Title: ESMI-II: The EffectivenesS and cost effectiveness of community perinatal Mental health servIces
Funder: Department of Health and Social Care

Abstract: Background: Perinatal mental health (PMH) problems are problems that occur when a woman is pregnant or the year after childbirth. They are a serious public health issue. They cause mothers suffering and can sometimes be associated with problems for the baby (e.g. premature birth) and affect her partner's wellbeing. Babies of mothers with PMH problems may also have later childhood and adulthood problems such as mental health problems. This might happen if the mother suffers stress when pregnant or if she has difficulties in her interactions with her baby. The NHS is investing £365 million to improve PMH care but we do not know which community PMH teams are best at helping women, their partners, and babies._x000D_ _x000D_ Research plan: We aim to produce high-quality evidence about which types of Community Perinatal Mental Health Teams are most effective in improving mother and infant outcomes, and in what circumstances. We will first need to assess the different types of PMH teams across England and find the best way to measure the quality of mother-infant interactions in routine care. We will use existing data to answer these questions. We will then assess which services are most helpful in improving PMH outcomes, under what conditions and for whom. _x000D_ _x000D_ We will invite 100 pregnant and postnatal women who are receiving services from a perinatal community mental health team, 100 partners/co-parents, and 50 health providers to take part in the study. Women will be invited from different areas in England, from up to 10 different services with different types of provision. For example, services may differ in:_x000D_ _x000D_ Specialists (e.g. specialist mental health midwife, perinatal psychiatrist, perinatal psychologist, perinatal nurse)_x000D_ Location (e.g. in maternity clinics, mental health clinics, home visiting) _x000D_ Treatments (e.g. counselling for planning a baby, treatments for the mother-infant relationship, psychological treatments)_x000D_ _x000D_ We will ask participants to complete interviews about their experiences of care. We will also gather data from services about how many people are referred to the service, the number of sessions attended, and what types of interventions individuals receive. We will also aim to interview up to 30 women who are from ethnically diverse and low-income backgrounds who suffered from perinatal mental health but did not receive services from CPMHS. In these interviews we will explore barriers that women might have had in gaining access to CPMHS for support. We will put this information together to evaluate which types of PMH teams help women and their families get access to evidence-based treatments during pregnancy or postnatally. We will assess which treatments and services benefit women and in what contexts. We will also use national NHS data to test whether women with a history of serious mental illness (e.g. bipolar disorder) are less likely to need inpatient care or crisis team input if they live in an area with a PMH team. The national NHS data will also be used to explore whether mental health care received before pregnancy varies by region and ethnicity, and if previous care makes a difference to mothers’ and babies’ outcomes. _x000D_ _x000D_ The team: We are experienced clinicians and researchers. We will work with advisory and oversight groups, including women with lived experience and their partners. These groups will make sure we carry out the research ethically and properly. _x000D_ _x000D_ Dissemination: We will publish our findings in research journals and present at conferences and stakeholder workshops. We will work with social media “influencers” and charities to tweet, blog and vlog, and we will make our research available on Twitter and Instagram using infographics and videos.

Lay abstract: Research Question: Which types of CPMHT are most effective in improving mother and infant outcomes, how, why and in what contexts?”_x000D_ _x000D_ Background: Perinatal mental health (PMH) disorders (mental disorders occurring in pregnancy or the year after childbirth) are a serious public health issue, associated with distressing symptoms and poor functioning, pregnancy complications, maternal deaths, and long-term negative effects on child cognitive, social and emotional development. These are thought to be mediated prenatally by the effects of cortisol on the developing fetus leading to alterations in infant stress reactivity, and postnatally through deficits in mother-infant interaction. Stigma, lack of specialist services and lack of trained staff have meant access to mental health care has been poor. NHS England recently invested £365 million to improve parent’s access to care and health outcomes._x000D_ _x000D_ Aim: We aim to produce high-quality evidence about which types of Community Perinatal Mental Health Teams are most effective in improving mother and infant outcomes, and in what circumstances._x000D_ _x000D_ Objectives: 1) To develop a taxonomy of variations in Community Perinatal Mental Health Teams (Work-Package (WP)1); 2) To develop and validate a measure to assess quality of mother-infant interaction for use by Community Perinatal Mental Health Teams (WP2); 3) To evaluate the effectiveness of Community Perinatal Mental Health Teams (WP3&4)._x000D_ _x000D_ Methods: In WP1 we will develop and use a taxonomy of Community Perinatal Mental Health Teams which captures how they vary in their configurations and the services they provide (e.g. co-location of teams in maternity units; home visiting; psychological and mother-infant interventions). (months 1-3) WP2 will provide a full psychometric assessment of interaction coding schemes using an existing cohort with child outcomes.(months 1-24). In WP3, using a realist evaluation approach, we will conduct qualitative interviews with up to 100 women, 100 co-parents, and 50 health and social care practitioners. We will also gather service level data on number of referrals, sessions attended and routine outcomes to understand which Community Perinatal Mental Health Team configuration works most effectively for whom, in what circumstances, why, how and to what extent (months 6-36). In addition, we will aim to interview up to 30 women from ethnically diverse and low-income backgrounds who suffered from moderate to severe PMH difficulties and who did not access CPMHS to explore the barriers that women encounter regarding access. In WP4 we will use linked national NHS data, in a before-and-after study, to examine how access to care changes over time as new Community Perinatal Mental Health Teams are developed, and test whether mothers with a history of serious mental illness (e.g. bipolar disorder) are less likely to need acute care if they live in an area with a Community Perinatal Mental Health Team (months 6-36). In addition, we will use linked data to explore how mental health care received immediately prior to pregnancy varies by region, ethnicity and socio-economic diversity, and whether previous care is associated with infant and maternal mental health outcomes. We will triangulate results to improve the robustness of our finding, synthesize findings for an implementation toolkit and disseminate widely. _x000D_ _x000D_ _x000D_ Dissemination: Stakeholder events, policy briefs, newsletters to trusts/charities, social media, academic conference presentations and publication.

Research activity codes: 8.1 ORGANISATION AND DELIVERY OF SERVICES
Health categories: MENTAL HEALTH;REPRODUCTIVE HEALTH AND CHILDBIRTH