crying.

“I’m still trying to repair the relationship with my son.” 

Suicide is the leading cause of maternal death in New Zealand.  Twenty-eight mothers have taken their own lives in the past ten years.  

Our rate of maternal suicide  is seven times that of the United Kingdom.

Māori women are over-represented in the statistics, making up 57% of those who died by suicide in pregnancy or within six weeks after birth.

Jean Te Huia, a midwife with nearly three decades of experience, has seen its effects first hand.

“I've had two mums take their lives.  Both of them came as a surprise to both myself and their family.

“Everybody carries the guilt. I felt guilty. Was there more I could have done for her?”

The suicide of a mother has a profound, lasting effect. It makes the already difficult task of raising an infant seem impossible, sucking the joy out of new life.

“High suicide rates in Māori is predictable,” she says. “We know that Māori women are over-represented in a number of disparities. When we don’t have the services that help them and support them, then we’re going to get the outcomes that we see.”

Māori mothers are especially vulnerable to suicide and mental health issues because of the disproportionate poverty they face, Ms Te Huia says, and the subsequent challenges that stem from it -  like a lack of housing, lower education, and substance abuse.

“You watch in the media the shame and blame culture that’s around. I think many Māori are frightened to seek help.”

Another challenge, she says, is the fear that their babies will be taken if they speak out about their struggles.

“One of the worst cases we’ve seen is a mum has presented perinatally with problems of depression.  We’d sorted assistance for her and then, unfortunately, she was regarded at risk and her children were removed from her care.”

As CEO of Nga Maia Māori Midwives Aotearoa, Ms Te Huia believes incorporating kaupapa Māori into midwifery would lower the suicide rate among Māori mothers.

“All the stats show that when a Māori woman has a Māori midwife, her outcomes are better.”

But New Zealand’s maternity workforce is not comparable with the birthing population of Māori.  

Of our 3000 practising midwives, 88.2% identify as European. Only 9.4% identified as Māori, while at the same time, Māori women made up 22% of those who gave birth in 2018.

“When we have women ringing up asking for a Māori midwife and you can't provide that for them, you become frustrated with the system,” Jean says.

“We haven't been able to grow that Māori workforce in over 20 years. There’s been no plans to develop it, there’s no funding for it. I question does this government really care about Māori women?”

Sarah Hyndman’s voice is tinged with worry.  

“I just don’t think I did very well in that interview,” she says over the phone. “I don't know if I got across what I was trying to.”

The mother-of-three is open about her perinatal anxiety - a struggle that saw her admitted to hospital two years ago - but in her interview for Sunday, she smiled her way through difficult questions.

“I find it hard to go back to that place, you know?” she says. “I don't like to get emotional about it. I block it out.”

The place she struggles to go back to was her rock bottom two years ago.

“I had to get to the point where I was having really bad thoughts before anyone would help me.”

After the birth of her first child, Sarah started to feel crippling anxiety. She was too scared to drive, had trouble getting to sleep, and often felt like her throat was closing up.

She visited her doctor five times.

“They knew I’d just had a baby but said, ‘oh it’s just anxiety. Lavender baths will help.'”

When she had her third baby several years later, the anxiety was so severe, she would go days at a time without sleep.

“I went absolutely crazy. I couldn’t hold a conversation, I couldn’t follow along. I was scared to look after my baby because I knew I wasn’t OK.”

One weekend, after a long stretch of insomnia, Sarah’s husband took her to a walk-in clinic.

“The doctor sat me me down and I just burst into tears and explained the whole thing and how I was feeling.

“I clearly remember the doctor looking at me and saying ‘OK, well, this is a walk-in clinic and I don’t have the time to go through all of this with you ... what do you want me to do?’”

Sarah was crushed, believing she just had to pull herself together and deal with it. All hope of help had gone.

A Maternal Care Action Group NZ survey of 226 mothers with perinatal disorders revealed 43% felt their GPs were unhelpful or average. Mothers said their doctors didn’t always have the time to delve into mental health issues, didn’t know what to do, or appeared uninterested.

Sarah spiralled downward fast.  She hid away from her family in a room at her mum’s house, sitting alone in the dark for hours.

Her mum took her to the emergency department, desperate for someone to help her daughter. Sarah was given sedatives and sleeping pills.

But by that point, Sarah was too far gone. She felt delusional. Thoughts of ending her life crept into her head, and one night in desperation, she called the hospital for help.

“Once I’d gotten to the point where I’d given up, then I started to get support. That’s not OK.”

