The Maternal Mental Health Alliance’s Everyone’s Business Campaign calls for all women across the UK to receive the mental health care they and their families need during pregnancy and postnatally, as described in the following national guidelines and recommendations:
Action is now needed to secure these vital services across the UK!
Courtesy of Sussex and East Surrey Specialist perinatal mental health service
Perinatal mental health has moved up the political agenda in recent years and funding has been allocated by governments in England and Wales for specialist perinatal mental health services. However, decisions about whether and how much to invest money is increasingly being taken at a local level. The Everyone’s Business campaign needs your support to ensure local decision makers, providers and commissioners heed the Call to ACT NOW.
Below are some of the ways you can take action on behalf of the women and families in your area. Local champions across all parts of the UK are needed to influence service provision by ensuring decision makers in every nation, region and locality of the UK urgently invest in perinatal mental health provision:
Get in touch if there is an upcoming strategic event or meeting in your local area where campaign materials / presentations can feature – or if you have any other ideas for how the campaign can support: firstname.lastname@example.org
Use our campaign maps to identify the level of specialist perinatal mental health service provision in your area; share this with local decision makers, alongside the reasons why specialist services act as a catalyst for change across the whole pathway
Share your area’s starting point and feature images of the maps on social media (#everyonesbusiness) and within local media to highlight where funding for services is still needed or indeed to celebrate progress to date and inspire other
Know the Office of National Statistics’ annual birth rate for your area. This helps to work out the size of service your area requires and even where it should be located. Areas with a birth rate of less than 6,000 babies per year may need to join with neighbouring areas to commission a joint pathway of care
Share models of good practice with decision makers, providers and commissioners in your area. On a national and local level, models of good practice and guidance for specialist perinatal mental health services have been established. Please see examples below.
In all of the UK’s four nations, we call for perinatal mental health training to be incorporated into the undergraduate and postgraduate syllabuses for all GPs, health visitors, midwives, obstetricians and mental health professionals.
We also call for the establishment of a national training strategy to make sure all relevant existing health professionals, and others who work closely with families in the perinatal period, including those in the community and voluntary sectors, have access to dedicated high-quality training.
Health professionals and others who work with families in the perinatal period can play a significant role in promoting good mental health, preventing mental health problems and making sure women and their families receive the best care, treatment and interventions.
Universal health professionals such as GPs, midwives and health visitors are ideally placed to care for women and families affected by a mild to moderate perinatal mental illness. They are also well positioned to identify women with, or at risk of, a severe perinatal mental illness and to refer them to specialist perinatal mental health services and provide ongoing support.
Not just Scotland
Scotland is the only UK nation to have a perinatal mental health training curriculum for people working in healthcare. We must make sure England, Wales and Northern Ireland follow their example, and implement the curricula.
Skills that all health professionals caring for women during the perinatal period should have
An understanding of the importance of identifying women at risk of developing serious mental health problems and the associated risk factors.
An ability to understand and distinguish normal emotional changes and common difﬁculties from a mental health problem, and being able to recognise the ﬁrst signs of a problem.
Good listening skills and the ability to offer support, reassurance and understanding.
Knowledge of different types of disorders, their clinical features and an ability to distinguish between them.
Awareness of when and how to make referrals, and the range of different treatment options available.
Source: MIND. Out of the blue? Motherhood and depression. 2006.
Community specialist perinatal mental health teams
We call for community specialist perinatal mental health teams meeting national quality standards to be available for women in every area of the UK. As our map shows, these services are not available for all new mothers in the UK. Many areas do not even have local plans in place to develop these services. This is despite comprehensive models showing that these specialist services are both necessary and possible.
Not having access to a specialist team, or if a service falls short of nationally agreed standards, can mean the lives and life chances of women and their babies and families are put at unnecessary risk. See our Counting the costs section.
To end this unacceptable postcode lottery, community specialist perinatal mental health services must be available throughout the UK and meet nationally agreed standards.
UK Specialist Community Perinatal Mental Health Teams Please note, levels of provision in this map have been assessed using the best information available to us from local experts but have not been independently verified. Please contact email@example.com if you suspect any inaccuracy or know of recent developments that may alter the level of provision level in any area listed here.
no specialist team exists.
Some extremely basic level of provision exists but currently falls short of national standards and needs expanding.
