8 Sep 2022

The first phase of the study is detailed in a new report, ESMI-III: The Effectiveness and Implementation of Maternal Mental Health Services. Maternal mental health services (MMHS) are being implemented across England as part of the NHS Long Term Plan’s commitment to transform and improve access to perinatal mental health care.

MMHS services aim to provide evidence-based psychological interventions, integrated within maternity and obstetric pathways, for women and birthing people experiencing moderate to severe or complex mental health difficulties related to their maternity experience. This may include people who experience post-traumatic stress disorder following birth trauma, perinatal loss such as miscarriage, stillbirth, neonatal death, termination of pregnancy or parent-infant separation at birth due to safeguarding concerns.

The study is being carried out in two phases:

Phase 1 – focuses on organisational mapping and identifies barriers and facilitators to implementing MMHS. This aims to understand the core components and variation in MMHS delivery models.

Phase 2 – focuses on organisational case studies with selected MMHS sites. This aims to understand which MMHS models work, for whom, and in what circumstances, as well as how and why MMHS aim to improve maternal mental health.

The findings from phase one of the ESMI-II study have led do the development of national and local facilitators to implement MMHS.

Despite the challenges to implementation identified, there was a huge amount of dedication both nationally and locally to develop MMHS, reflected by the passion of teams to meet a long-standing gap in mental health needs. Some teams reflected on the achievements of their services, the amount that had been developed within a short space of time and the difference it is making to women’s lives who would otherwise not have received care.

Abigail Easter

Dr Abigail Easter, senior lecturer in maternal and newborn health, King’s College London and a maternity and perinatal mental health researcher at ARC South London

Among the recommendations from the first phase of the ESMI-III study are:

National recommendations

  • Develop and communicate a shared understanding and vision for the scope of MMHS
  • Allow capacity and adequate resource within the service for planning and operational management of the service
  • Provide guidance to MMHS for local key performance indicators (KPIs) for waiting times between referral and assessment, and assessment to treatment times
  • Provide template documents to facilitate integration of healthcare systems, such as job descriptions for key roles in MMHS teams, data sharing agreements, etc, while allowing these to be tailored to local settings
  • Support commissioning processes for scale-up and sustainability of the services

Recommendations for early planning service delivery

  • Engage with maternity services early in the service development process
  • Ensure contractual and physical access to IT systems across mental health and maternity trusts is in place ahead of launch of services and start of recruitment
  • Ensure staff are recruited into posts ahead of launch and allow for sufficient time to finalise contracts
  • Ensure all team members, including specialist midwives, have access to training and supervision

Recommendations for working as a multidisciplinary team

  • Ensure clear job descriptions, especially for specialist midwife posts, peer-support workers and psychologists are in place
  • Consider multidisciplinary triage forums, with maternity, mental health colleagues and, where appropriate, third sector organisations
  • Consider engaging peer-support workers at early stage of treatment journey, for instance, at assessment
  • Ensure a clear escalation policy is in place for access to crisis care through integrated care pathways and ensure all relevant services are involved and aware of this policy.

The ESMI-III study is funded by the NIHR Applied Research Collaborations (ARCs) Children’s and Maternity Research Priority Programme and is led by the NIHR ARC South London maternity and perinatal mental health theme at King’s College London, in collaboration with Liverpool University and Exeter University.

Find out more

Read the full report: ESMI-III: The Effectiveness and Implementation of Maternal Mental Health Services.

Read more about the ARC national Children’s health and maternity programme