Perinatal mental health
Making the case for action
Costs of perinatal mental health problems, a report from the Centre for Mental Health, reported that around 1 in 4 women experience mental health problems in pregnancy and during the 24 months after giving birth. When they occur, there’s a pressing need for prompt access to care. This is important, both to improve outcomes for the woman and to minimise the negative impacts on the unborn or developing baby or child.
Five year forward view
The Five Year Forward View aims to increase access to specialist perinatal mental health services so that by 2020/21 at least another 30,000 women each year will receive evidence-based treatment, closer to home, when they need it.
NHS Long Term Plan
The NHS Long Term Plan brings additional commitments. It aims to:
- Increase access so at least 66,000 women access specialist perinatal mental health services by 2023/24.
- Extend how long care can be provided by specialist perinatal mental health services, from preconception to 24 months after birth.
- Expand access to evidence-based psychological therapies in specialist perinatal mental health services to include parent–infant, couple co-parenting and family interventions.
- Offer fathers or partners of women accessing perinatal mental health services evidence-based assessment and signposting to support.
- Increase access to evidence-based psychological support and therapy, including digital options, in a maternity setting.
Maternity outreach clinics will be available across the country, combining maternity, reproductive health and psychological therapy for women experiencing mental health difficulties directly arising from, or related to, the maternity experience.
The National Collaborating Centre for Mental Health has developed perinatal mental health care pathways to support delivery of the mental health ambitions. The guidance follows a process agreed by NICE and sets out policy drivers and strategic context for transforming perinatal mental health care, as well as pathways to deliver transformation. It provides services with evidence, based on our guidance, on what works in perinatal mental health and case studies to support delivery of the national commitments.
Finding the right information
Our guidelines make evidence-based recommendations on topics ranging from preventing and managing specific conditions to planning broader services and interventions to improve the health of communities. They guide decisions about health and care by practitioners, providers, commissioners, service planners and users, and promote integrated care if appropriate.
Our guideline on antenatal and postnatal mental health is particularly relevant. It includes recommendations covering recognising, assessing and treating mental health problems in women who are planning to have a baby, are pregnant, or have had a baby or been pregnant in the past year.
The NICE Pathway on antenatal and postnatal mental health brings together everything we’ve said on this topic in an interactive flowchart.
The following video explains how to use NICE Pathways.
Using quality standards to make an impact on care and support
Quality standards contain a list of quality statements, each describing a priority area for quality improvement. They include metrics that can be a useful source of key performance indicators or performance metrics for system-wide performance dashboards. They help you identify areas to make high impact improvements in perinatal mental health. See how to use quality standards for more information.
There are several NICE quality standards that relate to perinatal mental health. Our quality standard on antenatal and postnatal mental health includes 7 statements that will help with improving quality in areas such as:
- maternal wellbeing
- service user experience of mental health services
- quality of life for women with severe mental illness
- neonatal and infant health and wellbeing
- suicide rate.
Other supporting quality standards include:
Support for improving quality
We publish a range of tools and resources to help with putting our guidance and quality standards into practice. You can find these on the ‘Tools and resources’ tab for each piece of guidance or standard. They include:
- baseline assessment tools (for all guidelines) and a quality standard service improvement template (for all quality standards) to assess whether your services are in line with our guidelines and quality standards
- shared learning case studies showing how organisations have used the guidance or quality standards in practice.
Shared learning case studies
Our shared learning collection contains over 800 case studies showing how organisations around the UK have used NICE guidance and standards to improve the quality of health and social care services.
The perinatal mental health project aimed to improve practice by putting NICE’s antenatal and postnatal mental health guideline recommendations into practice.
Aims and objectives
The project was guided by our recommendations to develop a consistent approach of best practice for perinatal mental health, despite the lack of financial resources. Objectives included developing:
- clear and responsive referral pathways that are accessible to all potential referrers
- robust training reflecting our recommendations for all relevant practitioners
- care pathways to embed our recommendations in practice.
- Having a perinatal mental health lead allows a focused and cohesive approach across services, promoting perinatal mental health. Changing practice takes bottom-up and top-down enthusiasm and requires passion and persistence so all the relevant services have an integrated approach.
- Training increases awareness and improves practice, but this must be supported, for example, through consultations and resources.
Endorsed resources are complementary information from sources outside of NICE to support implementation in practice.
- Tommy’s my pregnancy and post-birth wellbeing plan supports health professionals to recognise, support disclosure and engage with women who may have mental health problems.
- The Royal College of General Practitioners has produced a resource on the practical implications for primary care based on the NICE guideline on antenatal and postnatal mental health. It’s by the Maternal Mental Health Alliance and encourages GPs to ask themselves 10 questions about perinatal mental health.
- The multiple antenatal care pathway resource from the Twins and Multiple Births Association supports our guideline on multiple pregnancy: antenatal care for twin and triplet pregnancies.
We have developed a set of outcome indicators to support perinatal mental health. Visit our standards and indicators page for more information. Indicators can be particularly useful to local partnerships when:
- identifying where improvements are needed
- setting priorities for quality improvement and support
- creating local performance dashboards
- benchmarking performance against national data
- supporting local quality improvement schemes
- demonstrating progress that local health systems are making on outcomes.
NICE impact report on mental health
The impact report highlights progress made by the health and care system in implementing NICE guidance. It can be used to inform benchmarking and planning.