Some basic level of provision exists but currently falls short of national standards and needs expanding.
Women and families can access treatment that meets nationally agreed standards.
The role of a specialist community perinatal mental health team is to:
respond to a woman’s needs in a timely manner, have the capacity to deal with crises and emergencies, and make assessments in a variety of settings, including homes, maternity hospitals and outpatient clinics
have close working links with a designated mother and baby unit
care for women discharged from inpatient mother and baby units
work collaboratively with colleagues in maternity services, including providing a maternity liaison service
work collaboratively with adult mental health services to provide support to women with previous or longstanding mental health problems
offer pre-conception counselling to women with pre-existing mental health problems.
Courtesy of Sussex and East Surrey Specialist perinatal mental health service
The role of accredited specialist inpatient mother and baby units
Inpatient mother and baby units admit seriously mentally ill women in late pregnancy and the first year after birth, together with their infants. They aim to admit women directly without the need for prior admission to a general adult psychiatric ward.
Without these units, women have to be separated from their babies, which can be detrimental to the women and their babies.
There are 15 inpatient mother and baby units in England and two in Scotland. In Wales and Northern Ireland, there is not a single specialist inpatient mother and baby unit.
All mother and baby units continuously assess a mother’s care of and attachment to her baby to determine the level of supervision, support and guidance the mother requires to meet the emotional and developmental needs of her infant.
The staff at an inpatient mother and baby unit will have the skills needed to promote attachment and parenting interventions. Many units will also have psychologists who provide additional expertise in psychological treatments and parenting interventions.
West Scotland mother & baby unit
Morpeth mother & baby unit
Please note: the phone number shown at the end of the video is no longer active.
In order to ensure all women throughout the UK who experience a perinatal mental health illness receive the care they and their families need, wherever and whenever they need it, the campaign is focussing particularly on the following right NOW:
New government funds provided for specialist perinatal mental health services are not wasted, absorbed elsewhere or misspent. They should deliver well-planned and coordinated services.
This is because:
In the past, national funding pledges have not necessarily been translated into new services on the ground
Despite encouraging funding announcements, there is no legal obligation for CCGs in England to spend these funds on the specialist perinatal mental health services they are intended for. This is why we want each CCG to plan how it will spend its money now.
Outstanding areas of need must be funded in Scotland, Northern Ireland and Wales
This is because:
Despite clear SIGN guidelines, the Scottish government has yet to pledge funding for urgently required specialist perinatal mental health services.
Despite clear NICE guidelines, the Northern Ireland government has yet to pledge funding for urgently required specialist perinatal mental health services. In addition, Northern Ireland and the Republic of Ireland still do not have one Mother and Baby Unit.
Despite welcome funding being pledged for specialist perinatal mental health services in Wales, the nation still does not have an adequate level of services or a Mother and Baby Unit
Women and families must have access to specialist multi-disciplinary perinatal mental health services as part of a joined-up pathway of care their standard integrated pathway of care.
This is because:
Without an integrated perinatal mental health care pathway which features clear referral mechanisms, there is a real risk that women and families will not receive the right support at the right time, even though the specialist services they need exist.
It will ensure that other health and social care professionals have access to and receive ongoing training and advice from specialist perinatal mental health teams in their area. These professionals include GPs, health visitors, midwives, practice nurses, obstetricians, mental health professionals, and staff from voluntary and community organisations.
It’s only with your active support that we can ensure local decision makers, providers and commissioners heed the campaign calls and that women and families – in every area of the UK – will be able to access the right perinatal mental health support at the right time.
Our valued network of experts by experience includes mothers, fathers, siblings and grandparents from across the UK whose lives have been affected by perinatal mental illness. They share their stories to help raise awareness of perinatal mental health, reduce stigma and influence positive change.
