Better mental health support for new mums and those experiencing baby loss

Maternal Mental Health Services (MMHS) will bring together maternity, psychology and reproductive health services for women who experience moderate-severe mental ill health from loss or trauma as a result of their maternity experience, but previously did not have a service to access.

In this blog, Dr Giles Berrisford and Professor Jacqueline Dunkley-Bent provide an overview of their shared ambitions for MMHS, as well as the brilliant work to date to pilot those services in challenging times.

COVID-19 has had a strong impact on us all – including on new mothers and those experiencing baby loss over the past year. The pandemic has affected the maternity experience of thousands of women and birthing people, with more coming forward for support.

Expanding our mental health services is more important than ever. Immense progress has been made to expand specialist community perinatal mental health services in England over the past five years, with services now available in every area. The Long Term Plan has committed us to additional expansion of these services, responding to feedback from services and people who have used them.

We are delighted to announce the launch of new Maternal Mental Health Services (MMHS) in every region of the country as one aspect of this further expansion. These services (called Maternity Outreach Clinics in the NHS Long-Term Plan) will provide targeted care and support to women whose needs would not be met in other services.

MMHS are a joint project between perinatal mental health services and maternity services and will primarily support women who want to become mothers but haven’t been able to, due to infertility or loss. This group of people have been falling between gaps in existing service provision – not meeting the criteria for a community perinatal mental health service, but still requiring the perinatal expertise that these teams possess. The MMHS will help to fill this gap. For example, MMHS teams will support women experiencing Post Traumatic Stress Disorder (PTSD) following a miscarriage, stillbirth, neonatal death or termination of pregnancy.

This innovative programme will identify where gaps currently exist and develop strategies to meet this need. Other potential gaps that MMHS may support include women who experience mental ill health following the removal of a baby due to safeguarding concerns; women suffering from tokophobia – a severe fear of childbirth which can lead to women avoiding pregnancy; or those who suffer from birth trauma. The MMHS will be holistic offering assessment of and signposting for partners, where necessary, ensuring the needs of the whole family are identified.

MMHS will be a new addition to a range of services designed to support the mental health of women and families during the perinatal period – most prominently specialist community perinatal mental health services, but also talking therapies (IAPT), counselling services, or bereavement services. It will be crucial to establish clear and effective communication between those existing services, so that women can receive the mental health care they need as quickly and efficiently as possible.

By doing so, we are hoping that mental health and psychological support will be further embedded across the services that women may use in the perinatal period – including Maternity and Neonatal services, IVF clinics, Neonatal Intensive Care Units, Pelvic Health services, GPs, A&E, and so on.

These services should be psychologically aware, adopting a personalised and trauma-informed approach to care. MMHS will have a crucial role to play to make this happen particularly because they will have the expertise to support women suffering from mental illness due to trauma or loss. Therefore, they will be able to train staff across the maternity pathway.

Our shared goal is also to ensure MMHS are inclusive and accessible to all individuals who may benefit. We are inviting them to work with their local Perinatal Mental Health teams, networks and community organisations, to facilitate access for women from ethnic minority groups who have lower rates of accessing support in the perinatal period.

Thanks to the enthusiasm, willingness and incredible joint working between maternity and mental health colleagues at all levels, ten services are already being piloted in England. These services acknowledge the value of a multi-disciplinary approach to care and treatment and include key skills from a specialist midwife, psychological support, peer support and reproductive health. We invite you to read more about the work that is underway in Devon and Kent, where services started receiving referrals in January 2021.

Another sixteen services should be up and running in the coming months.  We would like to take this opportunity to thank everyone who’s been involved in making MMHS a reality in these challenging times – including people with lived experience, health and social care professionals, service managers, project managers, commissioners, voluntary and community sector organisations, academics, regional mental health and maternity colleagues, and so many others.

We know that the pandemic has had a significant impact on capacity to mobilise and recruit. We are hugely grateful for all the work that is being done despite current pressures, and we will do our very best to continue to provide high-quality and timely national support.

Dr Giles Berrisford

Dr Giles Berrisford is Associate National Clinical Director for Perinatal Mental Health for NHS England.

Dr Giles Berrisford is the Clinical Lead at the Birmingham Perinatal Mental Health Service at BSMHFT – leading one of the largest inpatient Mother and Baby Units in the country. He is the Chair of the national charity Action on Postpartum Psychosis (APP) – working closely with women and families directly affected by postpartum psychosis – the most severe form of perinatal mental illness. He is committed to bringing about improved access to maternal mental health services and reducing the unwarranted variation in care currently seen across the country.

Jacqueline Dunkley-Bent

Professor Jacqueline Dunkley-Bent has vast experience in healthcare provision and is the first Chief Midwifery Officer in England.

She has worked as a midwife and a nurse and held senior positions in clinical practice, education, leadership and management including: Director of Midwifery and Nursing positions for Women’s and Children’s services at Imperial College Healthcare Trust & Guy’s & St Thomas’ NHS Foundation Trust.

Academic roles have included: Senior Lecturer, Curriculum Leader, LME and Professor of Midwifery.

Jacqueline was appointed Chief Midwifery Officer in Spring 2019 at NHS England and NHS Improvement and is National Maternity Safety Champion for the Department of Health. She is also visiting Professor of Midwifery at Kings College London and London South Bank University.

Her experience has seen her leading and influencing national maternity standards and guidance. She also influences healthcare, nationally and internationally through research, education and publications and is frequently invited to speak at national and international conferences. She is a member of the British Journal of Midwifery editorial board and until recently was an active member of the Maternity and Newborn Forum at the Royal Society of Medicine.

She has joined the Tommy’s Charity National Advisory Board as Midwifery advisor, and the Women of the Year management committee. Her voluntary work currently includes Midwifery Advisor for the Wellbeing Foundation Africa and until recently a trustee.

In 2014 she received the HSJ, BME Pioneers award and in 2015 she was selected from over 100 nominations for inclusion on Nursing Times’ Leaders 2015 list that celebrates nurses and midwives who are pioneers, entrepreneurs and inspirational role models in their profession.