“The health visitor told me to ring you — but I’m not depressed, I’m just on my own a lot”

An EPDS score is a screening tool, not a diagnosis — assess properly. Use the Whooley questions (low mood, loss of interest) and a full risk assessment including self-harm, thoughts of harm to the baby, psychotic symptoms and bonding. An adjustment reaction is an expected, though distressing, response to a major stressor; it usually improves with support but raises the risk of later depression, so follow up. Isolation is a major driver of perinatal distress, especially for recent migrants whose expected family support is missing (many cultures have a structured postnatal rest period cared for by female relatives). Fear of social services or immigration consequences often silences women: be explicit that help-seeking does not lead to children being removed and does not affect visas. Visa dependants who have paid the immigration health surcharge have full NHS entitlement. Practical, local support (health visitor listening visits, Family Hubs, breastfeeding peer support, Home-Start, social prescribing, faith and cultural communities) and NHS Talking Therapies (which prioritises perinatal women) are first-line; medicines are not indicated for an adjustment reaction. Do not forget the woman’s own postnatal check — tiredness after a PPH warrants FBC and ferritin, and TSH for postpartum thyroiditis.