The effectiveness and implementation of maternal mental health services

Home › Research and implementation › Our research areas › Maternity and perinatal mental health

Adopted project
24 January 2022 — adopted January 2022 • completed September 2023

The effectiveness and implementation of maternal mental health services (ESMI–III)

The need for greater investment in perinatal mental health (PMH) care is well evidenced, both to ensure women receive adequate treatment and support and to provide short- and longer-term health benefits and cost savings to the NHS.

£22.6m
NHS transformation funding for MMHS service delivery in 2020–22

~30
Early Implementer and Fast Follower sites across all areas of England

There is now a national commitment to implementing Maternal Mental Health Services (MMHS), formally referred to as ‘Maternity Outreach Clinics’ in the NHS Long Term Plan. NHS England investment in the first phase (2020–22) covered Early Implementer and Fast Follower sites before commissioning transferred to Clinical Commissioning Groups (CCGs) in the national scale-up and sustainability phase (2022–24).

Project aim

To explore which MMHS model works, for whom, in what circumstances, how and why (i.e. what are the underlying mechanisms)?

About Maternal Mental Health Services

MMHS provide multidisciplinary integrated care and support to women experiencing moderate to complex mental health difficulties arising from trauma or loss related to childbirth. Conditions include:

Post-traumatic stress following childbirth
Tokophobia (fear of childbirth)
Miscarriage
Stillbirth
Neonatal death
Pregnancy termination
Loss of custody

The services provide trauma-focused and psychological interventions with a strong clinical and cost-effectiveness evidence-base. However, service delivery models vary across different areas, making evaluation of service configuration, delivery and implementation in Early Implementer and Fast Follower sites crucial to determine the most optimal models before national scale-up.

How the project will be carried out

The research team uses a realist evaluation approach — asking what works, for which people, in what circumstances and why. Seven research questions guide the work:

What is the variation in MMHS service delivery models in Early Implementer and Fast Follower sites across England?

What are the contexts, mechanisms and outcome configurations of MMHS in Early Implementer and Fast Follower sites?

Are MMHS effective in improving mental health for women who have experienced trauma or loss related to childbirth?

Are MMHS effective in improving psychological, knowledge, skills and confidence in maternity staff?

How successful was the implementation of MMHS in Early Implementer and Fast Follower sites?

What factors (challenges and solutions) affected the implementation in Early Implementer and Fast Follower sites?

Do MMHS provide equitable access to care and opportunities for addressing health inequalities?

How patients and service users are involved

The research team works with two established groups and a project-specific advisory group:

✓

ARC South London maternity and perinatal mental health PPIE network — a well-established diverse group of women and representatives from service user-led organisations with experience of maternity care and/or perinatal mental health difficulties

✓

Women’s Mental Health Parent Advisory Group (PAG) — women and partners with experience of mental health difficulties related to the perinatal period; meets quarterly to advise on all aspects of the research process

✓

Project-specific advisory group including representatives from voluntary organisations: Birth Trauma Association, Miscarriage Association, SANDs, the International Stillbirth Alliance, Tommy’s Baby Charity and Birth Companions — meeting six times throughout the project

Our collaborators

Professor Pauline Slade and Professor Helen Sharp, Department of Primary Care and Mental Health, University of Liverpool
Professor Heather O’Mahen, Department of Psychology, Mood Disorders Centre, University of Exeter
Laura Bridle, specialist perinatal mental health midwife, Guy’s and St Thomas’ NHS Foundation Trust
Dr Sarah Brand, University of Exeter Medical School
Zoe Mulliez, senior programme manager, NHS England and NHS Improvement

Potential benefits of the project

✓

Identify the most optimal MMHS delivery model and contexts that are barriers to implementation, to inform the national roll-out

✓

Improve the effectiveness of MMHS in identifying and treating women with mental health difficulties associated with loss and trauma related to childbirth

✓

Longer-term: improve psychological outcomes for women and families, with potential benefits for maternal and child health and wellbeing. Interventions which facilitate maternal mental health provide lifelong scope for reducing health inequity

📄

Read the Phase 1 interim report — ESMI-III: The Effectiveness and Implementation of Maternal Mental Health Services (September 2022)

This project (ESMI-III) was adopted by ARC South London Executive in January 2022. It is funded by the NIHR National Priorities Programme Children’s Health and Maternity and completed in September 2023.