The Maternal Mental Health Alliance (MMHA) responds to the launch of NHS England’s long term plan

January 7th saw the launch of the NHS Long Term Plan, setting out their ambitions for health care in England, including many positive goals for perinatal mental health.

Commenting on the publication of the NHS long term plan, The Maternal Mental Health Alliance (MMHA) Director Emily Slater welcomed the plan’s announcement and commitment to women and families in England, in particular the news of an increase in services to benefit more women and the extension of specialist mental health support for new parents, which will now be offered for two years after the birth of their child.

Emily Slater said:

“The Maternal Mental Health Alliance is really pleased to see that the NHS has committed to expanding perinatal mental health services and helping more women and families access vital treatment. The details of the long-term plan signals that the NHS wants to build on the success it has had creating specialist perinatal mental health services to ensure more women and families can access essential, lifesaving support.”

“Doubling the period during which women will be able to access psychiatric assessments and care after birth to two years and offering partners access to mental health services, will make a difference to women and families across England.”

“We welcome the £2.3bn set aside for mental health services, which will continue to tackle the long-established underfunding within mental health and work towards parity between physical and mental health.”

“The plan does not mention parent-infant services and how these will provide support for families, which would help deliver NHS England’s goal for all children and young people who need specialist mental health care to be able to access it, so we would welcome information on this. We would also like to see more details on what commitments the Government will make to local authorities funding, to ensure they can deliver the social care and public health services, including health visitors, that women and families need.”

Background:

The NHS long term plan, “will improve access to and the quality of perinatal mental health care for mothers, their partners and children by:

• Increasing access to evidence-based care for women with moderate to severe perinatal mental health difficulties and a personality disorder diagnosis, to benefit an additional 24,000 women per year by 2023/24, in addition to the extra 30,000 women getting specialist help by 2020/21. Care provided by specialist perinatal mental health services will be available from preconception to 24 months after birth (care is currently provided from preconception to 12 months after birth), in line with the cross-government ambition for women and children focusing on the first 1,001 critical days of a child’s life;

• Expanding access to evidence-based psychological therapies within specialist perinatal mental health services so that they also include parent-infant, couple, co-parenting and family interventions;

• Offering fathers/partners of women accessing specialist perinatal mental health services and maternity outreach clinics evidence-based assessment for their mental health and signposting to support as required. This will contribute to helping to care for the 5-10% of fathers who experience mental health difficulties during the perinatal period;

• Increasing access to evidence-based psychological support and therapy, including digital options, in a maternity setting. Maternity outreach clinics will integrate maternity, reproductive health and psychological therapy for women experiencing mental health difficulties directly arising from, or related to, the maternity experience.”

 Read the full report of the plan, including commitments to Maternity Services and Children’s and Young Peoples mental health services.

MMHA welcomes news that partners of new mums with mental illness set to get support on the NHS

This statement from the NHS in England is warmly welcomed as it acknowledges the important unmet need for mental health support and treatment faced by many new fathers, and by partners of women who are themselves suffering mental health problems.

This will require services within and outside the NHS to work together, enhancing detection of mental health problems and providing the right care for those individuals, as well as for parents jointly, and for their relationships with their babies.

A great deal is already being done by NHS England, with new Government money, to improve specialist mental health care to mothers with severe mental health problems. We look forward to seeing these improvements continue, now coupled with improvements in care for fathers, mothers and partners across all levels of mental health need, from specialist mental health services, talking therapies, GPs, and health visitor and maternity services.

The MMHA Everyone’s Business campaign has a champion network of experts by experience and this includes Raj’s story, highlighting the need for further support and information for fathers and partners.

Urgent Need For Improved Mental Health Support For New Mums In Northern Ireland Is Everyone’s Business, says MMHA

Thousands of pregnant women and new mums in Northern Ireland who suffer from mental health problems are at risk of receiving inadequate levels of support, new research has found.