It’s estimated that around 13% of expectant or new mums are living with an eating disorder. Abi (Edinburgh) In 2019, I was pregnant with my second child, feeling delighted, excited, and… utterly terrified. Why? Because since the birth of my first son, I had been battling an undiagnosed eating disorder that dominated every aspect of my … Continue reading Abi’s story→
It was horrific to have to travel 180 miles to the mother and baby unit and be so far away from my husband and son and everything and everybody I knew. Toni (Port Talbot, Wales) At around six months pregnant with my second child, I became severely depressed. Every day was a struggle to keep … Continue reading Toni’s story→
“Explain more about what maternal mental health means because some people didn’t really care about their mental health until things started getting out of hand… I know most of us in our country, we don’t really care about mental health when you’re pregnant. So I think this is gonna be really helpful.” In this series … Continue reading Fatima’s story→
“With the right care, there will be more positive experiences and LGBT+ people will be more likely to reach out if they are struggling with their perinatal mental health.” Laura-Rose’s story (London) When my wife and I first started on our path towards parenthood, we struggled to find any LGBT+ women, people or organisations that could offer us guidance and support. This resulted in our journey being a difficult one and left us feeling very isolated. We had no one to talk … Continue reading Laura-Rose’s story→
“Black women are more likely to have postnatal depression but are less likely to access care or to be referred for follow-up treatment.” Sandra’s story (London) When I had my first daughter, I thought it was going to be the happiest time of my life, but I just felt this huge pressure to be the … Continue reading Sandra’s story→
To the mum who puts on a brave face day after day when inside you are falling apart — please seek support. You are amazing and you deserve to be happy. Leanne’s story (Warwick) Before I had my son, I had a really naive view of mental illness, and I think I believed I was … Continue reading Leanne’s story→
Michelle’s story (Belfast) Following the birth of my daughter, I had frequent and often crippling panic attacks. They would hit me out of the blue, lead to shortness of breath and I would think, “Oh my God, this is it, I’m dying!” To find a solution, I spoke to my doctor, learned CBT techniques and … Continue reading Michelle’s story→
Michaela’s story (Belfast) Following the birth of my eldest daughter, who’s now six, I suffered with severe postnatal depression, psychosis and anxiety. Thankfully, I received support from the perinatal team including a psychiatrist, a mental health home treatment team, a psychologist at my local hospital and mental health nurses. I benefited greatly from this network … Continue reading Michaela’s story→
Jillian’s story (West Lothian, previously County Antrim) Whilst living in County Antrim in Northern Ireland, I gave birth to a healthy baby boy in February 2007. Because breastfeeding took a while to establish, we didn’t go home until four days after my son’s arrival. But everything seemed normal, perfect even, when we did return home. … Continue reading Jillian’s story→
Gill’s story (Aberdeenshire) Postnatal post-traumatic stress disorder (PTSD) is under recognised and under discussed. Many women find childbirth traumatic but have few outlets for these feelings and little opportunity to talk about their experiences, as the prevailing opinion seems to be “a healthy baby is all that matters”. I want to let other mums know … Continue reading Gill’s story→
Lucie’s story (Surrey) There are no words to describe losing a sibling at such a young age; and this loss is even more tragic because I know with the right support my big sister’s passing could have been avoided. If she’d received the perinatal mental care she needed after her son’s birth, she would still … Continue reading Lucie’s story→
Dani’s story (Belfast) I felt great at the start of my first pregnancy. But at six to seven months I developed a liver problem and my blood pressure started to go up. I was put on tablets and believed, maybe naively, that everything was okay. Then, during the birth of my daughter, I had an … Continue reading Dani’s story→
Lindsey’s story (County Down) I was a new, first-time mum with a five-month-old son when I found out I was nine weeks pregnant with twin girls. My husband and I got the shock of our lives, and throughout my pregnancy I experienced perinatal anxiety, as I was unsure how we would cope. After the birth … Continue reading Lindsey’s story→
Charlotte’s story (Cardiff) Following the birth of my son in 2012 I felt very unwell mentally. However, because Wales’ only mother and baby unit (MBU) in Cardiff was closed, I faced being admitted to an adult psychiatric ward without my baby. At that point, I completely broke down and said I was going nowhere without … Continue reading Charlotte’s story→
