Perinatal psychiatrist warns mental illness is leading pregnancy complication

Perinatal psychiatrist Edna Lekgabe has identified mental illness as the number one complication of pregnancy and the postnatal period, a prevalence that surpasses physical risks such as gestational diabetes and pre-eclampsia. According to Lekgabe, up to one in five women will experience a diagnosable mental health condition during the perinatal window, yet the current response to this crisis remains inconsistent and often inadequate.

The article highlights a critical gap where women frequently fall through the cracks of the health system due to fragmented care and extended waitlists. Lekgabe illustrates this trajectory through a composite case study of a woman dismissed by general practitioners and obstetricians as suffering from normal pregnancy insomnia. By the time she reached specialist care in a crisis state, months of deterioration had already occurred, leaving her unable to care for herself or bond with her infant.

Specific structural failures within the Australian public system are detailed, including waitlists for specialist assessments that stretch for months. This creates a dangerous delay for women who are deteriorating in their late second trimester and cannot wait until after birth for an assessment. The distinction is also drawn between the disorientation of new parenthood and major clinical illness, with a warning that normalising language risks minimising the need for urgent psychiatric intervention.

A critique of current screening protocols notes that identifying risk via tools like the Edinburgh Postnatal Depression Scale is ineffective without a clear, timely referral pathway to available care. In some services, a high score on a screening questionnaire generates a recommendation for supportive counselling that lands in a landscape where psychologists have six-month waitlists and Medicare-funded sessions are capped.

Lekgabe calls for three specific systemic changes to address these failures. First, she advocates for integrating mental health services directly into maternity clinics, ensuring psychiatrists, psychologists and mental health nurses are embedded in antenatal clinics rather than operating as separate referrals. Second, there must be an increase in the workforce of perinatal psychiatrists to meet the high demand.

Finally, improved public awareness is required to destigmatise the condition and ensure expectant parents understand that perinatal mental illness is common and treatable. Cultural factors contribute to the crisis where distress is often reframed as maternal inadequacy or failure rather than a medical condition requiring treatment.