Sarah and her one-month old son were admitted to the Mother and Baby unit at Starship Hospital - one of two inpatient facilities in New Zealand for mothers suffering from severe cases of perinatal disorders. There are just three beds available in Auckland.

Sarah says the care she received in hospital was “incredible”, crediting her recovery to the patient and experienced staff.

But she also says it didn’t have to get as bad as it did. If she’d known about perinatal disorders, if midwives had recognised the signs, if doctors had listened to her, she believes she could have avoided hospitalisation.

Dr Tanya Wright remembers Sarah from Starship Hospital. She was the Consultant Psychiatrist at the Mother and Baby Unit since its inception in late 2014, recently leaving the position to focus on her PhD.

The unit, she says, was set up after a Ministry of Health funded report in 2012 found maternal mental health care in New Zealand was seriously lacking.

“In New Zealand mental health services for mothers and infants do not exist in some places and where they do exist development has been somewhat piecemeal,” the report said.

In response, the National Government dedicated $18.2 million and some of that money was used to set up the Mother and Baby unit in Starship.

The unit has only three beds - a tiny number considering it serves the whole of the North Island. But interestingly, Dr Wright says they were often only partially occupied.

She says it comes down to how difficult they are to access and the fact they don’t suit everyone's needs.

“There’s so much stigma around these illnesses that women have to be quite competent to get the help that they need, like going five times to the GP in Sarah’s case. Five times!

“I’m also not really sure that this model of care is very satisfactory culturally. Māori and Pacific women, I think, really want care at home and with the families. They don’t want to come to hospitals.”

The Mother and Baby unit saw mostly educated, upper tiers of the income bracket, European women, says Dr Wright. She saw few Asian, Indian, Māori and Pacific mothers.

“Should we have more beds? Yes, but only within a more complete package.”

The “complete package” is no easy feat. Mental Health services have been underfunded for years.

“It’s really hard to add prevention into services that are already the ambulance at the bottom of the cliff. How do you pull money out those services?”   

The lack of education for women is another huge issue, says Dr Wright.

“We’ve had no health promotion. Mothers are not getting the information they need to really make an informed decision about what to do.”

Three-month-old Archie is overdue for a nap. His high-pitched squeals echo off the walls in the lounge while his mum, Lizzie, tries her best to get a dummy into his mouth.

As Archie cries and flails his tiny, pale arms in the air, Lizzie’s chest tightens.

“Sometimes I don’t even know what I’m anxious about,” she says.

“It’s just there. It physically hurts in my chest - it actually hurts. It’s suffocating.”

Lizzie is battling perinatal anxiety and depression. When she and her partner Brian Mead asked for help from Maternal Mental Health a few months ago, they were met with long wait times.

The implicit message they got is one echoed by medical experts in the field: unless you’re incredibly sick, we don’t have the resources to help you.

“We’re focusing on people that are about to jump off the cliff and then suddenly, there’s no focus on the people that are walking or sometimes crawling to the edge of the cliff,” Brian says.

For Lizzie, it all started at the beginning of her baby's life.

The birth was traumatic - Archie stopped breathing and was in NICU for several days. The early separation devastated Lizzie and when she finally took Archie home, things didn’t get better.

Flashbacks to the birth haunted her daily, she struggled with sleep deprivation, breastfeeding issues, and Archie’s colic. Lizzie became increasingly unwell.

“It was maybe eight, nine weeks I just didn’t feel any connection to him,” she says.

“I was expecting to want to give my life to him and to have this immediate bond and love for him, but it didn’t come immediately.”  

Brian knew she needed help quickly, and went straight to private specialists. He was happy to pay anything to get Lizzie treatment, even $450 he was quoted for an initial appointment with a psychiatrist. But he wasn’t prepared to sit on the month-long waiting list.

“[They] were talking about three to five weeks to get an appointment. To me, it didn’t really make sense. She needed help now.”

Brian decided to try the public system instead. Lizzie was scheduled in for an appointment with Maternal Mental Health two weeks later, but her hope was crushed when she went in for an assessment.

“I left feeling worse than I did going in - they told me there wasn’t going to be any available help until about three months later.

“That really shattered my hope of feeling better. I was distraught.”

Lizzie came home and immediately went to hang out the washing. Brian knew what was happening.

“She cleans when she’s upset,” he says. “My initial feeling was anger.

“When you’ve waited two weeks and your partner returns home in tears, where is the help? If we can’t help our vulnerable mums, what are we doing?”

Brian persisted, calling back and asking for more help. His advocacy eventually worked and support has come for Lizzie a few weeks later in the form of visits from mental health nurses and medication.

But Lizzie knows not all mothers have an advocate like Brian. If they’re turned away once, they may not try again which can be detrimental for them and their baby.

