ESMI-III: The Effectiveness and Implementation of Maternal Mental Health Services
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ESMI-III: The Effectiveness and Implementation of Maternal Mental Health Services
Care and support for women experiencing mental health difficulties arising from trauma or loss related to childbirth — a national study to identify the most effective service delivery models for Maternal Mental Health Services across England.
Background
In recent years, significant investments have been made to improve perinatal mental health care in the UK. The most recent initiative was the NHS Long-Term Plan, with the implementation of Maternal Mental Health Services (MMHS) across 30 sites in all areas of England in 2021, before a national scale-up and sustainability phase in 2022–24.
MMHS provides multidisciplinary integrated care and support to women experiencing moderate to complex mental health difficulties arising from trauma or loss related to childbirth — including post-traumatic stress following childbirth, tokophobia, miscarriage, stillbirth, neonatal death, pregnancy termination and loss of custody.
The ESMI-III study will help identify the most optimal service delivery models and context-specific barriers to implementation across pilot sites to inform the national roll-out.
Research questions
The study takes a Realist approach to understand which MMHS model works, for whom, in what circumstances, how and why. Specifically, it aims to understand:
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The variation in MMHS service delivery models in Early Implementer and Fast Follower sites across England
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The factors — challenges and solutions — affecting the implementation of MMHS
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How effective MMHS are in improving mental health for women who have experienced trauma or loss related to childbirth
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The impact of MMHS on staff psychological wellbeing, knowledge, skills and confidence
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The feasibility and effectiveness of MMHS in providing trauma-informed training across the maternity workforce
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The challenges and solutions to sustainability and scale-up of MMHS
Research plan
The ESMI-III study is being conducted in three phases:
An organisational mapping of MMHS service delivery models across England, plus focus groups with Early Implementer and Fast Follower sites. This phase identified the core components of MMHS models in different areas and early lessons from setting up new services. Findings informed a series of recommendations and national guidance for the implementation of MMHS, disseminated through national interactive community practice workshops and NHS England.
In-depth organisational case studies with 4 Early Implementer or Fast Follower MMHS sites using a Realist approach. This phase explored staff and women’s experiences, barriers and facilitators to implementation, and how services work to improve outcomes.
A mixed methods survey, focus groups and interviews to understand and support sustainability and scale-up of MMHS. The team will facilitate trauma-informed training to staff in four sites and evaluate its effectiveness in improving knowledge and confidence across the maternity workforce in supporting women experiencing mental health difficulties related to perinatal loss.
Anticipated outputs
Findings will be shared throughout the study to help facilitate learning across the sites and inform further development, scale-up and sustainability of MMHS nationally. Dissemination includes:
Peer-reviewed journal articles and conference presentations
Informing NHS England and national implementation guidance
Community of practice workshops for MMHS teams across England
Reports and publications
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Final Report: ESMI-III — The Effectiveness and Implementation of Maternal Mental Health Services
PDF download - →
Impact case study: Informing national policy on perinatal mental health and maternity care - →
ARC Bite: Prioritising child health and maternity evidence-based interventions or service models — a stakeholder-driven process
Research team
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Pauline Slade Co-investigator |
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Professor Heather O’Mahen Co-investigator |
Professor Helen Sharp (University of Liverpool) · Dr Hannah Rayment-Jones (King’s College London) · Laura Bridle, Specialist Perinatal Mental Health Midwife (Guy’s and St Thomas’ NHS Foundation Trust) · Antoinette Davey (University of Exeter) · Kaat De Backer, Zoe Vowles (King’s College London) · Louise Fisher (University of Liverpool) · Claire Mason (Lancaster University)
Related content
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Informing national policy on perinatal mental health and maternity care — impact case study - →
MUMS@RISC study — maternity experiences of mothers separated from their babies due to social care proceedings - →
Maternity and perinatal mental health research at ARC South London - →
Patient and public involvement in maternity and perinatal mental health research
Original source: arc-swp.nihr.ac.uk — NIHR ARC South West. Archived June 2026.