Thousands of women confront mental health issues in thriving community perinatal scheme

Thousands of pregnant women have confronted mental health issues before they become more serious thanks to a thriving perinatal mental health service in Devon.

Since it began five years ago the ten-strong Devon and Torbay Perinatal Health Team has identified, supported or signposted thousands of women who needed mental health support.

Now, all of the women who give birth every year in the three acute hospitals in Devon and Torbay are asked by midwives about their mental health and those who report concerns or are at risk are referred to the team.

In the last three years, 5,698 of the 22,715 women who gave birth needed the service. All of those women received evidence based advice, either in a letter, following a telephone conversation or in response to a face to face assessment.

Dr Jo Black, a consultant perinatal psychiatrist who heads up the scheme across the region’s three hospitals, said: “We’re picking up that one third of women are concerned about their mental health – this can be women who have never disclosed their problems before, people with pre-existing disorders or even survivors of sexual abuse in childhood.

“We make it very easy for women to tell us what they are worried or concerned about. The women don’t have to go to a mental health unit to see us, they can see us at their antenatal clinic or at home after the birth and we provide them with information, treatment, reassurance and normalisation.

“It might be a woman who has been so ill she has needed an admission postnatally to a psychiatric ward in the past. We will plan with her, her midwife, her partner, GP and health visitor to create a plan to reduce the risks of this happening again.”

The teams help women from the pregnancy planning stage through to post-natal support and make sure they are monitored closely during pregnancy.

In 2011-12 South Devon and Torbay Clinical Commissioning Group (CCG) was paying around £750,000 providing services for women who had not been able to access locally commissioned perinatal care and escalated to needing more serious interventions such as stays in intensive care, medium secure units, admissions to antenatal wards or mental health units or more regular visits to the GP because of mental health problems during or after pregnancy.

To improve local services and prevent a repeat of this cost escalation the CCG commissioned this new team, initially costing around £150,000 for four members of staff. The following year, the CCG were delighted with the success of the scheme, with dramatically reduced costs and better outcomes for women and families.

Dr Geraldine Strathdee, NHS England’s Director for Mental Health, said: “This initiative has made a huge difference to women’s lives in Devon, Torbay and Exeter and it is fantastic to see such a successful example of integrated physical and mental health care, one of the Five Year Forward View priorities.

“This type of service is not seen in every area of the country but it could be replicated in other areas where more women, their partners and children could benefit. Commissioning Programmes like this are changing lives and are a key part of our evolving NHS.”

The service is run by Devon Partnership NHS Trust and in place at Torbay Hospital, Royal Devon and Exeter and North Devon District Hospital.

All the midwives in Devon and Torbay have an induction and mandatory training carried out by the perinatal team to make sure they are comfortable asking initial questions which open a conversation about mental health.

“For example, a woman who has a history of sexual abuse as a child may have concerns about her delivery,” said Dr Black.

“She may be avoiding going to antenatal check-ups but by enabling that woman to discuss her anxieties we can normalise her concerns and work with the midwives to make sure she has a safe and respectful delivery.”

If a midwife observes an issue they refer the woman to the perinatal team who take a number of actions: direct them to services or information, see them for a check-up to discuss medium level concerns or in more serious cases refer them for specialist care.

It is estimated perinatal mental health problems carry a total economic and social long-term cost to society of about £8.1 billion for each one-year cohort of births in the UK.

The London School of Economics last year reported that the NHS would need to spend just £337m a year to bring perinatal mental health care up to the level recommended in national guidance.

One of the challenges the team faced was getting upfront commissioning as evidence of savings is often from reduced urgent care admissions or other areas which can be harder to quantify.

But Dr Black said the schemes should be run in every area as the benefits to the patient and the NHS were clear. “Mental health problems in the perinatal period are serious, with significant morbidity and mortality. And yet with the right treatment and support, the outcomes for mum and baby can be dramatically improved. It should be the expectation of every woman that she can access high quality mental health care in her pregnancy if she needs it wherever she lives and gives birth,” she added.

One mum Becky Davies started suffering from severe postnatal depression (PND) in 2012 after her first daughter was born.

She said: “I became very ill a few weeks after the birth with intense anxiety and suicidal thoughts. I was very low and tearful.

“Knowing the impact this was and would have on my family I went to the doctor. When I think of my experience from this point onwards I feel extremely lucky. My GP was brilliant and as a result the perinatal mental health team became involved very early on in my illness. This team really know their stuff, they are experts in their fields and what they do with very little resources is nothing short of a miracle.

“Every expectant or new mother should have easy access to this service along with their families, they prevent suffering for all involved and save lives every day.”

The perinatal team also worked with families from Devon and a local film maker to make a film to break down stigma and support others going through perinatal mental health issues.

It has been viewed more than 5000 times in more than 40 countries, including countries with little or no mental health care.