Introduction

The Hertfordshire Community Perinatal Team (CPT) was set up in January 2017, one of 20 community perinatal mental health services to receive national investment through Wave 1 of NHS England’s Community Services Development Fund.

A multi-disciplinary team, it runs joint antenatal clinics at hospitals around the county, and outpatient clinics at Hertfordshire’s children centres, which can be less stigmatising for families. Individual assessments and interventions are offered at a convenient location for women, usually their home.

The range of interventions include advice around medication in pregnancy and breastfeeding, psychological therapies, support from nursery nurses and occupational therapy, as well as practical advice and help for mums about caring for themselves, their babies and families.

It also provides specialist training for multi-agency professionals, including health visitors, GPs and midwives, to help ensure women at risk of or who are experiencing perinatal mental health problems can be identified earlier, and receive faster access to treatment and support.

Consultant psychiatrist Sarah Cohen said: “We work together to provide a comprehensive service for a woman, depending on what her particular needs are.

“The service has been very well received by mums and we have had very positive feedback. It’s also been very well received by other professionals who are able to turn to us for advice for managing women in the perinatal period.”

Impact of investment

More than 400 women in Hertfordshire experience severe mental health illness in the weeks before and after the birth of their baby each year, with another 1,375 having mild to moderate needs. Most are struggling with depression or anxiety conditions, including obsessive compulsive disorder, but issues can also include eating disorders, self-harm, Autistic Spectrum Disorder and learning difficulties or a severe mental illness, including post-partum psychosis.

Hertfordshire’s joint perinatal commissioning group had already carried out an analysis of local perinatal services and what women said they needed prior to the award of national investment in November 2016. This meant progress could happen quickly once the funding was in place.

The CPT began work in January 2017 and, after a period of mobilisation and training for new staff and local professionals, it opened for referrals in March 2017. The number and location of clinics was then steadily increased until it was possible for any woman in the county to access a clinic within a 30 minute drive.

Over its first year, the service saw more than 700 women, from more than 1,600 referrals. A detailed evaluation of activity in its first nine months, showed the team received 1,236 referrals, 42 per cent, 525, of which came from antenatal services, followed by GPs (28%, 348) and health visitors (13%, 158).

Approximately two thirds referred (67 per cent) were experiencing perinatal mental health problems for the first time, but around 74 per cent, 528, had a history of other mental health problems. Most referrals concerned pregnant women, 63 per cent, but the service also provided pre-conception care planning or counselling for 15 women.

While some women were signposted to other services, such IAPT or children’s centres, 72 per cent of those identified as needing support from the CPT had their face-face assessment within six weeks, the average time being 32 days. Urgent and emergency referrals are usually managed on the same day they are received, organised by either the CPT or the mental health crisis team.

Like many expectant mums, Victoria Sweeney hadn’t wanted to be on medication when she and her husband were expecting their first child. But she then suffered a relapse of the anxiety and depression she had suffered from previously which left her very distressed and worrying she wouldn’t want her baby.

Mrs Sweeney, 34, was referred to the community perinatal team which helped her to understand her anxiety and develop her confidence ahead of son Vincent’s birth in November 2017.

“It made a really big difference,” she said. “The team never made me feel like it was a stupid worry to have. They helped me to completely understand what I was doing and what I was going through, and what I would need to do when he was here.

“You think these things are normal, and you’re supposed to suffer, but you’re not, and there are people there to help you.”

Clinical Lead occupational therapist Erzsebet Pek works with mums to offer practical help, giving advice and teaching new skills that can reduce anxiety and help them to look after themselves and their families.

“We’re now at the point where we’re discharging women and we can see they’ve met their goals,” she said. “They’ve managed their mental health, and they’ve managed the transition, through to being able to look after their newborn babies and develop their family relationships and roles.”

The future

The CPT has been staffed with 13 permanent members in post since August 2017 and now comprises a consultant psychiatrist, junior doctor, psychologist, occupational therapists, four community psychiatric nurses, a mental health social worker, nursery nurse, its team leader and an administrator.

An additional £411,000 awarded this year (2018/19) through Wave 2 of the Community Services Development Fund will allow the team to expand further, enabling it to widen the support it can provide and help to bring down waiting times.

The CPT is looking at how it might offer more clinics in areas where referrals are highest, and how to provide more support for mums with more complex or severe perinatal mental health needs.

Training has been offered for more than 200 multi-agency professionals, including for midwives and obstetricians, with plans to continue this and roll out further teaching to liaison and community mental health staff.

At the same time, the CPT is working with these partners to improve how it responds to referrers and the feedback it provides to them, as well as tackling issues around inappropriate referrals where women can be better supported in other ways.

Feedback from mums, captured via the trust’s standard reporting forms, has so far been positive, and average global improvement scores for women with perinatal mental illness show these mums to be ‘very much improved’ following treatment.  The team is, however, developing its outcome measures to capture women’s recovery and progress in more detail.

Dr Cohen said: “Developing the CPT and seeing the positive impact it has had on so many families in Hertfordshire, has been such an exciting and rewarding time for all of us. We’re now about to expand the team, doubling it in size, and looking forward to rolling out our service in the next few months to more women in Hertfordshire, seeing them sooner and offering them more perinatal specific interventions.”