Ep 165: Raising Awareness for Perinatal Mental Health with Hamish Magoffin from the PAM Foundation
Fertility Forward Episode 165:
Today’s guest is leading the charge in raising awareness for perinatal mental health (PMH). On the Fertility Forward podcast today is Hamish Magoffin, Founder of the Pranaiya & Arthur Magoffin (PAM) Foundation. Hamish established the PAM Foundation in memory of his late wife, Pranaiya, and their son, Arthur. The foundation is dedicated to raising awareness, improving care, and supporting research on (PMH) conditions. Hamish has taken on remarkable challenges to promote PMH awareness, including running and cycling across the UK. Beyond his philanthropic work, he is also the Co-Founder of Break Off Capital, which has been investing long-term capital in companies commercializing cutting-edge science for over a decade. Tune in to hear the story behind the PAM Foundation, the people and projects driving its mission, and the foundation’s goals as it expands into the US. Hamish also discusses the importance of developing better awareness and follow-up care for PMH and how his endurance challenges tie into this critical cause. Don’t miss it!
Rena: Hi everyone. We are Rena and Dara and welcome to Fertility Forward. We are part of the wellness team at RMA of New York, a fertility clinic affiliated with Mount Sinai Hospital in New York City. Our Fertility Ford Podcast brings together advice from medical professionals, mental health specialists, wellness experts, and patients because knowledge is power and you are your own best advocate.
I am so excited to welcome to Fertility Forward today, Hamish Mcgoffin, who is the founder of the Pranaiya and Arthur McGuffin Foundation, established in memory of his late wife, Pranaiya, and their son Arthur. The foundation is dedicated to raising awareness about improving care around and supporting research in perinatal mental health conditions. As a runner, Hamish has undertaken significant endurance challenges to promote PMH awareness, notably running and cycling across the UK in two and a half weeks, and recently breaking the record for the Central Park Loop Challenge, running 19 laps of the park with 116 miles in 17 and a half hours. In addition to his philanthropic efforts, Hamish co-founded Break Off Capital over 10 years ago, investing long-term capital in companies commercializing the latest science. Yay! Thank you so much for coming on. Many of our listeners know, they hear me talk about running and what a running nerd I am. So you certainly surpassed me in that super psyched to help for your recent accomplishment and all the amazing work you do with the PAM Foundation.
Hamish: Thank you.
Rena: So tell us if you wanna dive into your run or the foundation?
Hamish: I guess we can start off with the foundation.
Rena: Okay. So tell us a little bit about the PAM Foundation and what you created?
Hamish: Sure. So PAM Foundation named after Pranaiya, Arthur McGrain, was set up about three years ago and we've been established in the UK and Thailand doing work across various aspects. We were set up with three pillars. The first one, awareness and education. So just trying to raise awareness, break the stigma associated with perinatal mental health. Obviously there's a big stigma attached to mental health issues in general, but also particularly out in Asia and through raising awareness and trying to educate, not just mothers but families, fathers, and the general public, we hope to address that issue. And then the second pillar that we've been established with is care. So trying to improve care, be it professional care, so training psychologists, psychiatrists out in Thailand. Also setting up new and improved sort of digital methods for screening and identification of perinatal mental health issues and really trying to look at best practices around the world, take those out to, to Thailand, to Asia and see how we can adapt those in the appropriate cultural context out there and also providing like social support networks, group support, peer mental support. And then the the third pillar research is focused across different aspects of research from our experience, just understanding that there's a lack of really knowing that physiology behind perinatal mental health issues, PPD, postpartum psychosis, et cetera. And the solutions at the extreme end of the spectrum, kind of one size fits all at the moment with sort of standard SSRIs and antidepressants. More recently there have been the synthetic communal developments, but from my point of view, one thing that I wanted to address on the research front was understanding what exactly is going on and we can go into to more detail about some of the, the medical research that we're supporting. But in addition to the medical research, we're looking at the economic costs, return on investment opportunities in perinatal mental health. So we're working with the London School of Economics. There's a research team there that's looked at the economic cost of perinatal mental health issues in the UK and elsewhere. And that's been key in getting the government to really focus on the issue in the UK. So we're working with them and a host of universities out in Thailand to do a similar report. And then finally looking at the epidemiology. So what is the prevalence, what are the risk factors associated with prenatal mental health issues, PPD, et cetera. And working with Sural Hospital on that, supporting some of their research, news research in that area. And that's in summary what we've been doing and more recently and sort of we can dive into the run as well. Why I did the run was we recently set up here in the US. We've got our 501C3 exemption. And so looking to expand our efforts into the states and looking at where can we support research, but also looking at obviously some additional firepower from the US to support our initiatives overseas in Thailand and the UK for some of those that we have in the pipeline.