The research, from NSPCC Northern Ireland, the Royal College of Midwives (RCM) and the Community Practitioners and Health Visitors (CPHVA), has found increased strain is being put on  midwives and health visitors across Northern Ireland with the issue currently receiving insufficient attention from policy-makers.

In Northern Ireland, this will affect approximately 2,400 to 4,800 live births each year[1]. If untreated, perinatal mental illnesses can have a devastating impact on women, babies and families.

The new report, Time For Action, published on 26th November by NSPCC Northern Ireland and partners, highlights gaps both in the identification of mental health illnesses and the response provided to women once they have disclosed problems or been detected in primary care. In its key recommendations, the report calls for the development of specialist services for women including a mother and baby unit for women who need close care and supervision and a training standard on perinatal mental illness for all professionals in Northern Ireland who care for women during this period.

MMHA’s Northern Ireland Co-Ordinator Lindsay Robinson said:

“If left untreated, perinatal mental health conditions can have devastating consequences for women and their families and we know that many hundreds are affected by these problems every year in Northern Ireland.

“There are clear national guidelines setting out that specialist services for women are vital. Despite this, Northern Ireland is the only part of the UK which has not invested in them.

“Specialist perinatal mental health services save lives – that’s why we’re calling for the development of specialist services for women in Northern Ireland, including a mother and baby unit for women who need close care and supervision. ”

Midwives and health visitors who took part in the research stressed that continuity of care and face to face time with mothers and babies is crucial for improving identification of problems and providing support.  But the research found that this was undermined by underfunding, overwork and growing levels and complexity of demand.

While the research found that health visitors and midwives in Northern Ireland experience similar types of challenges in identifying and responding to perinatal mental illnesses as their counterparts in the rest of the UK, professionals in Northern Ireland have not benefitted from the levels of investment made in England, Scotland and Wales. Northern Ireland is the only part of the UK which has not committed to investment of funds in perinatal mental health, despite major funding (£390m) having been pledged via the Barnett formula in 2016.

The report calls for:

  • A training standard on perinatal mental illness for all professionals in Northern Ireland who care for women during this period;
  • A review of ways of working within midwifery and health visiting services to improve continuity of care and the time that these professionals have to spend with women;
  • Clarification on the use of screening tools, and review of training needs around ‘how’ midwives and health work with women, including advanced practice skills around disclosure;
  • Greater alignment of the role of professionals to respond to perinatal mental health needs, and also support the parent-infant relationship and infant’s mental health; and
  • Development of specialist services for women including a mother and baby unit for women who need close care and supervision.

 

The research involved a survey of 332 health visitors and midwives located across all five Health and Social Care Trusts in Northern Ireland[1]. The survey covered the following topics: recognition, referral and management of perinatal mental illness; training; and opportunities and challenges. It also gathered demographic information

A cautious estimate based on 2016 workforce census headcount data put the final survey sample at approximately 23 per cent of the health visitor population and 15 per cent of the midwife population (rounded to the nearest percent). See Department of Health and NISRA: https://www.health-ni.gov.uk/news/ni-health-and-social-care-workforce-census-march-2016.

 

MMHA responds to MBRRACE report into UK maternal deaths

Today the latest UK Confidential Enquiry into Maternal Deaths has been published by MBRRACE-UK.

This year the report – Saving Lives, Improving Mothers’ Care 2018 – examines in detail the care of women who died during or up to one year after pregnancy between 2014 and 2016 in the UK and Ireland from mental health conditions, blood clots, cancer, and homicide, and women who survived major bleeding.

Maternal suicide is the fifth most common cause of women’s deaths during pregnancy and its immediate aftermath, and the leading cause of death over the first year after pregnancy.

The report states that “there is now greater awareness of the importance of mental health during pregnancy and in the first year after birth. But there is still a long way to in recognising symptoms, supporting women with mental health problems and providing access to specialist perinatal mental health care.”

Maternal deaths are not evenly spread across the population. Black women are five times and Asian women two times more likely to die as a result of complications in their pregnancy than white women.

In response, Dr Alain Gregoire, Chair of the Maternal Mental Health Alliance said:

“The human tragedies described here emphasise the urgency of addressing the gaps in perinatal mental health care in pregnancy, postnatally and pre-conceptually.

The enquiry shows that maternal suicide is the fifth most common cause of women’s deaths during pregnancy and its immediate aftermath, and it remains the leading cause of death over the first year after birth.

Alongside improvements in specialist mother and baby mental health services – that are becoming evident in England and Wales, women need professionals in all services to be as interested, knowledgeable and skilled in mental health care during maternity as they are in their care of women’s physical health. Women and babies also need services to work together and to have the capacity and resources to provide routine detection, prevention and treatment, and crisis care, all of which are needed to ensure care is both effective and safe.”

Read the full report on the MBRRACE-UK website.

Final Mums and Babies in Mind project report published

This month the MMHA published the final report for our  Mums and Babies in Mind project (MABIM). The project supported local commissioners and providers to improve services and pathways for mums with perinatal mental health problems and their babies.

MABIM took a whole-system approach, working with professionals from a range of disciplines not only to improve services, but also to create local pathways and partnerships, which are essential to ensure that all women experiencing perinatal mental health problems get the right support at the right time.

The final project report describes the activity that took place through the MABIM project and its reach and impact. This is accompanied by a more detailed evaluation report produced by Professor Susan Ayers and her team at City University. Both reports demonstrate that MABIMwas very well received and seems to have resulted in positive changes to local services and care pathways. They contain useful messages about barriers and enablers to local progress in tackling perinatal mental illness.

You can view the final report here and the evaluation report here.

Marce 2018 – Global Experiences, Global Dialogues, Global Responses

Sally Hogg attended the Marce Society 2018 Biennial, to share learning and gain insights into global best practice in maternal mental health.

It was an absolute privilege to attend the International Marce Society Biennial meeting in Bangalore last week. The meeting brought together over 500 delegates from 31 countries to discuss the latest science and practice in protecting and promoting maternal mental health. I was there to share learning from the MMHA Mums and Babies in Mind Project, alongside trying to capture useful insights for those at home.

This was the first time that a Marce conference had been held in the Global South. The conference really opened my eyes to the challenges facing Low and Middle Income countries where the vast majority of the world’s babies are born, the prevalence of perinatal mental health problems is particularly high, and there are fewer resources to support families. The conference chair, Jane Fisher, powerfully reminded us that enabling mothers to be healthy is key to enabling children, and therefore societies and economies, to reach their full potential and thrive.

The conference was held in the National Institute for Mental Health and Neuroscience (NIMHANS) in Bangalore, which is a large mental health hospital and academic centre. NIMHANs has a 5 bedded Mother and Baby Unit, which is the only unit in a country where 26 million are babies born each year. The facilities were, in many ways, basic compared to the UK. But there was much that we could learn from them: The MBU had beds for a family member to stay with women (albeit only for female relatives – not dads or male partners). There was a strong multidisciplinary team including lactation support, which was particularly interesting to me, as we have recently done some work about the need to improve breastfeeding support and advice for mums with severe mental illness. NIMHANs hospital – including the MBU – incorporates yoga into the care they provide to patients. I was sorry that due to the full conference programme, I didn’t get a chance to learn more about the use of yoga.

It was a very full conference, with three long days of high quality presentations and discussions. As is often the case at events with many parallel sessions, it was hard to choose what to attend. I focussed on presentations which had clear implications for policy and practice, which meant I missed a lot of interesting stuff about the biological determinants and mechanisms of mental health problems.

So what were my highlights and take home messages from the presentations and symposiums I did attend?

I was challenged by a symposium chaired by Susan Ayers that really brought to life the complexities and limitations of screening.

I was excited by Jane Fisher’s launch of the new WHO nurturing framework which I think provides a useful way to talk about early child development with policy makers.

It was heartening to see that the UK is one of the countries that is leading the way in the provision of specialist community and inpatient services. Our campaigning is inspiring others too – we heard about maternal mental health alliances developing in Canada and Africa and of people considering how to replicate our powerful maps of provision, and there was regular use of the #everyonesbusiness message.

I was encouraged to hear about how services were being designed with implementation and scaleability in mind: Maria Muzik discussed the co-production of the MomPower intervention, and Heather Rowe described research with parents, providers and policy makers to inform the development of support for new parents.

Birth trauma was a recurring theme in the conference. As Evita Fernadez described in a plenary, “the way in which we give birth has major implications for women’s future health and that of their babies” and yet there is a “crisis in childbirth” with many women experiencing traumatic births in India and around the world. Evita spoke encouragingly of the tide starting to turn thanks to powerful campaigns to harness womens’ voices and to global recognition of women’s rights to respect, support and choice in their birth, by organisations such as the World Health Organisation. In another plenary, Jon Cox prize winner Bryanne Barnett called on professionals to gain an in-depth understanding of the current and past experiences of women, including recognising and respond to both the physical and mental harms that result from traumatic birth. In a great symposium on birth trauma, Susan Ayers discussed evidence that positive support during birth can buffer against stressful events, whereas a lack of support or interpersonal difficulties increase risk of PTSD. Pauline Slade presented the Straw-b self-help tool which contains information and psychological exercises for women at risk of PTSD. And, in perhaps the most surprising study of the conference, Antje Horsch, showed that women who play tetris for 15 minutes in the 6 hours following an emergency c section are less likely to develop PTSD (which is thought to be because visuo-spatial tasks can change the way in which therefore reduce the likelihood of intrusive memories.)

Whilst the conference showcased a wealth of fantastic practice, we were constantly reminded that the majority of women in the world who are experiencing perinatal mental health problems are not getting support. It wasn’t all doom and gloom however. There were a number of examples of innovations which could enable more women to access evidence based support: Atif Rahman shared the evidence of the impact of the Thinking Healthy (CBT based) intervention which has had a proven impact on women’s mental health in LMIC countries when delivered by community health workers or peer supporters.

Cerith Waters shared how his stretched service in Wales had developed a Perinatal Play and Development group, which enabled the service to have more contact with women. The 6 week group includes mindfulness, psychoeducation and elements of watch, wait and wonder.

Finally, a number of speakers from Australia, including Jeannette Milgrom and Jane Fisher showcased digital interventions which could drastically improve the reach of services. We were reminded that 63% of the population in low and middle income countries have a smart phone (something that was clearly on show when out and about in Bangalore!).Siobhan Loughnan shared positive results from use of a short, three session perinatal iCBT intervention called MUMentum, which can be used as self-help or as an adjunct to face-to-face support. Jeannette and Jane spoke about  the Mumspace website, which hosts a range of universal, targeted and specialist interventions (including the Baby Steps, Mind Mum MumMood Booster apps) and the What Were We Thinking intervention, which helps parents to learn about caring for their baby (including crying, soothing and sleep) and about their journey as parents  (including their relationship) through a group based seminar for parents, website, app and moderated peer-to-peer blog, all supported by a training programme for maternal and child health nurses (equivalents of our health visitors)  .

There were some things missing from the conference. The audience was largely health professionals or academics. I felt that the input of community or charitable organisations was missing, and I didn’t see much on place-based and whole system approaches.

But overall it was a fantastic three days. I left feeling that although there is a huge amount to do, but there is lots of valuable work to learn from, and in the UK we are privileged to have opportunities to put this learning into practice.

Marce 2018 – Global Experiences, Global Dialogues, Global Responses

Sally Hogg attended the Marce Society 2018 Biennial, to share learning and gain insights into global best practice in maternal mental health.

It was an absolute privilege to attend the International Marce Society Biennial meeting in Bangalore. The meeting brought together over 500 delegates from 31 countries to discuss the latest science and practice in protecting and promoting maternal mental health. I was there to share learning from the MMHA Mums and Babies in Mind Project, alongside trying to capture useful insights for those at home.

This was the first time that a Marce conference had been held in the Global South. The conference really opened my eyes to the challenges facing Low and Middle Income countries where the vast majority of the world’s babies are born, the prevalence of perinatal mental health problems is particularly high, and there are fewer resources to support families. The conference chair, Jane Fisher, powerfully reminded us that enabling mothers to be healthy is key to enabling children, and therefore societies and economies, to reach their full potential and thrive. Continue reading Marce 2018 – Global Experiences, Global Dialogues, Global Responses →

Professional bodies welcome report highlighting need for more maternal mental health experts

The Maternal Mental Health Alliance (MMHA), the Institute of Health Visiting (iHV), the Royal College of Obstetricians and Gynaecologists (RCOG), and the Royal College of Midwives (RCM) are delighted the NHS Benchmarking report on Universal Perinatal Mental Health Findings was published on Friday 14 September.

Prior to this study, information on service provision and staffing of universal perinatal mental health (PMH) services was not available at a national level.

The Maternal Mental Health Alliance (MMHA), the Institute of Health Visiting (iHV), the Royal College of Obstetricians and Gynaecologists (RCOG), and the Royal College of Midwives (RCM) are delighted the NHS Benchmarking report on Universal Perinatal Mental Health Findings was published on Friday 14 September.

The data collected from providers suggested that:

Capacity in universal services is very limited and does not provide the necessary broad base from which the Specialist PMH services can operate effectively and efficiently.

The provision of specialist perinatal mental health care within universal services is highly variable across England, with some areas having no, or limited, provision (obstetric & midwifery providers 61%; health visiting providers 30%).

The large gap in health visiting PMH capacity was particularly evident, with 70% of providers having no specialist provision within the service.

This report is critical because it focuses on the universal element, where the vast majority of women need to receive their care. Universal services are a crucial element of the PMH care pathway at every local level and have the potential to create great savings in relation to both human and economic costs in the short and long term.

Alain Gregoire, Chair of the MMHA, said:

“There has been excellent progress in funding specialist perinatal service provision across England, but we know that specialist services alone are not enough.  All women in pregnancy and postnatally should have equitable access to the support, prevention and treatment they need for their mental health as much as for their physical health. This report shows that investment is essential to ensure that there are sufficient, well-trained staff across universal services so that women get the care they should expect from the NHS, and our children can get the best start in life.”

Read the full statement from the MMHA, iHV, RCOG and RCM here.

Maternal Mental Health Alliance Responds to the Long Term Plan for the NHS

The Maternal Mental Health Alliance has recently responded to the NHS Long Term Plan, the Health and Social Care Select Committee’s 1001 Days Inquiry plus a specific response on how NHS services could better support fathers.

Alongside reinforcing our Everyone’s Business Campaign messages about the need for sustainable, high quality specialist services in all areas of the country, we also emphasise the importance of a range of effective services and joined-up pathways of care in each local area so that ALL women can get the right support at the right time, whatever their level of need.

The MMHA is also clear that services must engage with fathers, and that there must be support available for families where there are difficulties in the parent-infant relationship.

Our policy positions have been co-developed through ongoing discussion with our member organisations and women with lived experience. These policy submissions can be found in the Resource Hub.

 

 

 

News

Scottish Government announce new funding for perinatal mental health services

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The Scottish Government has published its programme for government, which includes a package of measures to do more to support positive mental health and prevent ill health. This includes a focus on perinatal mental health, which Maternal Mental Health Scotland and the Maternal Mental Health Alliance believe is a positive step for the improvement of services in Scotland.

We look forward to hearing more about the detail of this announcement, and what it means for specialist perinatal mental health services in Scotland, as well as those provided by the Third Sector. Perinatal mental health is #everyonesbusiness.

The full Programme for Government can be downloaded here. Perinatal mental health is mentioned on page 64: