New research involving ARC South London maternity and perinatal mental health researchers at King's College London, and in partnership with the University of Exeter and the London School of Hygiene & Tropical Medicine, has found that women with a history of severe mental illness face a lower risk of relapse after giving birth in regions where they have access to a community perinatal mental health team (CPMHT).
The research, published in Lancet Psychiatry, is the first of its kind to evaluate the effectiveness of CPMHTs, and suggests that women with access to specialist support have a reduced risk of acute relapse after birth, but also highlights the importance of the need for mental health services to work more closely with maternity services.
CPMHTs were rolled out in England from 2016 as part of a unique national initiative to improve the access to specialists for women with perinatal mental health problems and overall mental health outcomes. Women with a history of severe mental illness such as bipolar disorder and severe depression are at greatly increased risk of relapse in the first few months after birth and CPMHTs aim to improve access to preventive care during pregnancy in addition to treating new episodes of mental illness during pregnancy and after birth. However, little research has been conducted into exploring the effectiveness of such CPMHT care.
This study identified 70,323 women who had given birth to a single baby, and who had contact with a secondary mental healthcare service in the ten years immediately before their pregnancy. Researchers followed this group to establish how many experienced acute relapses in their mental health after birth – defined as either being admitted to a psychiatric hospital, or being cared for by a crisis resolution team.
Researchers found that access to care significantly improved – 24.2% of women accessed care during pregnancy in areas where a CPMHT was available compared to 17.9% in areas where no CPMHT was available. In addition, an acute relapse after birth was found in 1117 (3.6%) of 31 276 women where a CPMHT was available and in 1745 (4.5%) of 39 047 women where one was unavailable.
The period after birth can be a time of increased risk for women with severe mental illness such as those with bipolar disorder or a history of severe depression. It is very encouraging to see that having a community perinatal mental health team in an area is associated with significantly reduced rates of relapse after birth – a time when mothers want and need to be well, and at home with their infants
Professor Heather O’Mahen, Professor in perinatal clinical psychology, University of Exeter, one of the study’s senior co-authors said, “Pregnant and postnatal women can face many barriers to mental health care. The government’s investment in CPMHTs has made a real difference in their ability to access needed treatment.”
Conversely, the researchers found that women in regions with CPMHTs were at an increased risk of undergoing stillbirth, neonatal death, and giving birth to babies small for their gestational age.
Professor Dharmintra Pasupathy, co-author, Professor of Maternal and Fetal Medicine, University of Sydney said, “There is no simple interpretation that we can give for these associations but it may be that more intensive psychiatric support available in a region may negatively affect the midwifery and obstetric support that women with severe mental disorders receive during pregnancy and childbirth. This is something that we urgently need to study in greater depth as the full facts are not clear.”
Dr Ipek Gurol-Urganci, the lead author, Associate Professor of Health Services Research, London School of Hygiene and Tropical Medicine said, “The results of this study highlight the value of the data that the NHS routinely collects on the care they provide. Without these national data, it would not have been possible to evaluate the role of CPMHTs, a unique approach to provide support to women with severe mental illness during pregnancy and after birth.”
This study was funded by the National Institute for Health and Care Research (NIHR).