Features

Mapping maternal mental health services

06 June 2018

Dr Alain Gregoire of the Maternal Mental Health Alliance calls for an end to the postcode lottery and the roll-out of perinatal mental health units across the UK.

In April, the Maternal Mental Health Alliance (MMHA) launched new maps showing the provision of specialist perinatal mental health teams across the UK. The maps, part of the MMHA’s Everyone’s Business campaign, show that women across nearly a quarter of the UK (24%) still cannot access any specialist perinatal mental health services.

Since the publication of the maps, NHS England has announced that it will be rolling out community perinatal care to 35 new sites (covering 134 clinical commissioning groups) and is on course for full geographical coverage of England. Progress in other UK nations is variable.

Why are these services needed?

Perinatal mental health problems include those that existed before pregnancy, as well as illnesses that develop for the first time, or are exacerbated in the perinatal period. Examples of perinatal mental illness include antenatal and postnatal depression, anxiety, obsessive compulsive disorder (OCD), postpartum psychosis, post-traumatic stress disorder and experiences of trauma. These illnesses range from mild to severe and require different kinds of care.

More than one in 10 women develop a mental illness during pregnancy or within the first year after having
a baby (NSPCC, 2013). Women with the most severe perinatal illnesses need to be able to access vital specialist services wherever they live; if left untreated, these illnesses can have a devastating impact on women and their families (Bauer et al, 2014). In the most serious cases, perinatal mental illness can be life-threatening: suicide is a leading cause of death for women during pregnancy and one year after giving birth (MBRRACE-UK, 2016).

Many of you in your day-to-day roles in the community come into contact with women with perinatal mental health problems who need specialist services but who cannot access them. Health visitors, midwives and those who work in the voluntary and community sector, for example, can play a key role in identifying women who may need support and signposting to the right services.

One of the mums who works with us on our campaign, Kirsten, told us that she experienced OCD during her first pregnancy that led to an all-consuming terror. She felt desperate, invisible and exhausted and, despite speaking to 11 different professionals about her mental health, she was unable to get the help she needed. During her second pregnancy there was a specialist team in her area; she was offered coordinated care, advice on medication, and support. It was life-changing for her, and shows the huge difference services can make when they are available.

What do the maps show?

Our map of specialist perinatal mental health service provision shows that 43% of areas have improved their colour rating since 2015, when the maps were last published. They were created with data collected from the Royal College of Psychiatrists and regional perinatal mental health networks last year. Each area was rated using nationally accepted criteria, including the
Royal College of Psychiatrists’ Centre for Quality Improvement (CCQI) Standards (2014). The maps are colour coded: red means that no specialist perinatal mental health provision at all is available to mothers and babies, and green means that the area has a team that meets national standards. Pink means extremely basic provision exists, and amber that basic provision exists.

Improvements have not been consistent across the country (see Mental health map, above).

What are the implications of gaps in services?

Specialist perinatal mental health services save lives; they provide specialist treatment and can also act as a catalyst for change across the whole care pathway, providing expertise and delivering training to a range of health and social care professionals including health visitors, GPs and midwives.

Women across all levels of need benefit too: health visitors and midwives can carry out the identification of unwell or high-risk women with the confidence that specialist advice or care will be available if needed; and can access local, up-to-date training opportunities, knowing that they are participating in a coordinated pathway of care.

Government investment

Different nations have received different levels of investment. NHS England has made great strides in implementing large-scale improvements in perinatal mental health services using new government funding. Four new in-patient mother and baby units (MBUs) have been commissioned in Dartford, Exeter, Chorley and Norwich, due to open in 2018-19. NHS England is also enacting a range of changes that will improve quality and sustainability of these services. In Wales, all health boards have received some funding for specialist community teams and have rapidly implemented staffing on the ground, but without sufficient funds in most areas to meet national standards of care. There is still much to be done until women can access these vital services across the UK. Currently, there is no MBU in Wales. In Northern Ireland, the government has given no funding to date and there is no MBU; the great majority of women have no access to any specialist perinatal mental healthcare at all. In Scotland, the government has provided no new funding to date.

Without a totally green UK map, women and families will continue to miss out on essential life-saving care. The MMHA is calling for an end to this postcode lottery.

Alain Gregoire is founder and chair of the Maternal Mental Health Alliance.


 

Time to reflect

What could you do to help raise awareness of these gaps in services and to champion specialist services in their local area? Join in the conversation on Twitter @CommPrac using the hashtag #MaternalCare


 

Resources

Become familiar with the level of specialist perinatalmental health services in your area using the maps at bit.ly/MMHA_maps

Look at the statistics from a report (Bauer et al, 2014) that highlight why this is important at bit.ly/perinatal_costs

Share the maps on social media using the hashtag #everyonesbusiness as well as with your local media, highlighting where funding for services is still needed or indeed to celebrate progress to date and inspire others.

Invite the MMHA’s Everyone’s Business team to deliver presentations along with lived experience champions in your area. Contact info@everyonesbusiness.org.uk to arrange.


 

References

Bauer A, Parsonage M, Knapp M, Iemmi V, Adelaja B. (2014) The costs of perinatal mental health problems. See: http://eprints.lse.ac.uk/59885/1/__lse.ac.uk_storage_LIBRARY_Secondary_libfile_shared_repository_Content_Bauer,%20M_Bauer_Costs_perinatal_%20mental_2014_Bauer_Costs_perinatal_mental_2014_author.pdf (accessed 23 May 2018).

Mothers and Babies: Reducing Risk through Audits and Confidential Enquiries across the UK (MMBRRACE-UK). (2016) Saving lives, improving mothers’ care. University of Oxford: Oxford.

NSPCC. (2013) Prevention in mind: All babies count: spotlight on perinatal mental health. See: nspcc.org.uk/globalassets/documents/research-reports/all-babies-count-spotlight-perinatal-mental-health.pdf (accessed 23 May 2018).

Royal College of Psychiatrists. (2014) Service standards: second edition. See: rcpsych.ac.uk/pdf/Perinatal%20Comunity%20Standards%20Cycle%203.pdf (accessed 23 May 2018).

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