Womens Mental Health

Celeste: 

Welcome to the Nursing and Midwifery Health Program Victoria podcast series where we will be diving into issues that impact the way nurses and midwives navigate today's ever-changing world. I'm Celeste Pinney, a registered midwife and senior clinician at the Nursing and Midwifery Health Program Victoria and host of this podcast. The Nursing and Midwifery Health Program is a support service which provides care and assistance to nurses, midwives and students by experienced nurses and midwives. 
 
Our service provides a space where our colleagues can bring with them any sensitive health issues impacting their wellbeing. The program is voluntary and importantly, it is free to access, confidential and independent. Our focus today is on women's mental health. Given the importance of this issue and knowing that many women in nursing and midwifery are struggling with mental health concerns, we consider it vital to explore and illuminate the distinct mental health challenges encountered within both their work and everyday lives. 
 
Our guest speaker today is Katrina Locandro, head of strategy and operations and the research lead at Women's Mental Health Australia, which is formerly known as the LipTember Foundation. Women's Mental Health Australia is the nation's leading organisation dedicated to improving mental health outcomes for women across the lifespan, investing in undertaking annual gender specific mental health research to ensure timely, trended data, capturing gaps and improvements for better mental health and exploring the mental health issues, triggers and barriers faced by Australian women and their lived experiences with mental health. Welcome, Katrina.  

Katrina: Hello, thank you for having me. So great to have you on the podcast.  

Celeste: Thanks for giving us your time today. Could you tell us a little bit about the Women's Mental Health Australia and the work that you're doing to support women and their mental health?  

Katrina: Yeah, absolutely. So kind of like you covered, we're the national organisation dedicated to improving mental health outcomes for women and girls across their lifespan. And the focus for us is really in four interconnected areas. So research, advocacy, education and awareness initiatives. So firstly, gender specific mental health research. We release this annually to make sure that we're tracking women's lived experiences with mental health and illness year on year. Secondly, advocacy, where we use the evidence to push for gender responsive policy, better training for the workforce and integrated care models.  

And then finally, education and awareness. So designing programs to fill the gaps in gender responsive mental health care, as well as broader awareness campaigns that share women's stories, challenge societal stigmas and drive public conversation. So ultimately, the goal is to ensure that women receive the mental health care that recognise their realities and the, I guess, lives that they live day to day.  

Celeste: Thank you. It sounds like such an important organisation. You're doing really critical work in the women's mental health space and we're always looking for resources for our participants who are, I think, 98%, about 98% of nurses and midwives are female or identify as female. So, you know, this is a really important piece that I think we look into and cover today.  

Katrina: Absolutely.  

Celeste: So how would you define women's mental health in your research?  

Katrina: Yeah, so we define women's, I guess, mental health in our research around the emotional, psychological, social wellbeing of all people who identify as female. So that's really important. We capture anybody who identifies in that space. So importantly, I think we also, we look at mental health through a gendered lens. So that means recognising the influence of women's hormonal, reproductive life stages, gendered expectations, like caregiving, and the broader social pressures that women can face. The research also covers, or we use the Kessler Psychological Distress Scale, so the K10, and we use that to measure anxiety and depression related symptoms of all the participants, as well as include their self reported mental health issues, rather than just limiting the data to clinical diagnosis, because that then allows us to capture women who may be struggling but aren't yet in the system. Because as we know, there are a lot of people who are struggling with their mental health but aren't seeking support.  

Celeste: Yeah, okay. Well, thank you for that. That's really good to know. What relatively accessible programs or initiatives does the Women's Mental Health Australia promote or provide for women's mental health, especially for women who might be experiencing acute distress?  