Rena: Wow, that's incredible. And you've done all of that in three years?
Hamish: Yeah. Yeah, that's right.
Rena: That's amazing. My reach is in America, but I work with my patients all the time on postpartum. We talk about it and the importance of follow up care. You know, I think even in the US there's such a stigma around it and you know, my population I work with mostly is people that have undergone fertility treatments. And that probably specifically is people that feel like they don't have any justification to feel anything other than happy after giving birth because they went through such a journey. And so they're not even allowed to feel any sort of emotion other than that, which I think is so debilitating.
Hamish: Yeah. Yeah. And there's definitely a a, a social pressure that comes with it and the expectations that everything should be perfect. And if you're, you're not, you're a terrible mother, but even sort of intrusive thoughts are quite prevalent. So not even having baby blues or PPD or or anything associated with that, the intrusive thoughts, the stats are about 70%. So even just day to day, having those thoughts is common. And then the social pressures that come with that and really feeling that in the age of social media where everything looks perfect and everybody posts up everything that's perfect online. And if you don't match that, then that adds to the pressure and you feel terrible. I know that there are some celebrities that have been open about addressing that. That's definitely in the minority. And also just the general awareness is even from the run that I did, I've had a bunch of people reach out saying, I wasn't even aware of this. And turns out some of their friends open up about their experiences and those that weren't aware of it, I mean those that people in sort of sixties, seventies even that weren't aware of, it turns out a lot of their friends went through it or friends of friends. So there's still, despite, I mean I mentioned looking at best practice overseas, there's nothing perfect in US, UK, Australia, et cetera. Whilst they might be at the forefront of providing care, there's still a lot of awareness that needs to be developed.
Rena: Sure. And I don't know how it is overseas, but I, I know here, you know, you give birth, you go to the OBGYN, they give you, you know, sort of a one pager, you fill it out, they say, oh, you know, maybe you have postpartum and then that's it. You're sort of left to your own devices. And if you're already in that space, you know, regardless of what your mental health diagnosis is, it's very hard to help yourself.
Hamish: Yeah, that's right. And there's sort of standard Edinburgh postnatal depression score, EPDS, that gets used. There needs to be a protocol in place and a follow up. There's no point just asking the question. I was like, oh, okay, I need help. What do I do? But there's also I mean we were in our situation, I was familiar and aware of PPD and as soon as Pranaiya started exhibiting some signs, then we sought help and she put her hand up and said, yes, she needed help. But that's often not the case. So it is having that general awareness and that follow-up procedure. But even for us, we didn't know where to go in Thailand. There's no one that's really qualified to assist with someone as sort of severe conditions that as Pranaiya developed. But even in New York, there's like the, the New York Motherhood Center and a bunch of people like such as yourself that, that are dedicated towards helping those. But there's also the, yeah, a general need to to bang the drum about it and raise that awareness so people know where to go. And also self-help as well. I mean, as you said, it's hard to do, but just some basic things, going out for a walk and just sort of starting, starting somewhere.
Rena: Sure. I focus with my patients a lot on sleep and sort of the importance, if you have a history of anxiety or depression, sleep can be one of the number one, you know, indicators that are so important that you have sleep. So figure out how you can get help, what that's gonna look like for you. And I, as much as I can work with people to put supports in place so that they have in their back pocket. Maybe they need it, maybe they don't once they give birth. But I think as you said, you know, in New York, sure, we have a ton of resources here, which is great, but it's more as you're doing really raising your voice and I think changing the conversation so that it's more extreme and it's more talked about, you know, because I think, you know, research shows that people that go through a trauma and don't talk about it have higher levels of anxiety and depression. So building out your supports is one of the most important things you can do.
