Service provision

Unusually within mental health contexts, almost the entire population of women and birthing people experiencing perinatal mental health difficulties have routine contact with health services. This provides multiple opportunities for the early identification and treatment of mental health conditions, which may impact up to 1 in 4 women during the perinatal period (1,17).

• Early identification and intervention are particularly important as the adverse impacts of perinatal mental health conditions are not inevitable. Instead, this depends on a range of factors, including parenting skills, social support and the length and severity of mental health conditions (5).
• There are a range of effective interventions that improve the outcomes of perinatal mental health conditions (110). The provision of high quality perinatal mental health support often allows people to have more positive experiences of pregnancy and improves parent-infant interactions (150).
• A meta-analysis of qualitative research based in the UK found that non-judgemental and compassionate support and patient involvement in treatment decisions, are key to good experiences of mental health care during the perinatal period (34). Symptoms of perinatal mental health conditions are more likely to be disclosed when patients have continuity of care and a good relationship with a trusted professional (34).

This needs assessment focuses on local services (as summarised in February 2023) providing support during the perinatal period, ranging from universal services to those providing more specialist support (151). It focuses on: services for all infants and parents; voluntary and community sector support; perinatal mental health support; and specialist perinatal mental health services.

Figure 30: Services covered in this needs assessment.

There have been substantial developments in the provision of perinatal mental health support over the past 10 years, both nationally and locally (152). The strengths and gaps in current local service provision have been evaluated  using the Pathway Assessment Tool, which rates services and pathways against national guidelines.

National guidelines

Key guidelines in perinatal mental health include:

• Centre for Mental Health’s briefing for integrated care systems on on maternal mental health.
• Supporting High-Quality Perinatal Mental Health Care: What does good look like?
• NICE Guidelines on antenatal and postnatal mental health and pregnancy and complex social factors: a model for service provision for pregnant women with complex social factors
• Royal College of Psychiatrists guidelines:
  • Perinatal mental health services: Recommendations for the provision of services for childbearing women
  • The Perinatal Mental Health Care Pathways: Full implementation guidance
  • Standards for Inpatient Perinatal Mental Health Services
• Guidance for commissioners of perinatal mental health services
• Guidelines on specific types of care:
  • Standards for Community Perinatal Mental Health Services
  • Supporting mental healthcare in a maternity and neonatal setting: Good practice guide and case studies
  • Five Principles of Perinatal Peer Support: What does good look like?
  • Guide for delivering preconception care to women with a serious mental illness
• Guidelines on specific aspects of care:
  • Ensuring digitally enabled health care is equitable and effective for all
  • A good practice guide to support implementation of trauma-informed care in the perinatal period
  • Involving and supporting partners and other family members in specialist perinatal mental health services: good practice guide

Switch to telemedicine 

Since the early stages of the COVID-19 pandemic, many services have made a switch to telemedicine (the remote or virtual delivery of services).

• Telemedicine has a range of advantages, including removing geographic barriers to care; and potentially being more accessible for parents with unpredictable childcare schedules and those who are unable to take time off work (31).
• Online care has been shown to be effective: for example, online psychological interventions are an effective way of delivering treatment for anxiety and depression during the perinatal period (153); and online peer-moderated discussion groups may increase help-seeking and reduce stigma (31).
• Patients report high levels of satisfaction with telemedicine services, and report that they improve their access to healthcare (154).
• However, a complete switch to telemedicine may widen inequalities faced by vulnerable groups (including people with limited access to technology and those who experience domestic abuse) (31).
• It is important to structure services around people’s preferences and needs and avoid a ‘one-size fits all’ approach, in order to prevent digital exclusion (155).

Geographical mapping 

A mapping of services was carried out by Susan Sadek in 2022. This map highlighted that there are geographic gaps in service provision across Cambridgeshire and Peterborough. For example:

• MPower offers support to women who have experienced recurrent custody loss. This service currently only operates in Fenland, although there are plans to expand this to cover Peterborough.
• Lack of parent-infant infant therapy in Peterborough and SG8 postcodes
• Varying provision of social support groups, including those providing support for people with low to moderate mental health needs

Figure 31: Location of services across Cambridgeshire and Peterborough. Image source: Susan Sadek 2022

References

Full list of references can be accessed here.

150. National Collaborating Centre for Mental Health. The Perinatal Mental Health Care Pathways: Full implementation guidance [Internet]. 2018 [cited 2023 Mar 1]. Available from: https://www.rcpsych.ac.uk/docs/default-source/improving-care/nccmh/perinatal/nccmh-the-perinatal-mental-health-care-pathways-full-implementation-guidance.pdf?sfvrsn=73c19277_2
151. Sadek S. Cambridgeshire and Peterborough Perinatal and Infant Mental Health Services Guide. 2023.
152. Maternal Mental Health Alliance. Map of Specialist Community Perinatal Mental Health Teams (UK). 2020.
153. Loughnan SA, Joubert AE, Grierson A, Andrews G, Newby JM. Internet-delivered psychological interventions for clinical anxiety and depression in perinatal women: a systematic review and meta-analysis. Vol. 22, Archives of Women’s Mental Health. 2019.
154. Ackerman M, Greenwald E, Noulas P, Ahn C. Patient Satisfaction with and Use of Telemental Health Services in the Perinatal Period: a Survey Study. Psychiatric Quarterly. 2021;92(3).
155. The King’s Fund. Moving from exclusion to inclusion in digital health and care [Internet]. 2023 [cited 2023 Mar 9]. Available from: https://www.kingsfund.org.uk/publications/exclusion-inclusion-digital-health-care#structuring-services-around-peoples-needs

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