Hazel’s story (Falkirk) Following the birth of my second baby, I experienced postnatal depression. But in the Fife area, where I was living at the time, there were no services to support me. After I asked my GP for help, I was given anti-depressants and sent away. The effect of this was that my attachment … Continue reading Hazel’s story→
Clare’s story (Glasgow) During my pregnancy with my daughter, I felt very little – no excitement, no anticipation, no fear. I was mildly concerned about this, so I mentioned it to my midwife, who referred me to my local perinatal mental health service. There, a community psychiatric nurse (CPN) helped me understand that I didn’t … Continue reading Clare’s story→
Elaine’s story (Chester) The birth of my son was very difficult. I had a retained placenta, which led to me haemorrhaging after he was born. A consequence of this traumatic experience was that I developed mild to severe postnatal depression, which eventually led to psychosis when my son was seven months old. Given electroconvulsive therapy … Continue reading Elaine’s story→
Charlie’s story (Bridport) With all three of my children I struggled with perinatal mental health problems, including postnatal depression and post-traumatic stress disorder. During these extremely difficult times, I received excellent support from a number of specialist perinatal mental health professionals. They included those working at my Mother and Baby Unit, midwives, community psychiatric nurses … Continue reading Charlie’s story→
Kirsten’s story (Peterborough) The symptoms I showed during the pregnancy of my first child included OCD, general anxiety and low mood. I spoke to 11 different professionals before I started to receive help. This left me feeling exhausted, and I couldn’t understand why I had to tell my story so many times, and why I … Continue reading Kirsten’s story→
Kathryn’s story (London) My pregnancy sailed by in a buzz of baby shopping, scans and antenatal classes. All this changed less than 24 hours after our son was born. We had a very long and difficult labour, followed by a petrifying emergency C-section. We were then placed in the High Dependency Unit, but a few … Continue reading Kathryn’s story→
Laura’s story (Surrey/now in Southampton) When I fell pregnant, I had pre-existing mental health difficulties and a diagnosis of bipolar disorder. I was known to be high risk for postnatal ill health, but I received little support and few preventative measures were put in place. It seemed that the community mental health team and the … Continue reading Laura’s story→
Maria’s story (Bristol) My first son, William, was just one day old when he died in 2005. During and after my 11-year-old son’s and nine-year-old daughter’s pregnancies I struggled with a number of mental health problems. With Joel, I felt very anxious whilst pregnant with him, and then felt isolated and depressed following his birth. … Continue reading Maria’s story→
Admit how you are feeling, even if it is really hard. Jenny’s story (Belfast) Four years ago I had my second child. After he was born, I felt differently from how I had felt when his older brother had been born. Something wasn’t right. I felt depressed and struggled to bond with my new baby. I … Continue reading Jenny’s story→
Raj’s story (Berkshire) My wife developed stress-induced psychosis when she was nearly 30 weeks pregnant. At the time, she saw me as an antagonist, and due to her condition I was subjected to mental and verbal abuse as my wife’s perception of reality was affected. Our GP offered us no clear advice or counselling at … Continue reading Raj’s story→
Money and resources need to be directed towards supporting women with mental health issues. Jenny’s story (Oxfordshire) I suffer from bipolar disorder and was treated with lithium. For five years my husband and I had raised with my psychiatrist the issue of us trying for a family, but she kept failing to find out about … Continue reading Jenny’s story→
Ann’s story (Hertfordshire) After my daughter’s birth I suffered from severe antenatal obsessive compulsive disorder [OCD] and lived with a crippling fear that something terrible was going to happen to her. At a time when I should have been enjoying being a new mum, I was gripped by panic and couldn’t even watch the news. … Continue reading Ann’s story→
Peter’s story (Newcastle upon Tyne) My daughter developed serious postnatal depression. Her condition deteriorated over a period of several months and culminated in a suicide attempt and a missing person’s search for two days. She had left me with her baby while she went ostensibly for a jog. When she failed to return, I raised … Continue reading Peter’s story→
Joanna’s story (Exeter) Five days after the birth of my first child I experienced extreme anxiety and a sense of terror overwhelmed me. I was diagnosed with PND [postnatal depression], but I didn’t feel depressed, just incredibly anxious. I was prescribed antidepressants and gradually I started to feel better. But when I discovered I was … Continue reading Joanna’s story→
Hannah’s story (Bristol) After the birth of my son I developed mild postnatal depression [PND] and moderate anxiety. I suffered panic attacks and was fearful of being judged as a ‘bad mother’, as being incapable of looking after my child in the ‘right’ way. Despite regular visits to my GP, it was two years before I … Continue reading Hannah B’s story→
Hannah’s story (Thirsk) I had a straight-forward pregnancy and gave birth to my first baby after an emergency c-section in 2009.When I started having irrational, racing thoughts and very strange behavior my community midwife sent me to my GP. Things worsened and few days later, I saw a different GP who referred me to a … Continue reading Hannah’s story→
Chris’s story (Huddersfield) After my partner Joe suffered several miscarriages, we feared we would never be able to have a baby. But in 2010 we were delighted to welcome our beautiful daughter into the world. Joe was determined to be the perfect mother, but when she struggled to breastfeed, it led to feelings of severe … Continue reading Chris & Joe’s story→
Becky’s story (Dawlish) Two weeks after my baby was born I started suffering from severe postnatal depression [PND]. I began to have suicidal thoughts and couldn’t even look at my daughter or pick her up. The antenatal classes gave me unrealistic expectations about parenthood which I could not meet, and the attitude of one midwife … Continue reading Becky’s story→
Sally’s story (South Lanarkshire) I was diagnosed with severe postnatal depression [PND] after the birth of my second child in July 2013. The NHS only offered me medication and referred me to its Crisis team, who sent me home to listen to relaxation music. I was also told it would take 21 weeks on the … Continue reading Sally’s story→
Lyn’s story (Kent) Losing my beautiful daughter, Rebecca, to perinatal suicide came as a complete shock. She had no history of mental ill health and no problems. She had everything to live for, and yet she took her life. What chance then do mothers with existing mental health difficulties or a previous history have? We must … Continue reading Lyn’s story→
Michelle’s story (Bridgend) After the birth of my child I went into a downward spiral of thinking I couldn’t cope with having a baby. I was so distressed I was unable to sleep and even had to force myself to eat. I’d just had a son and desperately wanted to be happy, but I struggled … Continue reading Michelle’s story→
What are specialist perinatal mental health (PMH) services?
‘Specialist perinatal mental health (PMH) services’ provide life-saving care to women and families affected by severe or complex mental health problems during pregnancy and in the first years after birth. Services include:
Inpatient Mother and Baby Units (MBU), where mum and baby are cared for together when hospitalisation is required.
The importance of specialist PMH services
There are clear national guidelines setting out that specialist services for women who meet the need threshold are vital. As well as providing life-saving care, specialist PMH services also:
Act as a catalyst for change across the whole pathway, including for women who do not meet the need threshold for referral.
Identify gaps in other parts of the care pathway, including for women with so-called mild to moderate PMH problems, and advocate for them to be addressed.
Share expertise with, and deliver training to, a range of health and social care professionals, including GPs, health visitors and midwives.
Mapping specialist PMH services in the UK
What do the latest maps tell us about the provision of specialist PMH community teams in the UK?
Sustained and coordinated efforts have led to improvements in specialist PMH service provision, as our maps show. However, it remains patchy, especially in Northern Ireland, Scotland and Wales, where women and their families still face a tragic postcode lottery.
No specialist team exists
Some extremely basic level of provision exists but currently falls short of national standards and needs expanding
Some basic level of provision exists but currently falls short of national standards and needs expanding
Women and families can access treatment that meets nationally agreed standards
Let’s turn the map green for women and families across the UK!
Mother and Baby Units (MBUs)
1. NHS Lothian Livingston Mother and Baby Unit (6 beds) St Johns Hospital, Howden Road West, Howden, Livingston, West Lothian, EH54 6PP Tel: 01506 523000 2. West of Scotland Mother and Baby Mental Health Unit (6 beds) Leverndale Hospital, 510 Crookston Road, Glasgow G53 7TU Tel: 0141 211 6500
NORTH EAST / YORKSHIRE
3. Beadnell Mother and Baby Unit (6 beds) Northumberland, Tyne and Wear NHS Trust St Georges Hospital, Morpeth, Northumberland, NE61 2NU Tel: 01670 501869 4. Leeds Partnership NHS Foundation Trust Mother and Baby Unit (8 beds) Temporarily relocated to Parkside lodge, 16 Stanningley Road, Armley, Leeds LS12 2AE Tel: 0113 85 55505
5. Ribblemere Mother and Baby Unit (8 beds) Chorley and South Ribble District General Hospital, Preston Road, Chorley, PR7 1PP Tel: 01772 520780
6. Manchester Mother and Baby Unit (10 beds) Andersen Ward, Laureate House, Wythenshawe Hospital, Southmoor Road, Wythenshawe, Manchester, M23 9LT Tel: 0161 291 6829; Fax: 0161 291 6821
Please note, although located in the North East, the Beadnell Mother and Baby unit is also able to take referrals from the North West. Please see above for contact details.
