New FOI data finds huge gaps in provision of care for perinatal mental health

Released on: 04 July 2014

New Freedom of Information (FOI) data from NCT shows that only 3% of Clinical Commissioning Groups (CCGs) contacted have a perinatal mental health strategy.

NCT sent FOIs to 194 CCGs in England and 186 replied. Only 3% said they had a strategy. Out of the 97% with no strategy, 60% have no plans to put one in place.

Fifteen percent of CCGs were unable to offer any information and directed the charity to local NHS trusts or NHS England, suggesting a lack of clarity about who is responsible for commissioning and providing services.

The charity also contacted 193 NHS trusts to ask if they were able to provide a perinatal mental health service with trained specialists. Over half of all trusts (54%) said that they do not provide any perinatal mental health service. Thirty-three trusts (17%) did not respond to the FOI request.
Only 26% of the trusts contacted provide a dedicated perinatal mental health service. However, just 13% of trusts contacted have a full team in place. Fourteen percent are employing only one specialist perinatal mental health midwife or doctor, frequently on a part-time basis. 

Belinda Phipps, CEO, NCT said:
“One in ten mothers experience some form of postnatal depression, but there are clearly huge gaps in the support and care being provided to them across England.
 “While we found some areas with excellent care, too often we have found situations where there is no care, or very little care. If there are whole areas where GPs, midwives and health visitors have no training or time to dedicate to this vital service then women will not get the help and support they need. For many parents this will result in months of misery, damaging both family relations and children's well-being. And, in the most extreme circumstances, it will result in tragedy and loss of life.
"We need to see properly staffed and resourced services with clear lines of responsibility and clear targets for delivery. And we need to see that happening urgently. ”

NCT is a member of the Maternal Mental Health Alliance (MMHA), a coalition of UK organisations committed to improving the mental health and wellbeing of women and their children in pregnancy and the first postnatal year. The MMHA will launch their campaign #everyonesbusiness to highlight the gaps in provision of maternal mental health services on Tuesday 8 July.

1. More than one in ten mothers experience postnatal depression after having a baby. More rarely, women develop postpartum psychosis, a severe mental illness that requires inpatient treatment. In addition, either parent may suffer antenatal depression during pregnancy or post-traumatic stress disorder after a frightening episode at the baby’s birth.

2. NCT received FOI responses from 194 Clinical Commissioning Groups across England and 193 NHS trusts in England. The requests were sent out between February and May 2014.

Key findings were:

• 5 CCGs (3%) said they have a strategy for providing perinatal mental health services
• 117 CCGs (60%) have no plans to develop a specific strategy for perinatal mental health
• 34 CCGs (18%) said they were developing or planning to develop a strategy
• 30 CCGs (15%) were unable to offer any information and directed us to local NHS trusts or NHS England
• 8 CCGs (4%) did not reply
• 16 CCGs reported having no GPs with any specialist training
• 50 trusts (26%) provide a perinatal mental health service. 26 of these employed only one specialist perinatal mental health midwife or doctor; frequently these roles were held on a part-time basis
• 5 trusts (3%) offer some sort of minimal provision
• 105 trusts (54%) said that they do not provide any perinatal mental health service
• 33 (17%) did not respond to the FOI request

3. Expected provision of care, outlined in a recent report by the NHS Confederation includes:

- Every ward or midwife-led unit should have a specialist mental health midwife both to provide more specialist care and to act as an advocate for good perinatal mental health amongst the other staff
- Commissioners and providers need to collaborate to develop a perinatal mental health strategy that meets the need of their local population. This is ultimately a role for commissioners but providers have a role to play in improving understanding of what high-quality services look like
- Women with more serious perinatal mental health problems need access to a specialist service with trained staff including a specialist psychiatrist and in the most severe cases access to a mother and baby unit. These services need to work closely with community based mental health services to ensure continuity of care

4. NICE recommend the provision of Specialised In-Patient Mother and Baby Units for women with psychosis or very severe depression and specialised Perinatal Community Psychiatric Teams for all women requiring secondary psychiatric care in pregnancy or the postpartum year.