Hamish: And breaking down those barriers and are some people in New York that have had difficulties and like aware of what happened with Pranaiya, but still hesitant to reach out for help because then it's, oh, it's a bit embarrassed to do that. So yeah, normalizing the conversation and making people comfortable to put their hand up and say, I, I need help.
Rena: Right. Well I think, you know, across the board, whatever you're struggling with, asking for help is one of the hardest things we can do. You know, and it's sometimes it involves ego or self will or whatever, but asking for help is, I always tell people that's not weak, that's really strong. Mm. So are you finding as you're doing this work in Asia, are there barriers for you or they're very open to what you're doing and improving care?
Hamish: Yeah, there's definitely change. Even since everything happened on our end and post covid, the conversation is starting to open up about mental health in general. There is still a big stigma and whatnot attached to it, but I think also as the younger generation starts coming through, they're more open to talk about their issues and about mental health. So there is progress and I've also been encouraged by those that we've reached out to in Thailand to support our initiatives. So for example, the researchers that I mentioned at Raj Hospital that have put their hand up and said, yes, we want to help out and we want to conduct our own research into this. People at the Ministry of Public Health starting to take an interest in this and wanting to address it. Perinatal mental health in general sorry, perinatal mental health, but also the Department of Mental Health. They're sort of starting to push out some more initiatives and also I guess a bit of as I said, the younger generation coming through a bit of a changing of the guard and the way that people approach things and increase interest from some of the OBGs as well. In Thailand, I guess historically it's been very much physical aspects that have been dealt with and prepartum, but thinking about, okay, maybe we need to start incorporating some perinatal mental health education into the OBG certification and then thinking about, okay, what does that mean post birth and working with hospitals and potentially pediatricians to try and build it in, to the checkups or the babies. But everyone's tight on time, everyone's tight on resources. So it's just trying to figure out how to build in those protocols and address that, but it's moving in the right direction. So I've been, yeah, encouraged by people's feedback.
Rena: That's amazing. And what about now for the US since you got your 501C3? Or are you looking to make moves here?
Hamish: So the goal for the US there's already postpartum support international and various other charities that really focus on the awareness and the training with their certification with the PMHC and whatnot. So those aspects I guess we're looking to replicate out in Thailand initially. And for us, I guess me personally, what I would like to look at is where there's, I mean there's, the awareness isn't ideal and there's issues funding and addressing this within the the healthcare system, but there are people and organizations addressing that. And where I feel passionate about the wanting to address is understanding it better, the research. And so looking at what is the physiology, what is actually going on and how do we address that? And it fits, I guess there's obviously a spectrum of conditions and CBT and other methods are, are generally sufficient, but for the more extreme end then we need to try to get a better understanding as to what's going on. I mean, we went through the whole gambit, but we went through trying to address it with antidepressants, DTMS and a whole range of things that didn't work and we ultimately ran out of time and things don't work and you're highly anxious. Then sort of what happened with us was very much, oh, this is reinforcing the belief that I can't be fixed and adding to the anxiety and everything. And so the rolling of the dice on the therapeutic side just made things worse and not, there's a lack of real understanding as what's going on physiologically. I mean yes there are hormonal changes and things, but it's like why do you get a headache? It could be a multitude of reasons and there's no silver bullet. So similar to what we're doing in the UK, what we're supporting with the Department of Physiology, Anatomy, Genetics, we're supporting some research there that's looking at the disruption of epigenetic factors pre and postpartum. So what is going on in the brain that is changing, that gets disrupted to not just the hormones but neurogenesis and what is actually going on there that gets sort of way late and is there a way to understand that better and fix that? And so looking at the initiatives in the US starting to reach out to some of the universities that are looking at that early stage research and also alternative treatments. So I guess a hot topic at the moment is psychedelics, et cetera. And so is there a place for that here? So looking at, been speaking with neuroscience, Melissa Lavasanni as well, so various people that are in that field and sort of starting to get a, an understanding of what that landscape looks like here and seeing where we can plug in and support.
Rena: Oh wow, that's amazing. And so interesting and I think everything you said is, I mean if only everybody knew that, right? And I think what you touched upon sort of that frustration where, okay, this didn't work and now I feel like I don't know where to go. And if everyone is telling you, well that's it, that's all I got for you. Yeah. And having to do the work and advocate for yourself, which again, if you're already in a state of having all this going on in your brain and you can barely get out of bed, how are you supposed to do that for yourself?
Hamish: Yeah. So for me that's a big thing of how do we get a a better understanding? I mean this is obviously a long, long-term project and we don't, I mean, trying to understand what's going on in the brain is difficult enough, but for me that's something that I would like to address.
Rena: I mean I think that's incredible and I, I think the impact of that on so many people could be huge. And just having that understanding, you know, for mental health, you know, again, as we sort of we're talking about, I think there's continues to be such a stigma around it and that can be done for, you know, people in general to understand no one chooses this and this is what's going on. Okay. And here are various ways we can treat it.
Hamish: Yeah. And understanding what that suite is from, is it multimodal or like looking at CBT through to some of the synthetic hormones, Brex standalone or for some people they have standard SSRIs work for others they don't. So what are some other options? Is there a way to understand exactly what's going on? I mean the diagnostics are obviously very difficult, but with advances and some of the portfolio companies that are looking at sort of various biomarkers for early stage like cognitive impairment, et cetera, is there a way to start looking at this as well? And big questions gonna take a lot of time, but that's fine. I'm willing to, to put in the the time and time and effort for it.
Rena: Yeah, you're in it for the long haul. It sounds like a lot of implants for the foundation.
Hamish: Yeah. Yeah.
Rena: So tell us a little bit about the run and how that ties into this?
Hamish: Yeah, so running's always been my thing for a long time now. And after everything happened with Pranaiya and Arthur sort of, I guess you find yourself in a bit of malaise and just trying to get out and go for walks just to get moving, get out of the sun, get some fresh air rather than sort of sit around on the couch. And I guess sort of one thing led to another and as I was able to sort of start getting out for runs, those runs got a bit longer and then starting to think about, okay, how can I build this into like is there a goal that I could set to try and sort of challenge myself? And I found that initially after everything happened and setting a goal, the initial goal that I set is called the Joggle genre Grit to Lands End. So the top of Scotland to the bottom of England. And I set that as a goal to try to run that. I found just mentally having something that I could just sort of go out and just slowly chip away and work towards and focus on the training for that. It's just sort of long slow training so it's not to impact heavy on the body really helps me just have that line in the sand for something just to, just to focus on. And at that point it's sort of basic slow running, it's just input yields results and input in and then sort of results out. It is just sort of chipped away at that. And having done joggle, I got injured off a few days and ended up on bike and ended up doing 50% on bike, 50% on foot. That really helped me sort of, you know, reset and have something to aim towards. And so since then I've been doing a lot more running and trying to get my marathon time down and thinking about the next challenge. And so when we got set up here I thought, oh I could do a challenge in the US and it came across the Central Park Loop Challenge, so running as many laps as possible between open and close and Central Park. And it just seemed like a good way to get the community together here in New York that I've come to notice since being here over the past year. And it was a nice way to celebrate Arthur's birthday and, and just have something that can hopefully raise awareness as well. And through that I think we've done a good job and everyone that supported had a bunch of people reach out such as yourself that it's great to have along. And even like just through that, as I mentioned, we had a lot of people come up and say, oh thank you for sharing the story. Or people that ran, they had friends reach out to them like saying thank you for joining and helping raise the awareness around this. I had PPDI haven't told anybody, et cetera. So it enables those that have suffered in the past to be open about their experiences as well and help them to address that post. So that's been good. And so thinking about okay, what's the next challenge?
Rena: Yes. Okay, so what is the next challenge?
Hamish: Yeah. Few ideas yet to be determined. The 8th of March was a bit of a tester to see how much my body could handle. So after the 116 odd miles, it was pretty sore the next day thinking about some back to back things like the juggle again. But I think my body needs a bit more conditioning before I take on anything larger
Rena: And what an incredible feat And you know, I think right as people in this sort of the endurance field can attest to, right? You finish one thing and then it's what's next because it's such a high and then you come down and it's like okay, I gotta keep chasing. Yeah. But what a thing to do for the PAM Foundation and just as someone that got to come out and do one loop with you, I mean I think the grassroots support people coming out, people talking about... I think it's just such a great community.
Hamish: Yeah. The running community in New York's been fantastic and a lot of people really stepped up to get behind me and sort of make sure that there was at least one person per lap and organizing the cheer squad and all the running around getting hot food and supplies and everything. It wasn't, I mean, sort of joke that I had the easy job, I was just sort of running around in circles, whereas everybody else was a little bit more frantic trying to get things ready, put stuff up on social media, take photos and organize everything. So there's a lot that goes on behind the scenes to just support someone running around.
Rena: Sure. Well, and I think for people that aren't familiar with this, I mean so much goes into it, you know, the nutrition, you chatting a little bit about that, but you were so organized with your food plan and eating and I think when I saw you doing a lap, you're eating spaghetti bolognese. I know there was a lot of, you know, you have to be so organized and dialed into that to accomplish something like this.
Hamish: It's interesting. It becomes a lot more, I mean there are some people that are not scientific about it by any stretch of the imagination. Some of the sort of more grassroots trail runners, but I guess I take things a little bit more seriously and a bit more scientific. So I had the, the spreadsheet out and and counting the calories and the macros and trying to make sure that things went according to plan. 'cause It basically just becomes an all day eating contest trying to eat, I think it was like 12.5 thousand calories while you're running. Basically. It's hard to get that amount of food in. So it becomes…
Rena: Oh that's amazing. It's like actually it's hard to do.
Hamish: Yeah. So I mean I came up well short of that, but you try. There's also, you mentioned sort of the high of it and then sort of trying to figure out what's next. It's, to me, I've been reading a lot about endurance and various aspects around sort of the physiology and brain science and whatnot. And for me it's interesting to think about what the overlap is between like enduring a run like that versus enduring what life throws at you and sort of how the two go hand in hand. And by, there's some sort of, I guess some debate as to does one help the other, does one come before the other? Does the physical endurance as a sort of an endurance runner previously, does that help when things get tough or is it vice versa? And so I guess it's, yeah, for me, just interesting to think about that and the tie up between life and running for long, painful distances.
Rena: Sure. I mean, I know for myself and I know, you know, so many people in the sport, I got into doing the endurance races when I was going through my own difficult time. And I would, you know, for myself, those things, those challenges, what I put my body through, that's what I draw upon when life throws me things outside of that. Right. I can do that, then I can. And so I, I think there is a direct link and you know, I think my own personal goal is longevity in the sport because it definitely helps me mentally, you know, and sometimes I think to myself, right, if you go out there, if you have a workout in the morning, whether it's a long run or speed work, for me personally, I take that through the day, right? And I sit there and I think, okay, I've already done the hardest thing I need to do today. The rest is easy, you know, if I can get out there and do Yeah. And that feeds me. I mean, my own mental struggles are the hardest. If you take that away, you know, if I'm injured, if I can't go out and do that, okay, I gotta figure out how, what can I do so that I can myself up for success because that keeps me mentally strong.
Hamish: Hmm. Yeah. And also like for the, for the Central Park Loop challenge, the goal was 20 laps and the last sort of lap 14 onwards going up Harlem Hill and knees started playing up a bit and it's, I guess I'm someone that can be quite persistent slash stubborn and it's trying to find that, what's the line between the two? And so knowing when to call it quits, which I've had to do a couple of times in the past year, and I guess historically maybe I wouldn't have done that, but learning, learning your limits, learning how, finding that fine line between pushing your limits for improvement versus doing damage. So for the run in Central Park, I think I got the right mix, got that 19th lap done in record time and then decided to call it quits. And I, I don't regret that either. So I guess take that into, into life as well, trying to figure out that, that line of stubbornness and persistence.
Rena: Sure. Well an old coach of mine told me that's discipline. He said, you know, discipline going out and running every day, that's like brushing your teeth. You have that. Discipline is knowing when to stop because when you're at that level, you are more apt. You want, you set a goal, so in your mind it's 21, that's it. And I'm gonna be crawling to the finish, but then to what? Right. So you then, you know, you're out of the sport for the next month, you injure yourself. And it, like you drew upon that, you realized, okay, I gotta make a choice. I can smash a record, I just have to pivot. And that's, and I think that's much harder to come by.
Hamish: Yeah. And going into, and one thing I've learned as well is going into the, into the run and going into any race you sort of have, in this case, I had sort of my, my base goal of 20, I had my stretch goal if things went well 'cause you never really know what's gonna happen on the day of, of an extra lap. But then ultimately that, that fallback, that second tier goal was to try and get that record just on the 19 laps as well. So going in, being prepared, like you mentioned all the food and everything, but also mentally when things start to go sideways, so you're not having to figure everything out on the fly, you're mentally fatigued. It's okay, what was my backup plan? Where am I? Do we, do we pivot, do we change or do we take it down an option and sort of figure that out as well?
Rena: Yeah. And it sounds like you're able to do all of that and still smash a record and have this amazing achievement.
Hamish: It worked out well.
Rena: So tell, I mean you touched upon a little bit about sort of long-term goals for Pam Foundation or what you're thinking about. Yeah. If anyone wants to get involved or more long-term goals, let's
Hamish: Sure. Yeah. So starting overseas first we've got working with the Ministry of Public Health, trying to put in place national guidelines and get sort of training up across the board all the way from sort of healthcare volunteers through to psychiatrists and more sort of highly trained specialists. In the UK where on the epigenetic study that I mentioned, we're about halfway through, so a year and a half through the the three years. So hopefully we'll get some results this year, some initial results, which we'll be able to share, which, which should be interesting. And then we've also been discussing about getting an endowment in PR and Arthur's name to ensure that this research continues at Oxford beyond our lifetimes. And then can make sure that that's, yeah, something that's long lasting. And then in the US we would like to, as I mentioned, sort of start, start getting plugged into the, the research ecosystem here to assist and also looking at some fundraising events. Obviously all this requires a bit of funding and it's, the funding environment is increasingly challenging at the moment. And so trying to tap into sources and organizations and people that are passionate about addressing perinatal mental health. And I find there's a lot of enthusiasm in the US for addressing this. And so there's trying to build that community here and get things going.
Rena: Amazing. And what about for you on the physical front?
Hamish: We've got Boston in the short term. Boston and London. We've got a charity spot and someone running for us in London, so that, that's going to be great. And then we have a bunch of charity spots in London over the next four years, and we'll look to do the same. New York Marathon now that we're set up here. And so for me, obviously a big thing is, is running. And so tying that in, everything sort of starts to blend into one. If the, the running is tied to the foundation is tied to me personally and everything that's going on, but also bringing in other people to do that socially and get people involved. In the, in some of these charity rungs, there's always huge amounts of enthusiasm and, and it's great to get to get people on board and then later in the year, a few more marathons and then yeah, figure out the next rung challenge. We'll see how that goes.
Rena: Okay. Well our listeners love to follow you and if they do wanna get involved with the PAM Foundation or follow your running achievements, where can they?
Hamish: So pamfoundation.org is the website and we have a lot of social media links on there, so feel free to reach out via social media, Instagram, Facebook, et cetera. That's on there.
Rena: Wonderful. Anything else that you wanna share with our listeners that they should know
Hamish: In terms of sharing? Anything else? I don't think so. You covered a lot of, a lot of aspects. Foundation and running, that's about it.
Rena: But I think it's incredible what you do both with the PAM Foundation and your running achievements. So thank you so much for taking Thank you to come on
Hamish: Thanks very much.
Rena: The way we like to end our episodes is by saying something that you are grateful for, so of gratitude that you have today?
Hamish: Grateful for all the support that everyone's given me. Since everything happened on the personal front, a lot of people have stepped up to support me. And then even more recently with the Run, it's been fantastic. And it just goes to show that just that sense of community and encouragement is still there. It's great to have people on board that really care about you and in my case, not being in New York for too long, but made some great friends and yeah, just very grateful for everyone's support.
Rena: Oh, that's so beautiful. I guess I would piggyback on that and say community. I think community is so important. I think it's really hard to do life alone and family, friends, however you get that community is super. So I feel really grateful for mine.
Hamish: Very good.
Dara: Thank you so much for listening today and always remember: practice gratitude, give a little love to someone else and yourself, and remember, you are not alone. Find us on Instagram @fertility_forward and if you're looking for more support, visit us at www.rmany.com and tune in next week for more Fertility Forward.