7. Barberry Mother and Baby Unit (10 beds) Barberry National Centre for Mental Health 25 Vincent Drive, Edgbaston, Birmingham B15 2FG Tel: 0121 3012190 8. Brockington Mother and Baby Unit (8 beds) South Staffordshire and Shropshire Foundation Trust St Georges Hospital, Corporation Street, Stafford, ST16 3AG Tel: 01785 221560 / 01785 221554 9. Derby Mother and Baby Unit (6 beds) The Beeches Unit, Radbourne Unit, Uttoxeter Road, Derby, DE22 3WQ Tel: 01332 623828 10. The Margaret Oates Mother and Baby Unit (8 beds) Hopewood, Foster Drive, Nottingham, NG5 3FL Tel: 0115 952 9481 ext. 12825
11. Kingfisher Mother and Baby Unit (8 beds) Hellesdon Hospital, Drayton High Road, Norwich, Norfolk, NR6 5BE Tel: 01603 786745
SOUTH / SOUTH WEST
12. Thumbswood Mother and Baby Unit (6 beds) Hertfordshire Partnership NHS Foundation Trust, 2 Bowlers Green, Kingsley Green, Harper Lane, Nr Radlett, WD7 9HQ Tel: 01923 633880 13. Rainbow Mother and Baby Unit (5 beds) The Linden Centre, Pudding Woods Drive, Chelmsford, CM1 7LF Tel: 01245 315629 14. Rosewood Mother and Baby Unit (8 beds) Greenacres, Bow Arrow Lane, Dartford, Kent DA2 6PB Tel: 01322 622101 15. Winchester Mother and Baby Unit (10 beds) Southern Health Foundation Trust, Melbury Lodge, Romsey Road, Winchester, SO22 5DG Tel: 01962 897711 16. Florence House (5 beds) St Ann’s Hospital, Dorset Health Care University NHS Trust 49 Alumhurst Road, Bournemouth, BH4 8EP Tel: 01202 584320 17. The New Horizon Mother and Baby Centre (4 beds) Avon and Wiltshire Mental Health Partnership and NHS Trust, Southmead Hospital, Dorian Way, Westbury-on-Trym, Bristol, BS10 5NB Tel: 0117 414 7270 18. Jasmine Lodge Mother and Baby Unit (8 beds) Wonford House, Dryden Road, Exeter EX2 5SN Tel: 01392 539100
19. Coombe Wood Perinatal Health Unit (8 beds) Park Royal Centre for Mental Health, Acton Lane, London NW10 7FL Tel: 020 8955 4495/6/8 20. East London Mother and Baby Unit (12 beds) Homerton Hospital, Homerton Row, Hackney, London, E9 6SR Tel: 020 8510 8420 21. Channi Kumar Mother and Baby Unit (13 beds) South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Monks Orchard Road, Beckenham, Kent, BR3 3BX Tel: 020 3228 4255
22. Uned Gobaith (‘Unit of Hope’) (6 beds – interim) Tonna Hospital, Tonna Uchaf, Tonna, Neath SA11 3LX Tel: 01639 862921
The human and economic cost of not treating perinatal mental health problems effectively is significant.
Untreated perinatal mental health problems have a wide range of effects on the mental and physical health of women, their babies, partners and loved ones, meaning insufficient support is a major public health concern.
Perinatal mental health problems are also one of the leading causes of death for women during pregnancy and the year after birth.
The costs of undiagnosed or untreated perinatal mental health problems include:
1. Avoidable suffering
Perinatal mental health problems can cause intense, debilitating, isolating and often frightening suffering for women.
2. Damage to families
Perinatal mental health problems can have a long-term impact on a woman’s self-esteem and relationships with partners and family members.
3. Impact on children
Perinatal mental health problems can have an adverse impact on the interaction between a mother and her baby, affecting the child’s emotional, social and cognitive development.
4. Death or serious injury
In severe cases, perinatal mental health problems can be life-threatening. In the UK, suicide is one of the leading causes of maternal death in the first postnatal year.
5. Economic costs
Research commissioned by the MMHA shows that the economic cost to society of untreated perinatal mental health problems far outweighs the cost of providing appropriate services: