How NHS is letting down menopausal women

Mental health services are failing women by not considering the impact of menopause, patient safety researchers have found.

Women are often prescribed antidepressants when hormone replacement therapy (HRT) would be more appropriate, they said.

A new report on the suicide of 56-year-old NHS manager Frances Wellburn found that staff working on community mental health teams are not trained in this area, and that menopause is not routinely considered a contributing factor in women with a bad mood who need help.

The report noted that midlife is a point at which mental health can deteriorate, leading to an increased risk of suicide.

In addition, women may be at increased risk of developing schizophrenia or other psychotic disorders during or around menopause.

The report from the Healthcare Safety Investigation Branch (HSIB) further warned that too many people commit suicide when they are considered to be at a low or moderate risk of suicide.

Despite national guidelines telling staff not to classify people as low, medium or high risk, too many NHS trusts still use the system, leaving people without proper care, researchers concluded.

The report details the case of Ms Wellburn from York, who was in contact with local mental health services between 2019 and 2020.

In a foreword to the survey, her sister described her as a “kind, thoughtful, resourceful, funny and caring” woman who was “loved and appreciated by her family, friends and the people she worked with.”

Doctors noted that Ms Wellburn had persistent psychotic depression and although she was prescribed an estrogen hormone just before she died, it was generally a ‘potentially unconsidered’ factor among those who treated her

Ms Wellburn had a history of depression, which was treated with medication by her GP, and was out of contact with mental health services until September 2019 when she began to have suicidal thoughts and was admitted to hospital.

After being discharged, Ms Wellburn was in regular contact with community mental health services run by Tees, Esk and Wear Valleys NHS Foundation Trust.

However, there was a long gap in care then as the country went into a Covid lockdown, with no contact between Ms Wellburn and the trust between February and May 2020.

Ms Wellburn was hospitalized again in May after her mental health deteriorated and was subsequently in contact with community teams until her death in August 2020.

Doctors noted that she suffered from ongoing psychotic depression and although she was prescribed an estrogen hormone just before she died, it was generally a “potentially unconsidered” factor among those who treated her.

This is despite her sister telling the HSIB team that the impact of menopause on Ms Wellburn was profound, both physically and mentally.

The report warned that when assessing women, mental health services do not consider the full effects of menopause and do not look at its potential impact on more severe mental health symptoms.

It said experts in menopausal care had suggested that the symptoms of menopause and perimenopause are ‘often mistaken for depression, leading women to be prescribed antidepressants instead of HRT’.

The report added: ‘Staff also told the study that current assessments of mental health do not prompt practitioners to consider menopause as part of an individual’s holistic assessment.’

The HSIB issued a series of safety recommendations, including a call for Nice to review available research “regarding the mental health risks of menopause and, if necessary, update existing guidelines.”

The Royal College of Psychiatrists should also form a working group to find ways menopause can be considered during mental health assessments.

A spokeswoman for Tees, Esk and Wear Valleys NHS Foundation Trust said it was unable to comment on care for individual patients, but added: “We fully support the findings and recommendations in the HSIB report on care delivery within community mental health teams.

“We will continue to work closely with our partners in the wider health and social care system to ensure improvements are made.”