Perinatal mental health support
Many mainstream mental health services provide support for new and expectant parents, including primary care, Talking Therapies (previously known as IAPT), and other mental health services (such as adult mental health services and child and adolescent mental health services).
- Primary care can provide support for new and expectant parents and refer on to voluntary and community organisations, Talking Therapies and secondary mental health services (21).
- National research that highlights that women have mixed experiences of seeking support for their perinatal mental health at GPs (172). They felt more positive about support when it was personalised and integrated, and when they were involved in making decisions about their care.
- The 6-week postnatal health check carried out by general practitioners is a ‘crucial safety net’ for identifying mental health problems in mothers and birthing parents who have previously not disclosed mental health difficulties, or those who have been missed by the system (172). However, a recent national survey of over 2,600 mothers and birthing people found that (173):
- 16% of respondents did not have their postnatal health check.
- Of those who did have a postnatal health check, only 1 in 5 were satisfied with the time their GP spent talking to them about their mental health. 30% said that mental health was not mentioned at all during the consultation.
NHS Talking Therapies (previously known as IAPT) provides support for people experiencing mild to moderate mental health difficulties (151).
- National research highlights that psychological wellbeing practitioners have limited training on the emotional changes associated with pregnancy, changes in family dynamics associated with the perinatal period and the clinical features of perinatal mental health conditions (21). None of the treatments provided by the NHS Talking Therapies focus on parenting or developing caregiver-infant relationships (21).
- Nationally, women with perinatal mental health conditions report positive experiences of being supported by NHS Talking Therapies. However, they also highlight barriers to access (such as difficulties identifying their own mental health difficulties and insufficient explanation of the services offered by NHS Talking Therapies) and that therapy could sometimes be better tailored to the perinatal period (such as by allowing fathers and babies to attend appointments) (174).
NHS Cambridgeshire and Peterborough Talking Therapies offers cognitive behavioural therapy (CBT), interpersonal therapy (IPT) and eye movement desensitisation and reprocessing (EMDR) for people experiencing mild to moderate mental health problems. Therapies are given in person, and via video consultation, telephone or typed chat.
- It has 6 teams based in Cambridge North, South and Central; Huntingdon; Fenland; and Peterborough.
- New and expectant parents are prioritised for assessment (which takes place within 2 weeks)
- Over the past year, there has been a substantial increase in the proportion of referrals into the service for peri/post-natal patients. The most of this increase has been in female patients.
Figure 40: Peri/post-natal patients as a percentage of total referrals into Talking Therapies. Data source: Cambridgeshire and Peterborough Talking Therapies
Recovery rates for patients in the perinatal period are similar to the overall recovery rates of the Talking Therapies service, of around 50 to 60%.
Links with wider mental health and learning disability services
Some new and expectant parents may have continued care during the perinatal period from general mental health or learning disability services. These services should follow guidelines to ensure that they have joined up perinatal mental health pathways (175).
The majority of local services work together with the specialist perinatal mental health team to support individuals during the perinatal period. The specialist perinatal mental health team can offer advice or directly provide support, depending on whether patients’ primary need is around perinatal mental health.
- Adult mental health services: There are strong links with the specialist perinatal mental health team, including a joint working protocol. The specialist perinatal mental health team works in an advisory role for locality teams, to provide advice when people with serious mental illness become pregnant.
- Child and adolescent mental health services (CAMHS): There are limited links between the specialist perinatal mental health team and CAMHS, due to the small numbers of people who are eligible for both services.
- Drug and alcohol services: There is joint working with the specialist perinatal mental health team, which can provide advice for practitioners working in drug and alcohol services.
- Eating disorder services: There are strong links and a joint working protocol with the specialist perinatal mental health team.
- First response service (FRS): Links between the specialist perinatal mental health team and FRS have recently been developed. FRS can refer people into specialist perinatal services and some staff have received training on perinatal mental health. Crisis support in working hours (9am – 5pm) is provided directly by the specialist perinatal mental health team for people already in contact with this service.
- Forensic mental health services: The specialist perinatal mental health team can jointly work with forensic mental health services, although the number of referrals is low. HMP Peterborough has a mother and baby unit (MBU) which has spaces for up to 12 mothers and 13 babies.
- Learning disability services: The specialist perinatal mental health team can work jointly with learning disability services. They do not tend to care coordinate as these services already provide this support.
- Personality disorder services: The specialist perinatal mental health team can refer people into the Relational, Emotional Difficulties Service (REDS) to meet specific needs around emotional regulation; as well as providing ongoing support to people who attend this group. There is also a joint working protocol in place with the Personality Disorder Community Service.
- 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
- Perinatal mental health services: Recommendations for the provision of services for childbearing women
- Guidance for commissioners of perinatal mental health services
- Best Use of Medicines in Pregnancy provides evidence-based information about medication use during pregnancy
- A five minute video by the Royal College of GPs on identifying perinatal mental health problems.
- A good practice guide to support implementation of trauma-informed care in the perinatal period
- Standards for Community Perinatal Mental Health Services
- Guide for delivering preconception care to women with a serious mental illness
Full list of references can be accessed here.
172. Khan L. Falling through the gaps: perinatal mental health and general practice [Internet]. 2018 [cited 2023 Feb 13]. Available from: https://www.centreformentalhealth.org.uk/sites/default/files/2018-09/falling.pdf
173. Healthwatch. Left unchecked – why maternal mental health matters [Internet]. 2023 [cited 2023 Mar 30]. Available from: https://www.healthwatch.co.uk/sites/healthwatch.co.uk/files/20230315%20Left%20unchecked%20briefing.pdf
174. Millett L, Taylor BL, Howard LM, Bick D, Stanley N, Johnson S. Experiences of improving access to psychological therapy services for perinatal mental health difficulties: A qualitative study of women’s and therapists’ views. Behavioural and Cognitive Psychotherapy. 2018;46(4).
175. Royal College of Psychiatrists. Perinatal mental health services: Recommendations for the provision of services for childbearing women [Internet]. 2021 [cited 2023 Mar 10]. Available from: https://www.rcpsych.ac.uk/docs/default-source/improving-care/better-mh-policy/college-reports/college-report-cr232—perinatal-mental-heath-services.pdf?Status=Master&sfvrsn=82b10d7e_4