Thousands of new, expectant or bereaved mothers will receive help and support for mental health problems through dozens of new dedicated hubs which are being set up across the country.
The 26 new hubs will bring together maternity services, reproductive health and psychological therapy under one roof as part of the NHS Long Term Plan.
Around 6,000 women will receive care and treatment for a wide range of mental health issues from post-traumatic stress disorder (PTSD) after giving birth to others with a severe fear of childbirth.
Maternal mental health services will provide improved, targeted care to those whose needs would not be well met in other services. For example, women experiencing PTSD following perinatal loss.
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 aims to reach a cohort of women that may previously have faced a gap in service by:
- Increasing support to the multidisciplinary team in relation to women and families who have experienced perinatal trauma
- Offering psychologically informed specialist assessment and formulation
- Further increasing links to wider psychological services
- Increased provision of evidence-based therapies
- Consultation and training to professionals
The Devon MMHS went live in January 2021. To date, 36 referrals have been made, 27 women have been assessed and ten women have started or completed treatment.
Devon was selected as one of the early implementer sites for the new hubs, with the Maternal Mental Health Service (MMHS) launching in January this year.
The service is offered both by Livewell Southwest, the provider of mental health services in Plymouth and Devon Partnership Trust which provides mental health services in the rest of the county.
Lizzie is one of the patients who has been treated, who had a miscarriage prior to her current pregnancy. This experience triggered low mood, a sense of lost safety and heightened danger, nightmares and intrusions around 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 it was identified that an assessment under the MMHS would be appropriate.
At assessment, an Impact of Events Scale was used to identify clinical levels of PTSD. The MMHS offered up to eight sessions of Eye Movement Desensitization and Reprocessing (EMDR) therapy, a psychotherapy treatment that was originally designed to alleviate the distress associated with traumatic memories; this intervention was able to reach Lizzie’s core worry that the miscarriage was her fault, and the sessions of EMDR were successful in working through this.
This freed Lizzie up to start feeling excitement towards the new baby, while continuing to remember the lost baby and not feel that she was responsible for what happened.
Through this work, all the identified symptoms of PTSD, as well as her feelings of low mood and loss of safety disappeared. Lizzie was discharged after three sessions of EMDR with significant improvement and evidence of good recovery, therefore 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 also making day to day life a struggle. Brief treatment enabled the processing of loss and renewed possibility of bonding and being excited about and preparing for her new baby.”
Several weeks after she had completed her treatment, and having had her baby girl Enfys, Lizzie said: “I feel unbelievably better after this pregnancy and birth 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 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 team 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.
NHS England and NHS Improvement launched an expressions of interest process into these services in July 2020.
NHS England chief executive Simon Stevens said: “The pregnancy and the birth of a new child are a special time for families but if things go wrong it can have a huge impact on women, their partners and even other children.
“That is why the NHS is developing maternal mental health services to help them get back on track as part of our Long Term Plan.
“NHS staff have pulled out all the stops to deal with more than 393,000 patients requiring hospital treatment for Covid-19 but we have also kept mental health services running and I am delighted that, we are now expanding help for new, expectant and bereaved mums despite the continuing pandemic.”
As well as offering psychological therapies for new and expectant mums the clinics will also provide training for maternity staff and midwives.
Ten sites will be up and running within months with the remainder opening by April 2022.
Every area will have one by April 2024 as part of the NHS Long Term Plan to increase access to psychological support for women before, during and after pregnancy.
Claire Murdoch, NHS England’s national mental health director, said: “Every woman has a unique experience with pregnancy and motherhood and some will need extra support to cope with mental health issues that can range from anxiety to severe depression so I am delighted that mothers across all areas of the country will be able to access this help if they need it.
“The NHS is here for everyone who needs help and the expansion of specialist care through the roll out of these maternal mental health services will strengthen the services already in place, enabling us to improve the quality of care and outcomes for many women.
“I would encourage any mum who needs this support to come forward safe in the knowledge that her mental health and well-being are of paramount importance and she should not feel ashamed of accessing the help she needs.”
It is estimated that it costs the NHS and social care sector £1.2 billion per year where women do not access high-quality perinatal mental health services.
Five years ago, 40% of the country had no access to specialist perinatal mental health care. However, specialist community perinatal mental health services are now available in each of the 44 local NHS areas and over 30,000 women were seen in specialist perinatal mental health community services in 2019/20.
Dr Giles Berrisford, NHS England’s national speciality advisor for perinatal mental health, said: “We know around one in four women experiences mental health problems in pregnancy and during the 24 months after giving birth, and these maternal mental health services will provide vital support, meeting the specific needs of these women.
“Their establishment will significantly contribute to the overall commitment of the NHS to enable at least 66,000 women with moderate to severe mental health difficulties related motherhood to access specialist care by 2023/24.”
Around 6,000 women are expected to receive care as part of the pilots by the end of 2021/22. The work undertaken by these sites will be vital to efforts to further scale up these services across the country.
Emily Slater, CEO of the Maternal Mental Health Alliance, said: “The Maternal Mental Health Alliance (MMHA) welcomes this positive step towards achieving ambitions for perinatal mental health laid out in the Long-Term Plan.
“For the more than 1 in 10 expectant and new mothers experiencing mental health problems, and the increased numbers as a result of the pandemic, there needs to be a system of care available to support them. These new services will enable more women than ever to access vital perinatal mental health care.
“The MMHA is keen to see training for all staff who interact with women and their families in the perinatal period, so we also welcome the role these services will play in upskilling the maternity workforce, alongside providing much-needed support.”