Clinical psychologist Dr Natalie Flynn says New Zealand is failing the majority of mothers with perinatal disorders.

“Look, all the workers that I know in maternal mental health are excellent, motivated and skilled - but there’s not enough of them,” Dr Flynn says.

Having worked in the public health system for more than 20 years, she says it is only resourced to deal with the very top end of severity.

When a mother is turned away from maternal mental health there are probably another five before her with more severe symptoms, says Flynn.

“For the person doing the assessment, their hands are tied - there’s only so much they can do.”

Dr Flynn specialises in maternal mental health. She says resourcing services is “extraordinarily urgent” and the price of inaction is huge.

“If people only understood the outcomes for babies when you have a mother who is depressed or anxious. It’s not just about the mother suffering - which is bad enough - it’s about outcomes for babies.”

Experts have called the effect of perinatal disorders on children “a major public health issue”.  

Decades of research have shown the importance of early attachment between a baby and its primary caregiver - usually its mother. It affects a baby’s physical, mental and emotional health and can persist into adulthood.

Dr Tanya Wright’s research from the Mother and Baby unit in Auckland found half of infants admitted were lagging behind developmentally and showed signs of infant mental health concerns.

A 2018 study published in JAMA Psychiatry found children of mothers with untreated, severe postnatal depression were more likely to have behavioural problems, and depression themselves later in life.

Dr Flynn left the public system and now works privately with women struggling with perinatal disorders. She doesn't have to turn anyone away, but at $190 per hour, she’s well-aware privatisation is not the answer.

“How many people can afford that? I’m out of reach for most women.”

Dr Flynn thinks one solution is evidence-based therapy groups, run by maternal professionals - a cost effective and proven way of treating struggling parents.

“You can tell a woman in front of you that says ‘sometimes I hate my baby’, that it’s OK,” she says.

“But she might not believe you until she hears three other women start crying and say ‘oh my gosh, I thought I was the only one’.”

The non-existent help for fathers is a major issue, too, says Flynn.

About 1 in 10 Kiwi men will experience depression after the birth of their child. However, there is no screening or specialised treatment for fathers suffering from perinatal disorders in New Zealand.

“I think it should just be called perinatal mental health, not maternal mental health. We need to be treating and supporting both parents.”  

Last year the Government launched its Mental Health Inquiry in a bid to address New Zealand's dismal mental health statistics.

5200 submissions were received, and over 400 meetings were held across New Zealand to find out how to improve mental health services.

In the 219-page report given to the Government in December it was noted, “maternal mental health is a major public health issue”.

The Government will respond to the report soon, and is expected to announce its “Wellbeing” budget in May. But with so many mental health services vying for a funding injection, the question is whether maternal mental health will see any of it.

Research shows investing in early intervention could actually save money. One study points to the cost of perinatal mental health problems being five times the cost of improving services. The authors note that “even a relatively modest improvement” in services would be sufficient to justify the additional spending.

Associate Health Minister and Minister for Women Julie Anne Genter says she can’t promise perinatal mental health services will be included in funding plans, but she hopes it will be.

“I know that our maternal mental health services are not up to scratch,” she says.

This is personal for Julie Anne. She’s a new mum to a bouncy, happy baby boy. Although she hasn’t suffered from perinatal disorders, she’s acutely aware that she could have.

“It was something I was really worried about before giving birth.  I didn't want to have any health issues that would prevent me from doing my job and also looking after my son.”

The challenge is building up a system that has been run down for almost a decade, she says. The process is slow.

“It feels extremely urgent to me. It breaks my heart to know that there are people out there still suffering, and we've been in government over a year.

“But what I've realised is that it takes time to build up those public services. To really see the benefit of the actions, it's going to take years.”

You can watch the full version of this Sunday story here on OnDemand.

Information on Perinatal Mental Health:

Perinatal Anxiety & Depression Aotearoa: (04) 461 6318 or visit pada.nz

Mothers Matter: Visit mothersmatter.nz  

Father and Child: Call/ text 021 892 980 or visit fatherandchild.org.nz  

Where to get help:

Need to Talk? Free call or text 1737 any time to speak to a trained counsellor, for any reason.

Lifeline: 0800 543 354

Suicide Crisis Helpline: 0508 828 865 / 0508 TAUTOKO (24/7)

Depression Helpline: 0800 111 757 (24/7)

Samaritans: 0800 726 666 (24/7)

Rural Support Trust Helpline: 0800 787 254

Healthline: 0800 611 116

If it is an emergency and you feel like you or someone else is at risk, call 111.