Around one in four women experience mental health problems in pregnancy and during the 24 months after giving birth. The NHS is committed to provide them with high-quality perinatal mental health care and has recently announced the rollout of 32 new dedicated Maternal Mental Health Services (MMHS) offering psychological therapy for women experiencing moderate to severe or complex mental health difficulties arising from trauma or loss in the maternity, neonatal or perinatal context.
As part of the Long Term Plan, specialist perinatal mental health services (both specialist community PMH services and MMHS) across the country will help at least 66,000 women by 2023/24.
Devon Maternal Mental Health Service
The Maternal Mental Health Service (MMHS) in Devon aims to assess and offer treatment to women experiencing a moderate/complex, severe mental health issue directly arising from their maternity experience.
The service went live in January 2021. 36 referrals have been made to date. 27 women have been assessed and 10 women have started or completed treatment.
Lizzie had a miscarriage prior to her current pregnancy. This experience triggered low mood, a sense of heightened danger, nightmares about the miscarriage and a lack of excitement about the new baby.
In pregnancy, Lizzie was referred to the Perinatal Mental Health Team (PMHT) by her Midwife, and subsequently sent for assessment with the MMHS.
An Impact of Events Scale was used to identify clinical levels of PTSD. Lizzie was offered up to eight sessions of Eye Movement Desensitization and Reprocessing (EMDR) therapy, which enabled her to reach the core worry that the miscarriage was her fault. The sessions were successful in working through this and enabled Lizzie to start feeling excited about the new baby, while continuing to remember her loss, and not feel that she was responsible for what happened.
Through this work, all Lizzie’s symptoms of PTSD, as well as her feelings of low mood, disappeared. She was discharged after three sessions of EMDR with evidence of good recovery, reducing risk of negative impact in the future for her and her children.
The Clinical Psychologist in the MMHS who completed the assessment and treatment on this case said:
“The MMHS gave Lizzie fast access to brief treatment which had a significant impact on her mental health. The difficulties were affecting her relationship with her unborn baby whilst making day to day life a struggle. Treatment enabled the processing of loss and renewed possibility of bonding and being excited for her new baby.”
Several weeks after her treatment and having had her baby, Lizzie said:
“I feel so much better this time compared to how I felt after my experience with my first child when there wasn’t any support available to me; even with the added distress of previously having a miscarriage, the pressures of COVID-19 restrictions and not being able to see my family. I feel happier, more confident and much better in my mental health. I feel fully recovered. The service was brilliant!”
The Maternal Mental Health pathway is integrated within the Perinatal Service, using existing structures and processes. Close collaboration with other local services, such as IAPT and hospital counselling services, is essential to ensure women receive the right support at the right time.
The MMHS is also liaising with local and national organisations targeting ethnic minority populations, such as counselling services, befriending services, support groups, and faith organisations. This allowed the service to gain a better sense of local demographics and to develop an accessible service offer (the team has designed a digital offer due to high levels of rurality and deprivation in the county) with cultural awareness training to staff.
Kent and Medway NHS and Social Care Partnership Trust (KMPT) and East Kent Hospitals University NHS Foundation Trust – Thrive: Psychological Support for Birth Trauma and Loss
Thrive is an inclusive, multi-professional service, offering assessment and interventions to those experiencing moderate/severe mental health difficulties as a result of birth trauma and/or loss.
Specialist Midwives within the service provide clinical expertise and knowledge of birth loss and trauma, and support for future pregnancies. The Specialist Clinical Psychologist provides EMDR therapy and Trauma Informed CBT.
Additionally, a person at the service with lived experience of birth loss or birth trauma is available to offer support and advice. This may include supporting someone at their assessment, sharing their experience of recovery, or linking in with support groups. Based on the need of each person, further advice and signposting can be offered.
The service started receiving referrals in in January 2021. To date it has received 16 referrals.
Charlotte, a mum involved in the design of the service, said:
“In 2018 I was pregnant with my first child. Although apprehensive about labour, I was looking forward to having the empowering experience I had heard described.
Unfortunately, my reality was not the experience I had anticipated. A combination of events (failed epidural, forceps delivery, third degree tear, a baby that was slow to respond, and post-partum haemorrhage) along with impersonal care from some of my care providers meant that my fourth trimester was a blur, filled with guilt and anxiety over what happened.
Due to a lack of understanding from myself and my care providers, my PTSD went ‘under the radar’ for a long time, but I was referred for counselling over six months later. If the THRIVE service had been available at the time of my trauma, I believe I would have been able to access treatment earlier.
Through the charity “Make Birth Better” I became involved in one of the ‘lived experience’ sessions run by a member of the KMPT perinatal mental health team, where people who had experience of birth trauma were given a platform to discuss their experiences, to help build the service now known as Thrive.
At the heart of the service are a group of care providers passionate about treating and preventing birth trauma. I hope that Thrive will continue to evolve in response to the feedback from its users, and I am honoured to be a part of such a transformative project.
As a patient, I have often felt like healthcare services have been built as a ‘tick box exercise’, but I am proud to say that Thrive has been developed in collaboration with those who have suffered birth trauma and loss.”
Upon referral to Thrive, all cases are triaged by the Clinical Psychologist and Specialist Midwives, determining which service is most appropriate in providing care and treatment to each person. -They work closely with local services to understand which would be most appropriate, with regular discussions taking place.
If it is determined that Thrive is the most suitable service, a risk assessment with the clinical psychologist and specialist mental health midwife will be offered; following which a plan of care will be formulated based on their needs.
Tanya-Jane Cox and Sally Densham, Specialist Mental Health Midwives at East Kent Hospitals University NHS Foundation Trust, said:
“As specialist perinatal mental health midwives, we feel privileged to have been invited to join the MMHS pilot project team. Thrive has been a wonderful opportunity to co-create a bespoke pathway which works collaboratively with existing maternity and psychological services to meet the needs of local service users.
Within our role we speak with those who have experienced trauma, to validate their experience with compassion, provide psychoeducation, let them know that they are not alone and offer hope that effective treatment is available.
We attend regular multi-disciplinary team meetings and client assessments, helping develop individualised care plans. Where a service user is pregnant, we liaise between the maternity service and Thrive, to co-ordinate multidisciplinary care pathways.
As the service continues to flourish, we are looking forward to developing psychoeducation groups as a complementary intervention for some service users. We are in no doubt of the benefits that service users and their families will experience as a result of receiving specialist treatment and intervention.”