Meeting the challenges of perinatal mental health care

Dr Jo Black is one of NHS England’s two Associate National Clinical Directors for perinatal mental health, working alongside Dr Giles Berrisford, the clinical lead at the Birmingham Perinatal Mental Health Service at BSMHFT.  Here she discusses her reasons for taking the role, the challenges ahead, and the partnerships being formed to deliver this vital transformation in NHS services and care:

My first few months as one of two Associate Clinical Directors for perinatal mental health have been fascinating, daunting and invigorating.

I am a perinatal psychiatrist working with a fantastic community perinatal mental health team in Devon.

Families in Devon tell us that having good perinatal mental health care in the community has been life-saving and life-changing for them. It has empowered women with mental health concerns to actively direct their care. They describe having a respectful experience in pregnancy, birth and postnatally.

It has brought fathers and co-parents into the care plan as partners not bystanders. It has given confidence to GPs, health visitors and midwives to be open about mental health conversations, knowing there is a robust pathway for women who need more specialist support. It enables considered, safe and measured responses to issues around safeguarding and domestic abuse.  It recognises, acknowledges and challenges stigma and assumptions on a daily basis.

Families in Devon also tell us how horrific it is to expect a mum and baby to leave their homes, communities and loved ones when they are at the height of a mental health crisis to receive care very far away. They describe how painful it is, having to choose to stay close to home in an acute adult mental health unit but without their baby, reducing their ability to breast feed, care for their babies and grow in confidence as a mother as they recover.

We’ve heard of dads sleeping in their cars in London near a mother and baby because they can’t afford accommodation and they desperately want to be close to their family; or a dad distraught because he can’t afford the petrol or accommodation to take his confused three-year-old daughter to visit her mum and sister and she has started wetting the bed again; or a mother minimising symptoms  to mother and baby unit staff in order to get home sooner, only to take an overdose because she was, in reality, still critically ill.

These stories and many others inspired me to apply for this job. Over the next five years we will reduce the variation in care available to mums and families, and make perinatal mental health care robust for all families in England, whatever level of care they need.

We have a lot to do and we need to get it right.

I was thrilled to chair a meeting earlier this month with leads for newly forming Perinatal Mental Health Networks in every region of the country. Some areas already have mature and well-functioning networks – other areas are in their infancy.  These networks will be the engines driving service development forward in each area, helping to make sure services work seamlessly for women and families. Networks will include providers of services, commissioners and users of services – this work is, after all, as the Maternal Mental Health Alliance says, everyone’s business.

Our Perinatal Mental Health Transformation Board brings together a formidable range of skills and experience. This Board will be working for the next five years to ensure all parts of the system pull together to get the service developments we so desperately need.

A key part of my A-NCD role is to provide clinical leadership with Giles to this Board, and to make sure everything it does has the theme of providing the best clinical care running through it. As practising clinicians, Giles and I bring our clinical experience and patient stories into the core of the perinatal mental health transformation programme team.

I want to finish by thanking the campaigners, the bloggers, the agitators, the parents and families, the healthcare professionals, the charities, the Royal Colleges, the politicians and the academics who made the case for this investment.

I want to remember families who have lost loved ones to maternal mental illness, and I want to say how sorry I am for your loss and that it has taken so long to get to this point.  I have been moved, shamed, inspired and motivated by those I have known and those whose stories I have read.

I look forward to being in a position where I am as proud of the comprehensive perinatal services available nationally as I am of my team in Devon, and that beds in mother and baby units are available and accessible to all families who need them, whatever their address.

Dr Jo Black

Dr Jo Black is a consultant perinatal psychiatrist with Devon Partnership NHS Trust, SW regional representative on the perinatal faculty at the Royal College of Psychiatrists and Chair of the Regional Reps Committee. She has developed an integrated community perinatal mental health service, with perinatal expertise embedded in the three maternity units serving families in Devon.

Jo has experience of working with teams, bringing together clinical, management and commissioning colleagues from primary care, acute and mental health services, women, families and colleagues from the third sector. She looks forward to bringing her energy, experience and ideas to this national role.