Katrina: Our primary role is to invest, I guess, in research and then translate that into advocacy priorities to make sure that we're changing the system from the top down. But we're also creating practical support programs where none exist in the community and educational campaigns designed to help women recognise the symptoms early and know where to seek help. But we've also provided funding to organisations who deliver frontline services such as 
preventative mental health programs, but also to other organizations that are paving the way for really new approaches to mental health care in the perinatal period, for instance. There's an organization we found called ‘Through the Unexpected’, and this organization is dedicated to creating and delivering the first ever national evidence informed online training for health professionals who want to address the psychosocial aspects of women and families who receive a prenatal diagnosis. because what we found is many women begin planning and preparing for motherhood when they find out they're expecting and this image can be shattered in a moment if they receive unexpected news that there is a difference in, I guess the health or development or genetics of their growing baby. 

And so it was uncovered that there was no available prenatal diagnosis specific training for mental health professionals and so we invested in changing that by funding through the unexpected. But when we're talking about women with, I guess, acute distress, we always direct them to the crisis intervention pathways because we're not a crisis support service. There are so many great helplines, evidence-based services, and it's really important to direct people in crisis to those because accessibility and immediate support are really critical.  

Celeste: Mm-hmm. Yeah okay that's really wonderful programs you've got there and especially for women who are pregnant or expecting. I'm a midwife myself and I know how important it is in terms of mental health preparing to be a mum and yeah everything that comes with that.  

Katrina: Yeah it's a very, I think the thing about I think your industry as well is that a lot of women who are midwives, nurses they are also mothers. They've been on both sides of the fence so to speak they've been the care provider but then they've also been the client I guess, and so then understanding the mental health implications I guess of your experiences and your lived experiences in that profession and how you then apply that to the women and people that you care for it's such a unique thing about your particular career is there's not many other kind of careers that have that really nuanced lived experience that you can add and where lived experience is actually valued, because I don't know of any person who has exactly the same experience when it comes to birth or pregnancy or anything like that. 
 
Celeste: Yes and i think it's, it's so important that women feel supported by their health care professionals who are taking care of them. um and that we really have a deeper understanding of what women might be facing through that journey yeah so it's really good to hear that there's more being more um resources put into that space. 

Katrina:  Yeah absolutely and yeah anything that we can do to make um the lives of health professionals easier in that space and more training and understanding. If there's people who are faced with having to deliver news about prenatal diagnosis to expectant parents, if you're not trained to adequately support those women who may have really direct responses to that, then that's not really setting up anyone for success. So making sure that we can help advocate for these programs and funding into developing them with lived experience and clinical expertise. I think is really important to set everyone up for success in the long term. 

Celeste: Yeah yeah I think there's definitely more awareness coming in around mental health through in pregnancy and motherhood and it's really good that you're a part of that too. As per your research, one of the main triggers for women's mental health issues was low self-esteem or low confidence. Do you have any idea why women are struggling with these types of issues and what could be done to improve those metrics?  

Katrina: Yeah, low self-esteem is a huge one. It's showing up consistently every single year in our research since we've started it in 2022. I think women are navigating a real big mix of pressures. There's societal expectations, there's all these appearance ideals, financial strain, unpaid caring responsibilities, constant self-critique and all of this really feeds into a sense of not being enough and I think for younger women it's amplified by life stages like puberty and things like social media, and for older women it’s sometimes tied to aging or menopause, perimenopause, or some of the feelings of isolation or loneliness. And I think to shift this, we really need early education and I guess preventative programs that are better suited to people in each of those life stages and what they're dealing with. So sometimes around body confidence or better workplace cultures.  
 
Celeste: And is this something that you've seen these statistics worsen over time, over the years? Like, are you seeing more women with issues of low self-esteem and confidence? Or is that just something that particularly came out in this report?  

Katrina: No, it's been pretty constant since 2022. As one of the main triggers, it kind of fluctuates by a couple of percent every year. Different age brackets or different priority populations have different triggers depending on what their mental health issues are, but this I guess statistic is based across the board so women from the ages of 14 to 80 something is like that's what the majority of people are saying are one of their main triggers, I don't think it's going anywhere anytime soon if if that's kind of what you mean, it's not like it's getting worse or better. 
 
Celeste: Yeah, I mean, ideally we'd like to see that shift in the opposite direction where women are feeling better about themselves and they're having more confidence and less self-doubt. But it sounds like it's a persistent issue.  

Katrina: Yeah, persistent I think is the correct word it's just, yeah it's persistent and it's enduring and i don't know how to solve that as an organization. I think it's more as a collective society that there's a lot of other things that need to change u,  because self-confidence and um low self-esteem like self-esteem generally isn't just something that's related to mental health issues, it's 
in a woman's life. And I think you kind of have to look at women as a whole, physical health, mental health, to be able to try and get to the root cause of a few of these issues. And it's not something that just changes overnight. 
 
Celeste: Yeah, absolutely. It probably, you know, for some people started when they were quite young, perhaps in childhood or through the teenage years, and then it's much harder to shift that without perhaps some education or therapy or help from professionals to work through those sorts of issues. And we definitely see that in the nursing and midwifery profession with 
particularly, and I'd say the younger cohort of nurses and midwives who are grads, students and grads in the early years of when people are working in the industry, their self-esteem and confidence is quite low. I guess it's obvious in some ways; they're learning. There is an enormous amount of pressure on nurses and midwives generall ythroughout their whole careers to perform you know, to meet certain standards and whilst also dealing with their own external issues in their personal lives, and when things are happening in their personal lives could be relationship problems, could be chronic health issues, mental, physical, could be finances could be housing you know, there's a big array of issues, it can be really hard to maintain a high level of standard in the workplace as well. And I imagine women across all kinds of industries are facing that too.  

Katrina: Absolutely. It's something that I don't think is unique, but it would definitely, I think, have a massive impact in nursing and midwifery because you're dealing with people who are obviously not at their best self on the daily, you know, or need assistance in some way, shape or form. So then when you compound that with your own mental health issues, challenges, stresses. It's, I think, more amplified than if you were just, you know, grocery shopping and talking to someone in the street, so to speak, you know.  

Celeste: Yeah, yeah, the type of work that you do when you're giving a lot, you know, you're pouring a lot emotionally into helping other people and particularly if you're seeing other people struggle and, you know, a lot of areas of nursing and midwifery are like that, although it can be obviously a very rewarding career, but you're also seeing people in, you know, unwell or having facing lots of different kinds of mental health issues, going through birth, comes with its own challenges as well. And this might lead into a little bit into the next question but in your latest report you found that 37% of women believe that they can manage their mental health on their own. 36% couldn't afford help or considered it too costly. And 35% of women didn't feel their mental health issue was serious enough to seek help. So given that we have a lot of women with mental health issues, why do you think it is that women feel that they can manage mental health issues on their own? And what do you see as some of the reasons why women don't or are not able to reach out for support? 
 
Katrina: Yeah I mean again this is really multifaceted but I think if you if you consider women are generally or often the central hub of a lot of families and family units and a lot of those women believe that they need to be the strong one or to hold everything together. There's also a lot of societal stigma and the fear of being dismissed, and you know especially for mothers there's a reluctance, a huge reluctance to burden anyone else with their issues so, and I think you know, nurses and midwives will probably relate to this quite deeply, because you would see a broad spectrum of women, so mothers daughters spouses, all these women who are all carrying that same kind of invisible mental load caregiving responsibilities any other life stage, stresses that they might be going through and you will notice that a lot of them will probably downplay their own issues or keep everything, to try and keep everything kind of humming along, because women, they're so used to carrying and caring for others that they downplay their own needs.  

And so that's why it's so important that we normalise seeking help as a strength. It's not a failure. And you can't pour from an empty cup, right? So you need to look after yourself in order to be your best self for others as well. And I think that really coming back to that, women being the central hub of families and not wanting to burden others. Again, it's just something that women do and they need to know that it's okay to look after themselves first. And I think that's really why they're not reaching out. It's not because they don't want to, but they don't feel like they can. 
 
Celeste: Yes, yes, really well answered. And I think that is a societal issue and perhaps a gender specific issue. Women are conditioned to believe that they need to behave or act in a certain way or that they're the maternal instinct. And we definitely see that in our profession where often people will come to us in crisis or they'll say, oh I should have seen you six months ago, you know I've left it really late, which is understandable because you know, as in the caring profession you're used to being the strong competent one and of course you know they are, but sometimes it can be really hard to reach out for help and there can be a stigma associated with it or perhaps a bit of shame that you know feeling oh am I weak and am I going to consider myself weak or are others going to consider me weak for reaching out for help? But I do think that is changing a little bit with more mental health awareness generally in the community. But, of course, it sounds like we've still got a bit of a long way to go in terms of, like, women may be giving themselves that permission that it's okay to reach out for help, not necessarily at the end stage of, you know, a mental health crisis, but even as a preventative, proactive kind of strategy. Yeah. 
 
Katrina: Yeah, and I think that's really important and especially the stance that we take at Women's Mental Health Australia is around that prevention, right? Like you don't have to be in crisis to seek mental health support. And I think that that is probably one of the biggest messages I want to get out there because when you're in crisis mode, it's so much harder to come back from that than if you are to invest in your mental health just like you do your physical health from the get-go. And making sure that you are recognizing the signs and knowing when things are maybe getting a bit too out of your depth and you really need to start getting the help that you need or asking the right questions. And there is so much support out there. And sometimes I find even in the industry, me working in the industry, it can feel sometimes a little bit overwhelming to navigate.  

There's so many different avenues to seek help. Which one do you take? Do you have the time to wait on certain wait lists? Or do you call a hotline? Or do you feel like that's impersonal? Everyone is so different when it comes to seeking help and support. But I think the first step is just that mental barrier of taking the first step. And once you do that, you'll find what works for you and you'll navigate it. And there's lots of resources, like we have resources on our support hub. You guys have great resources for your stuff as well. There's a lot out there, but sometimes just because there's so much, it's hard to navigate and that cuts you off and makes you feel, oh, I don't have time for that.  

Celeste: Yes, yes, people have very demanding lives and it can be hard to think that you can fit that in. But it's so important because I think I always like to think of it this way, that when you're, you know, if you're proactive and you are implementing your mental health and self-care strategies, when you're not in a crisis, that you're more likely to have built those habits to fall back on. It becomes more second nature. So when you are really struggling, it might be just that little bit easier to go for a walk or eat well because you've already kind of had the practice or put that into place. 
 
Katrina: Yeah, that's right. Muscle memory when it comes to self-care. And, you know, I can always do better myself as well, but it's one of those things you just keep doing it and it becomes part of your daily routine. And that's the best way to make sure that you're integrating it on the daily.  

Celeste: Yes. And perfect is the enemy of good. So it's better to do something even if it's just a little something rather than nothing at all. Yes. Or thinking you have to be perfect.  And something I found interesting in your research was there's a rising percentage of women between the ages of 40 and 49 that are suffering with depression and anxiety. Yeah. What do you think are the causes? Why are the rates rising? And what could we do to help women?  

Katrina: That is a very big question. Yeah. I think women in their 40s, they're really at this interesting crossroads. So like many of them are navigating perimenopause or menopause. They're juggling work, maybe caring for school-aged children or older children. They've maybe got aging parents who are also requiring a bit more care and their attention. They might be going through relationship changes or financial pressures. And then I think when you put on top of that all the hormonal shifts that kind of happen during perimenopause these shifts are really highly linked to anxiety and depression and women in their 40s are often in the busiest most demanding years of their lives and when it comes to their personal time and I think the best way and what we could do to really help these women is, and this is what we're advocating for, is, I guess, early screening in midlife. So accessing menopause-informed mental health support and workplace flexibilities and having health professionals proactively ask about mental health during their midlife health check-ins, right? 
 
At a federal level, like making sure that the menopause hubs that they're trying to roll out actually don't just look at, oh, here's the tick box of all the physical things you need to ask a woman in this period of their life, like how is their mental health, and going through and making sure that there's a really robust screening involved there, and that that's national across the board. So it shouldn't matter where you live, that women are getting that care, that holistic care, health care that's physical and mental health. So they work interchangeably, like together. They cannot exist in isolation, and so those are the types of things that can be done to help them um, why are the rates rising? I think yeah, for all of those reasons that women are just taking on so much at the moment and especially women in that life stage they're I think they call them the sandwich generation right? 

Yeah I don't again, huge issue don't know how to solve it individually, but there's a lot of things there and I think you know taking the time out to prioritize yourself or prioritize what's important to you um, because yeah if you say yes to everything in that time frame sometimes yeah it's hard you can't say yes to everything, but when everybody needs you yeah, I can understand how that would take a massive toll on your mental health. 
 
Celeste: I have read that uh life satisfaction according to research tends to drop through the decade of the 40s and then thankfully it goes up again once people are in their fifth decade of life, so a bit of a sobering statistic. I'm in my 40s I’m 42, so you know I’m entering, I’ve entered into that decade yeah um but I can certainly see from what you said. And there's just... Women are juggling so many things and I think we start to see at our organisation definitely women coping less. 

There's higher rates of burnout, things like fatigue. Women start to develop more chronic health issues as they're entering into the 40s and 50s years because often people have kind of raced along through the 20s and 30s and maybe part of it is it's caught up to them a little bit, or with the change of hormones their system's saying, hold on a minute slow down, like I can't go at the same pace as what I could 10 years ago it's too much and often people do need to, in terms of like how much they're working or perhaps they're working, they need to stop doing as much night duty or they need to look at their roster and try to make it so that it works better for them with things like sleep and rest. And I think that's really critical that we all reflect on, okay, you know, if I am in this decade, what can I do to make sure that my mental health is as good as it can be given we know that it can be more difficult than other times in life. 
 
Katrina: Yeah, absolutely. And sometimes you're just going through the motions and then you're like, oh, 10 years has passed and I haven't changed anything about what I've been doing to actually help myself now. And yeah, maybe these things aren't as important as they used to be and I should be prioritising this over this. So yeah, it's a really great point. And I think, and sleep obviously is a huge one and making sure you have good sleep hygiene and habits and things around that because it is so heavily linked to mental wellbeing and good mental health as well. 
 
Celeste: That is a  whole podcast series on its own, Sleep and Mental Health.  

Katrina: Yes, it is. I think you've done a few already.  

Celeste: We've done one on sleep, yeah. And it's especially hard for people doing shift work because you don't get the regularity and the circadian rhythm gets a little bit out of whack. And unfortunately, it makes it really, really hard to get that restoration that people really need. And when you're sleep deprived, your mental health just unfortunately, maybe not for everyone, but for a lot of people, it really can suffer. So yeah that's what we do here is we try to help people who might be having sleeping issues looking at okay, what adjustments can you make to a few tweaks here and there just to improve on sleep so that you can feel better. 

Katrina: Oh absolutely I mean I can't relate to it from a shift work perspective but as a mum I’m still very regularly in the trenches of multiple wakes in the night and um yes living in sleep deprived mode so yeah it's um yes very hard. 

Celeste: Definitely, yes. Lots of mums out there in that boat. Yeah. And out of curiosity, what have you found are the key mental health conditions that disproportionately affect women's mental health and why do you think that may be?  

Katrina: So the top ones are depression, anxiety and body image issues and they do disproportionately impact women over men or other genders just purely in the sheer numbers of them. But I think there's also things like perimenopausal anxiety and depression and other conditions that are linked to reproductive health, such as PMDD or other, I guess, perinatal mental health issues. And they do impact women and impact women differently. And that's because women and their mental health is shaped by biological factors like hormonal shifts, reproductive health conditions. 
 
But then also the societal side of things. So gendered expectations, unpaid care responsibilities, structural inequities. And so when you put those two things together, it collides and I guess the risk of mental illness kind of increases in women. But I also find that there was a really striking finding this year about just how strongly women's physical health conditions related to their mental health. So especially women who had very female-specific health conditions like endometriosis, PCOS, or perimenopause, for instance. And these women, so these women experiencing those particular physical health conditions that were gender-specific had significantly higher levels of psychological distress than women who, had maybe had physical health conditions like asthma or like gender neutral physical health conditions that weren't related to gender. And so that I think was an incredible finding is that if you are a woman with these particular conditions, you will most likely suffer more with your mental health than women who don't.  

And then of course suffer more than any other gender who doesn't even have to experience endometriosis. and PCOS. So it's a really interesting finding. There's a lot to dig into that. We found that out this year in the research. So now it's about making sure that we use that to advocate for better change for policies around gender specific physical health issues that can have a gendered approach when it comes to mental health. So, yeah, again, another really big 
big job, but someone has to do it and that's us.  

Celeste: That's really fascinating. Do you, you may not know the answer to this question, but do you have any idea why women with the gender specific health problems, like you mentioned endometriosis, as opposed to something like asthma, who men and women experience, why those women would have more severe mental health issues? 

Katrina: Yeah. So this, I don't have an exact answer because we aren't able to gather that from the research but what we can do is try and I guess, read between the lines and understand what is happening societally for these women with these physical health issues to give them I guess poorer mental health outcomes and really the hypothesis there is that there is still so much unknown about these physical health issues that there's not enough support. There's not enough, I guess, physical evidence bases that have been built to create the kind of health care that these women need. So they're struggling in the health system. Nothing's easy. Everything is a bit harder, I guess, than somebody who is suffering with back pain or a broken ankle. It's like, well, okay, health professionals know how to deal with that.  

But there's still a lot of unknowns about the female anatomy and I guess female health conditions generally, because there's no research that's been done until recently on these things so until this like body of evidence is built, then we can't find the answers that we need so of course these women are going to be having a harder time with life because they still don't have answers to their physical issues and how they're navigating that system and navigating this quite scary, I think physical issue that has really severe mental health implications. And I think if you add that on top, there's, I think people, there is not enough known about these conditions and I guess the impact. We know there is an impact, but we still don't have enough research worldwide to be able to, yeah, underpin it and to really say with certainty, this is why. 
 
Celeste: It makes a lot of sense. And if there's not the research there, then there's not going to be the appropriate best treatment options for people to help with. And I know endometriosis can for a lot of women with like significant levels of pain and other symptoms that can be very debilitating. And in fact, women sometimes can't even work or have to drastically reduce down the amount of hours they can work or function just in life because of the because of pain and other you know sleeping problems and things that come with these conditions so hopefully as time goes on and there's there's more awareness generated, yeah women will be offered better treatment options but I think at the moment it's just maybe in the more beginning phases because not that I'm an expert on things like endometriosis but I've heard a lot about it,  you know just generally in the media over the last few years and I think 10-15 years ago you just weren't hearing about it so it is relatively new like you said, as opposed to some other health issues that have been around for you know eons, and they've done lots of research and they've got better treatment options. 

Katrina: Yeah it's a matter of time it just sucks that women are the ones that you know miss out and have been for decades but we will get there and there's a lot of women and organisations like ours who are making a lot of noise at the moment and yeah I think we won't stop making noise, like especially when it comes to gender specific mental health issues until there is I guess that more widely adopted approach that gender needs to be at the forefront of these things and really kind of built into responsive care models because it's not just good for women it's good for men it's good for gender diverse if you, yes if you put a gendered lens on healthcare how much better would it be for everybody.  

Celeste: It's good for society as a whole isn't it yeah it's what affects one person or a number of people is really affecting everybody. 

Katrina: Exactly yeah yeah  

Celeste: That's really good and great that um you're out there doing the cheerleading. And I'm just also curious to know what would you consider to be culturally a sensitive approaches to researching and supporting women's mental health? 

Katrina: So culturally sensitive approaches really start with community engagement. So we I guess ensure that women from culturally and linguistically diverse communities or indigenous communities and the LGBTQIA plus communities, that they're all represented within our research and can share their experiences with mental ill health or mental health conditions safely. This kind of thing is really only now becoming best practice and doing things like co-design in your survey questions and using inclusive language, acknowledging people's trauma histories, you know, all those things are commonplace when you look at mental health with a lived experience lens like we do. And I think broadly understanding that family, spirituality and, you know, what community you're from may be really central to somebody's health and wellbeing and then measuring that, right? 

So that having that approach allows us to effectively advocate and make sure that we're communicating on behalf of these communities at government levels and making sure that they're represented correctly. And I think that that's what we do. And I think I really like seeing that more and more it's becoming more accepted, that that's how we make sure that we're including all perspectives and all priority populations in the work that we do. 
 
Celeste: Yeah, that's so good to hear because I think with Australia being such a multicultural society, it's important that we are inclusive and that we're not just looking at women who are from Caucasian backgrounds, but people from all different cultures and backgrounds and countries. And then we're going to hopefully have better treatment options and better support for women.  

Katrina: Absolutely. Yeah, yeah. 
 
Celeste: What barriers do you think women face in obtaining timely and appropriate mental health care and how can those barriers be mitigated? 

Katrina: Our research says that the major barriers really are affordability so it's just so expensive for women to seek mental health support at the moment, um but second to that is long wait lists, so if you want to see a mental health professional um a lot of them have maybe 12 months wait list even getting them and you know for some things and you know, that varies across the board, but at the end of the day, you need mental health support. You need it now. You're reaching out because you need it now. It's not, um, well, you know, you can do it preventatively like we talked about earlier. And that's great. If you're not in, you know, a state of really needing that support and you can wait a month or two or whatever it is. Great. But most of the time people who are seeking support, um, are seeking support because they need it. Um, so those are two really big barriers.  
 
Some other barriers we find is that because it is so complex to navigate, most people don't know where to go and don't know where to seek the right support for them. And other women are just believing that they're not suffering enough to be able to justify help. So that kind of stuff we talked about earlier. I think also, you know, for a lot of women, there's still a little bit of gender bias when it comes to mental health care. 
 
There's diagnostic delays for women who are especially seeking diagnosis for things like ADHD or physical things like endometriosis that then impacts their mental health. And so, yeah, just that lack of, I guess, integrated mental and physical health care where they're kind of seeking support in isolation for each thing, even though it's all related to the same issue. So from our perspective, how do we mitigate this? And really, there's just a lot of early intervention opportunities that are currently being missed in our health care system. So if I use like pregnancy, for example, this a pregnant woman has multiple touch points with the health system, like probably more than any other person seeking. Yeah, like support or health care. 
 
So they see multiple different types of specialists or people and have multiple like, regular appointments but what our research uncovered was that of pregnant women in 2025 only one in five of them knew where to go for mental health support so a woman who is like regularly in touch with people in the healthcare system only one of them out of five actually know where to go to get mental health support that they need so that's really concerning and I think perinatal mental health especially like it happens to a lot of women it's still not routinely screened and is dependent on whether you birth in a public hospital or a private hospital and that shouldn't be the case it should be the same across the board no matter how you choose to birth so I think these types of things really impact the things that we advocate for to really mitigate the barriers. 
 
So we're recommending things like mental health screening and making sure that it's embedded within physical check-ins at the key life stages. So things like pregnancy and menopause that I talked about earlier and just also investing in gender responsive training for the entire health workforce. Because like I said, when you put gender front of mind, it impacts, it helps everybody. It's better for everybody. I also think that nurses, midwives, you know, you guys are a huge, 
 
untapped resource in the healthcare system and you're uniquely placed to spot early signs especially in pregnant women for instance, you know validating women's experiences, normalizing help seeking and referring those who need it to the right supports and I know you're doing that already but there's just so much more that could be prepared and given to you to have the adequate resources to help these women and I think if we could tap into where in the healthcare system we could add those extra supports, those extra layers of information and make it easier for healthcare professionals, I think that we would be much better placed to see the burden of mental illness on women really reduce.  

Celeste: Yeah, that's really interesting to hear. There certainly are some barriers to seeing a psychologist or a psychiatrist. You know, the wait times can be really long and the cost is extremely prohibitive and hopefully that changes with time. But, you know, sometimes it can be hard to know, well, where do I go? What do I do? And even though our service has existed for almost 20 years, some people still say, oh, I never heard of you before, you know. And, you know, our service is free, so it's good because people don't have to pay anything and we generally don’t have a long wait time. But, yeah, I think it's really good that you're looking at what needs to be done in that area and more education, more awareness for health professionals so that they can be, you know, checking in with women's mental health rather than, you know, like leaving that by the wayside and just focusing on physical. 

Katrina:  Well, yeah, and I think also it's a hard one because there's no – from, I guess, a federal level, there's no real ownership over that particular piece; like who owns looking after a woman's mental health in the perinatal period -is it their midwife is it their GP, is it their obstetrician is it that there's no like no one is responsible for that particular, yeah no one is responsible, yes sorry I'm finding it hard to explain it but it's if you're not if there's no like ownership over that piece then it's like oh maybe they did that at their last appointment with their GP maybe they did it with their obstetrician, maybe they did it with their midwife maybe they did it you know so then it's like oh it's not my thing to worry about because oh they've probably already done it you know it's like, and so if we're not making it easy for health professionals like so we can't blame the health professionals.  

It's not easy to navigate and there's no like rules or regulations or not, there needs to be rules or regulations or just like streamlined kind of check-in points for these things, it's like of course women are going to fall through the cracks because one provider might be really really on top of mental health and one might not be because they're really focused on the physical aspects of um of a woman's uh, I guess the perinatal journey. So yeah it's just it's one of those things that sometimes there's nothing on the and it's kind of an afterthought and we just want to make sure that we're bringing mental health back to school because it really is a critical piece of the human body and mental health. Physical health and mental health it's really important so it shouldn't just be a tap on at the end of some kind of appointment. It really needs to be integrated heavily in our physical health system.  

Celeste: Yes, yes I absolutely concur and hopefully things can improve as time goes on, and as the health system, it can be a little fragmented navigating the health system, especially if you're pregnant or you're seeing multiple practitioners and, you know, it's sort of hard to know who's done what. My hope is that that changes over time as we bring different models of care. 
 
Katrina: Yeah, and you might not know. Like you might be in the perinatal window like a first-time mum. You don't know who's going to ask what and what things you need to do. You're relying on being guided through that process by your providers. And, yeah, it's just very different for each mum. But I think if they sometimes- they don't even think about it unless they ask the question about their mental health. Like, no, how are you actually going? Like, hmm, how you know how has this been for you in the fourth trimester or whatever it is and I think sometimes when you just open the floor to listen you learn quite a lot and women feel safe to share if they know it's okay, if they ask the question but you cannot ask the question sometimes women are just like oh maybe I shouldn't talk about it how I'm feeling. 

Celeste: Yes so important to be heard. Thankyou so much for joining us, it's been a really enlightening discussion. We really appreciate your time um and I’m sure everyone that's listening will learn a lot. 

Katrina: I hope so yes , I can talk a lot about this topic I’m very passionate  

Celeste: For people who would like to learn more about your organization and the research you're doing where can they find out about it? 
 
Katrina: Yes so um, we do our annual research we put it on our website every single year, you can  download it for free so womensmentalhealthaustralia.org.au. It'll be there easy to navigate we also, yeah have a whole bunch of information on our advocacy priorities, educational resources that we're doing so yeah check us out, and yeah definitely help us push some of these issues off the chain when it comes to yeah making real big societal change it happens really when it comes to policy, so yeah and I can definitely say that that report is fantastic and that the statistics are just laid out really nicely and for anyone who is interested in learning more about women's mental health and where it's at.  

Celeste: It is really one of the best research papers I've seen in terms of like visually and just very informative and easy to read and very like just so fascinating, I thought. Everything that comes out of that report, we've used some of it for our social media posts with statistics about women's mental health. So yeah, encourage everyone to have a look at that if they're interested.  

Katrina: Yeah, thank you.  

Celeste: Thanks, Katrina. And for any nurse or midwife in need of support you can reach us on 9415 7551. Thank you for listening, goodbye.