Risks and challenges to progress

Despite the different status of each nation and its respective approach to improving specialist perinatal mental health (PMH) provision, there are four areas which will be a risk to further progress if not sufficiently addressed.

1: Continued funding

Over the last three years, in all four nations, there has been an increase in both budgets allocated for specialist PMH services and an increase in what is being spent on specialist PMH services.

Thanks to this much needed, dedicated government funding, specialist PMH teams across the UK are expanding. Having increased investment has led directly to increased levels of provision across the UK and undoubtably has already transformed the lives of women, babies and families. This is a rare and impressive achievement by the Departments of Health and the NHS centrally, and this briefing acknowledges all those who have helped contribute to this important shift.

To salute these efforts, and to ensure their ultimate aims of equitable, high-quality care are met, we will be unrelenting in our campaign to ensure that the resources intended for perinatal mental healthcare are not diverted.

Using a Freedom of Information (FOI) request, we examined budget allocation and spending:

However, a significant proportion of local areas have indicated there will be an underspend for 2022/3. This will inevitably mean delivery of services are impacted and not all women and families who were meant to receive care may be able to access it.

We have not received any further funding since the team was set up with wave 2 funding in December 2019. Referrals have trebled since we started resulting in high acuity and staff burn out.

Healthcare professional

For those areas forecasting an underspend, the reason most frequently mentioned was recruitment issues and/or vacant posts.

Although workforce challenges were commonly cited as the factor impacting spending, anecdotal evidence provided by a number of teams consistently revealed that they had not received clarity about the money that was intended for their services or that funding that was allocated too late in the financial year or with uncertainty of continuation, all of which make recruitment difficult or impossible.

Without timely allocation and reasonable commitment of future monies, teams cannot plan their work effectively, the recruitment process is not able to go ahead and desperately needed roles remain vacant, all of which limits the support available to families and increases the pressure on an already-stretched workforce.

We are hoping that we will receive investment in April 2023 but at present we cannot make plans which would increase our access rate without knowing if we will receive investment.

Healthcare professional

2: A confident, capable, well-resourced workforce

Well supported teams with the skills and competencies to deliver care to women, babies and families will help ensure excellent care is available across the UK.

It is well known across the country and throughout the health system that there are extraordinary workforce challenges and pressures for existing staff. The evidence gathered in collecting this mapping data reflects this reality, with numerous specialist PMH teams telling us of the difficulty of recruiting some roles within teams and the impact this is having for the existing professionals.

Each nation is at a different stage of planning for their workforce needs. Often, there have been times when no clear strategy was in place, which has contributed to the current challenges of insufficiently resourced teams.

We have ongoing recruitment problems. There is a lack of suitably trained and experienced clinicians to take up the posts that we have.

Healthcare professional

3: Reaching all women and addressing inequalities

Investment and commitments to improve specialist PMH provision across the UK are helping transform the health care and the lives of women with the most severe and complex maternal mental health problems and their babies. But currently not all mothers, babies and families receive the care they need.

This can be due to lack of provision, as well as stigma and isolation. For some communities and groups, accessing quality care can be especially difficult, and there are additional barriers for women facing multiple disadvantages and systemic inequality. Trauma, deprivation and discrimination impacts heavily on the experiences of new and expectant parents.

In addition, the pandemic was hard for expectant and new mothers and their families, and many are still feeling the aftershocks. For staff trying to deliver care, the challenges are ongoing. This is being exacerbated by a subsequent cost-of-living crisis.


Laura's story

"My autism and history of trauma made it very difficult for me to communicate just how bad things were. I wasn’t able to ‘perform’ distress in the ways that were expected. This meant that I couldn’t get the help that I so desperately needed."

Read more

The Confidential Enquiry into Maternal Deaths provides clear and sobering evidence of the needs of women and families. Their reports consistently show that women of colour, women from deprived communities and those facing additional adversities including domestic abuse are significantly more likely to die during the perinatal period.

Action is needed at national and local levels so that services can ensure their systems allow women, babies and families with additional vulnerabilities and challenges to access them.


Chrissy's story

"I felt pressure as a Black mum that I’d be judged and not listened to."

Read more

4: Quality services and understanding women’s experiences of care

The improvements to specialist PMH service availability over recent years shows what can be achieved when there is national and local commitment to improving maternal mental health care. The progress that has been accomplished is impressive. Nevertheless, given the more complex landscape that both families and services face, it is important that our understanding of what good quality care looks like is re-examined to ensure it reflects current realities.

Ambitious quality standards

Across the UK, specialist PMH teams work to quality standards created by the Royal College of Psychiatrists’ Perinatal Quality Network (PQN).

These quality standards have been instrumental in supporting and accrediting teams and helping create consistent levels of care. The type one standards within the quality standards are the minimum levels of care that women, babies and families should receive.

At the time of writing, the quality standards do not address the different expectations that have begun to emerge within specific nations. For instance, the standards do not speak to the models of services that have been recommended by the Scottish PMH Network nor do they fully reflect the additional Long Term Plan requirements that teams in England must achieve, on top of the Perinatal Quality Network standards.

Therefore, this briefing has tried to acknowledge the differing landscapes. For example, the England map uses an additional colour in the grading system to reflect that many areas are now working to try and deliver the Long Term Plan7 ambitions for PMH.

New quality standards for Specialist Community PMH teams have been delayed but are due very soon.

You could spend decades in a library, or a consulting room and you still wouldn’t understand what perinatal mental illness feels like unless you’d lived it. We need all these different kinds of expertise to come together to make the necessary changes.

Laura, Lived Experience Champion

Hearing the voice of lived experience

The data collected for this briefing gives us a window into the state of specialist PMH services and helps illuminate the developments and some of the challenges, however it cannot sufficiently describe what women’s and families’ experiences of care feel like.

Listening to the voices of women and families will help services have a better understanding of how to make care feel welcoming and meet the needs of the local community.

There are examples of good practice happening. For instance, Scotland has made concerted effort to ensure the voice of lived experience informs their work by having a Participation Officer. This role works with stakeholders such as Health Boards and Scottish Government’s PMH Programme Board and actively engages with and listens to the voices of women and family members. However good practice is not yet consistent across the whole of the UK and having improved system and processes to help make this happen will make a positive difference.

Decision makers and services gathering feedback on women’s and families’ experiences of services is crucial and helps support a continuous cycle of quality improvement.

Read our recommendations to sustain progress