Informing national policy on perinatal mental health and maternity care

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Research by ARC South London’s maternity and perinatal mental health theme has been instrumental in informing clinical guidance and service delivery of perinatal mental health services.

What is the health problem?

Up to one in four women experience mental illness during pregnancy and up to one year after birth, often with long-term adverse consequences for both mother and child. In the UK, almost a quarter of maternal perinatal deaths are related to mental health or suicide, and 33% of women who die are known to have pre-existing mental health problems.

Suicide is the leading cause of maternal death in the postpartum period and one of the leading causes during pregnancy. It is crucial that health professionals can identify women experiencing mental health problems so that women can access mental health treatment and support, and we can improve outcomes for mothers and families.

The impact of our research on perinatal mental health guidance and policies

The findings from our research into perinatal mental health-related causes of near misses — events where a woman comes close to maternal death, but does not die — have influenced clinical guidance for women with serious mental illness. They were cited in the 2022 Royal College of Psychiatrists Annual Report, Perinatal Mental Health Services: Recommendations for the provision of Services for childbearing women, and NHS England’s Equity and Equality: Guidance for local maternity systems.

Our research has also informed the development and delivery of the Maternal Mental Health Service (MMHS) programme, which aims to provide psychological interventions, integrated with maternity services, for women experiencing moderate to severe or complex mental health difficulties during pregnancy.

Our research has informed recommendations to support the national implementation and sustainability of MMHS, and lessons to support the local development of new MMHS. The research highlighted the need for greater resources and training for women and families going through care proceedings during pregnancy, and the need for new training to embed psychological support into maternity care in partnership with the Centre for Child and Family Justice.

The ESMI-III study

The Effectiveness and Implementation of Maternal Mental Health Services (ESMI-III) study was funded through the NIHR Applied Research Collaborations’ (ARCs) Children’s and Maternity Research Priority Programme. It is part of a three-year programme aimed at identifying effective ways to implement evidence-based interventions to improve children’s health and maternity services across England.

The study is led by the NIHR ARC South London maternity and perinatal mental health theme at King’s College London, in collaboration with Liverpool, Exeter and Lancaster universities. The study aims to provide timely learning from the implementation of MMHS in ‘Early Implementer’ and ‘Fast Follower’ sites, to identify barriers and facilitators to early implementation and identify optimal service delivery and context-specific barriers to implementation across the pilot sites.

Real-time feedback from the ESMI-III study has informed national implementation workshops, led by NHS England, and has shaped the development of service delivery plans during the pilot phase of the maternity and perinatal mental health transformation plan.

In September 2022, the team published a report which included recommendations for early planning of service delivery, from the first phase of the ESMI-II study. They held the first of a series of stakeholder workshops with service delivery managers and clinicians to map the safeguarding pathway within MMHS and start to develop training and implementation guidance.

“Despite the challenges to implementation identified, there was a huge amount of dedication both nationally and locally to develop MMHS, reflected by the passion of teams to meet a long-standing gap in mental health needs.”

Dr Abigail Easter — Senior lecturer in maternal and newborn health, King’s College London; deputy lead for the maternity and perinatal mental health research theme, ARC South London

In the longer term, this research will help improve mental and physical health outcomes for women experiencing perinatal mental health difficulties, contribute to the overall ambition of the NHS Long Term Plan for improving access to perinatal mental health services and associated health economic savings from improving timely and effective access to maternal mental health services.

Why this change matters

Improving access to effective perinatal mental health care is crucial to improving maternal and family wellbeing and can help break the cycle of intergenerational transmission of mental ill health.

How are patients and service users involved?

Public and patient and stakeholder involvement and engagement (PPIE) has been central to this research:

• We have developed a diverse network of public and patient contributors through the ARC South London maternity and perinatal mental health theme. The network, co-ordinated by our PPIE lead, provide ongoing valuable input into the development and dissemination of this research.
• We have established a public and patient involvement and engagement group for women who have experienced perinatal trauma, loss, and bereavement. The group are directly informing our research into care pathways and access to psychological support.
• We engage with and partner with a wide group of voluntary organisations including Tommy’s Charity, Birth Companions, and the Maternal Mental Health Alliance.

Next steps for the research

The research team have secured further NIHR ARC funding to develop their research in perinatal mental health through the NIHR ARC national priority programme, including:

Find out more — key publications

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  Rising rates of perinatal suicide. De Backer, K., Wilson, C.A., Dolman, C., Vowles, Z. and Easter, A. BMJ Editorial, 2023.
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  Obstetric near misses among women with serious mental illness: Data linkage cohort study. Easter, A., Sandall, J., & Howard, L. The British Journal of Psychiatry, 219(3), 494-500, 2021.
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  Recognition and response to life-threatening situations among women with perinatal mental illness: a qualitative study. Easter A, Howard LM, Sandall J. BMJ Open 2019;9:e025872.
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  Mental health near miss indicators in maternity care: a missed opportunity? A commentary. Easter A, Howard LM, Sandall J. BJOG. 2018;125(6):649-651.
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  Changes in the identification and management of mental health and domestic abuse among pregnant women during the COVID-19 lockdown: regression discontinuity study. Hildersley R, Easter A, Bakolis I et al. BJPsych open. 2022 Jul;8(4).

Previous research which has underpinned and informed this research

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  ESMI-I Study: Perinatal mental health in pregnancy and the year after birth
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  Trevillion K, Shallcross R, Ryan E, et al. Protocol for a quasi-experimental study of the effectiveness and cost-effectiveness of mother and baby units compared with general psychiatric inpatient wards and crisis resolution team services (The ESMI study). BMJ open. 2019 Mar 1;9(3):e025906.
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  Howard LM, Ryan EG, Trevillion K et al. Accuracy of the Whooley questions and the Edinburgh Postnatal Depression Scale in identifying depression and other mental disorders in early pregnancy. Br J Psychiatry 2018;212:50–6.

Information needs of women with severe mental illness

Service user-led research, part funded by the NIHR ARC South London:

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  Dolman C, PhD: Women with Bipolar Disorder and Pregnancy: Factors influencing their Decision-Making regarding treatment, 2019.
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  Dolman C, Jones I, Howard LM: Pre-conception to parenting: a systematic review and meta-synthesis of the qualitative literature on motherhood for women with severe mental illness. Arch Womens Ment Health 2013, 16(3):173-196.
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  ESMI-II: The effectiveness and cost effectiveness of community perinatal mental health services.
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  Mason, C., Easter, A., Selby, V., Lever-Taylor, B., Fisher, L., Conroy, M. How to HOPE: Emerging Learning for Maternal Mental Health Services providing care for women facing separation from their baby at birth due to safeguarding concerns.

Original source: arc-sl.nihr.ac.uk — NIHR ARC South London legacy content archived May 2026.