Professor Heather O’Mahen from the University of Exeter previews her talk at the 2024 UK and Ireland Marcé Society Annual Conference in London on 25th January: Are perinatal community mental health teams effective? What’s the evidence?
Find out more about the International Marcé Society for Perinatal Mental Health https://marcesociety.com/regional-groups/uk-ireland-marce-society/
View the programme for the 2024 UK and Ireland Marcé Society Annual Conference https://www.kcl.ac.uk/ioppn/assets/ukims-flyer-jan-2024-v7.pdf
Get tickets for the UK and Ireland Marcé Society Annual Conference in London on 25th January: https://estore.kcl.ac.uk/conferences-and-events/academic-faculties/institute-of-psychiatry-psychology-neuroscience/health-service-and-population-research/ukims-conference-2024
Follow Heather O’Mahen on Twitter: https://twitter.com/@HeatherWillis18
I’m Heather Oman and I’m a professor of perinal and Clinical Psychology at the University of exitor clinical psychologist by background and also I work for NHS England as a National Specialty adviser to the paranal mental health Team this is a talk all about mental health in pregnancy and what we do and
How we help people in that situation and I guess we know that pregnancy is a potentially very challenging time for everyone involved but especially so for people with a history of mental health problems so what have you learned about that group of people in this work that you’ve done I think obviously you’re
Right Andre that this can be both a really exciting time and a really positive time for folks and one that they really anticipate but it’s a period of huge change um and so presents challenges um and if you are somebody who has maybe had mental health problems
Before um we learned in this research that there might be some specific challenges that are happening and some specific outcomes because of those challenges so I think there’s been a lot of research and a lot of clinical work around the more mental health challenges the wellbeing and the relationship
Challenges that can happen during pregnancy and postnatally um but there’s been a little bit less around some of the health challenges that can also occur um and that’s that’s interesting because we know from outside the perinatal period that there’s often an overlap between mental health problems and physical
Health problems as well so some of what we learned in this study was about how women who are pregnant but have had previous um mental health problems and particularly we looked at the last 10 years um before the they were pregnant um the extent to which those previous
Problems predicted whether they had risk for obstetric or negative or adverse neonate um challenges at Birth when you say obstetric and neonate what what does that mean so so there’s a variety of different ways of looking at that so from the neonate you can look at things
Like was the baby premature was the baby low in birth rate and then also we looked at kind of a conglomerate set of symptoms of a a range of different things that could potentially be less positive for baby at birth um so there’s that one as well um and then for
Obstetric challenges that it there’s a full gamut of things some of them are um can be quite unpleasant for those for those parents so it could be physical consequences of of birthing a baby um all the way up to having a c-section um so we’ve also got kind of a conglomerate
Um factor that we looked at there I suppose I should also say there’s there’s the worst kind of um challenge that could happen and that would be a still birth or um a neonate death um so we we did also look at that one as well unfortunately those are very rare um and
That’s something that’s really important to keep in mind when I discuss um these results what we did find um is that if we look at women who have a history of mental health problems and these are mental health problems as measured by whether they had accessed uh specialist
Mental Health Services in the past so these are people who have pretty serious and pretty complex mental health problems to have accessed those services in the past um and if they had access to those Services we found that they were at increased risk it’s not a given but
An increased risk risk of both negative obstetric and neonate outcomes um and that was qualified by the severity of those problems and the recency of those problems so the worst risk was for women who kind of were at the most serious levels of those problems so if they had perhaps accessed
Um crisis resolution teams or if they had been in hospital um or if those problems were occurring in the the year prior to them having the baby so the the risk was greatest there um so we think that’s really important um to recognize and to know about um that we should be
Asking women not just about their current mood but also their past history and how recent that history was and the level of care that they received and then we should be attending not just to their mental health needs but also to the health needs um that they might be
At increased risk of having And I suppose that’s not shocking findings is it it’s kind of quite intuitive findings in some ways that if you’ve had a history of mental health problems then you might have a higher risk of having difficulties around a pregnancy whether there are physical or mental health difficulties but I’m
Wondering about how it kind of plays into what we currently do in Services I suppose it’s not just maternity is it it’s around the kind of parental um support that we offer I don’t know my experience of becoming a father this was quite a while ago this was sort of 10
Years ago or something was that my partner was asked after she’d given birth about her mental health problems potentially you know how you feeling is Mom okay I wasn’t asked anything but that we neither of us were asked anything before or while she was pregnant about mental health history can
You kind of summarize for us this is hard this is a hard question but what do you think we currently do in services in terms of asking people about previous mental health experiences and then what do we do if we find out that somebody has them I I don’t know exactly how long
Ago it was that that you had children but I think things have moved forward a little bit in that um now in maternity it’s usually regular practice to ask parents about mental health problems um at least at the booking appointment but the guidance really is to ask multiple s
Throughout pregnancy and also postnatal and that’s really positive I think because it it helps parents get early and timely intervention and then of course we have had a massive expansion in perinatal Community Mental Health teams so those specialist teams that are there to particularly address the very specific and complex needs of perinal
Parents um so it’s great you know that the whole campaign was to turn the map Green and the map is green now there are perinal Community Mental Health Services across all of England um which is fantastic so for people that don’t know about that just give us a summary so
When did that happen and what are those teams what do they do so that started with the five-year forward plan so this has been in the last 10 years this has really been going on started with a 5-year forward plan to at least get those services in place and then with
The long-term plan in the last five years it’s really been about expand founding those services to make sure that it could reach a larger cohort of women and babies and birthing persons um and to offer a a broad range of services to them so it’s a multi-disciplinary team there’s um medication input from
Psychiatrists and specialist pharmacists there’s mental health nursing support and really importantly with that expansion there’s also psychological treatments there’s um parent infant treatments that are available um and there’s also occupational therapy often available amongst a host of provision um so it’s a really comprehensive and per needle specific um so these are services
That really get the needs of parents at a very vulnerable place and time and this Esme 2 project that we’re talking about today has looked at those teams how effective they are I mean what what’s your sort of overall big picture summary of the of those teams they’re really good
Value would be what I would have to say um so I think what’s really important to recognize is that even though the prevalence of mental health problems in the perinal period is similar um to outside the perinal period um the rate of individuals in the perinal period
That actually get help is compared to outside the perinal period is much smaller so in the perinal period we’re talking usually about 16 to 30 % of people with mental health problems will have accessed that care um that’s before we had these perinal teams outside the paranal period it’s usually about 50% of
Individuals so something’s not right in the paranal period And if you talk to parents they’ll say well I feel really vulnerable I feel really scared that people won’t understand what’s going on for me um I want to be the best parent that I can be for my child but what if
They take my baby away for example so they really want to know that there with somebody who gets it and can help them and be alongside them um and perinatal teams do that and we know from the Esme 2 study and looking at linked data nationally that they do improve the act
The use of mental health support in a timely fashion um and we know that they decrease um kind of they decrease more of the acute surfice level usage so people are using less kind of crisis resolution team/ hospitalization so more earlier treatment um which would be far more appropriate and the thing is
Paranal teams help TR treat parents but they also help the parent infant relationship and families get off on the right foot so there’s a huge preventative effect there that’s really good value for money um and I think that’s really Important so let’s fill down a bit then into what they do and how they do it and what works what’s the active ingredient of a community perinatal mental health team that’s the million million pound question I guess um there there’s there’s lots of things that that perinal
Teams do um some of the elements we did lots of interviews as well with um women um 130 women across the country and who had utilized different Services 55 of their family members so lots and lots of interview data um and from that data we really found out that a the the
Perinatal competence is really important so they get in there they know the types of problems that that parents are having they know the way that they’re um being pregnant and having a new baby affects mental health and how mental health can also likewise impact on the the relationship with the baby and how
Things are going with the baby it’s not inevitable but it can have an impact um and so they can get in there walk alongside those parents and say we know what this is about we know what things help um and they’re there with the right kind of tools that are specifically
Addressed to help parents during that time to deal with that um they can also really reassure there’s there’s things that aren’t just so specific so they can um they’ve got all the right skills but then they they can reassure parents in an accurate kind of way so what we heard
From a lot of parents was them saying I talked to other health professionals beforehand and they said oh no it’s fine everybody kind of gets anxious during this time or everybody kind of feels this way or feels that way and they’re like no I don’t think this is actually
The same experience as every other parent I think I’m actually really suffering um and so what they really found that the perinatal team was able to say is like nah this isn’t exactly the experience everybody else is having um but it is experience that a lot of
Parents do have we know what to do here about that um and if particularly if parents were having say problems with bonding with the baby and they felt really worried and scared about that they felt like the team could provide a really safe place to talk about those
Problems and get the support that they needed to help overcome those problems so I think that’s also a really important part of that kind of reassurance and appropriate skillful support um also what we heard from so many people paral teams I’m biased but they do a great job of being reliable
And consistent and this is something that isn’t always the case in every single Mental Health Service unfortunately they’re trying awfully hard but I think perinal teams do a really good job at that they understand how how many different Health Care Professionals are involved with people at that point and they’re there at that
As that Central kind of reliable consistent source of support that’s coordinating care for them across the past and when you’re overwhelmed as a parent that makes all the difference I think so that you can make the progress that you need it’s often a very lonely experience
Isn’t it if you’re a new parent and you’re struggling mentally and you’re struggling to bond with your child and I suppose there’s that cycle isn’t there of Shame and stigma and is kind of fed by this whole sort of perfect parenting Instagram rubbish and I wonder if
Services cuz you know these teams are new as you say they’ve only been built in the last kind of 10 years years or so I wonder what they can do to make sure they reach the parts that other services can’t reach are they reaching everybody
Do you think what what do they do to make sure that they reach the people who are really struggling yeah that’s such an important important point so in some ways I think they’re making good progress on that front they really know that and I think one of the really
Positive things that perinatal teams do is that they involve a lot of peer support within their provision um and I think that that makes critical difference um to so many parents um because you’ve got a they have inreach into a lot of communities and a lot of places where that doesn’t
Otherwise necessarily exist um and then they also have people that they know they kind of trust and it’s a bit of a segue into a system that you might be very unfamiliar with or we’ve also seen sometimes people have had negative experiences with other services in the
The past and so having a peer who said this has been really good and has really helped me um makes a huge difference to get folks in um and I think there’s still work to be done there’s a lot of folks that we know we still need to
Reach um and we’re not reaching as well as we could so part of what we’ve learned from Esme and other Studies have learned as well and we know in general don’t we is that we are not reaching as many ethnically diverse groups as we could be reaching we’re not reaching
Young parents as well as we could be um and I think there’s just a real priority and focus in teams right now to make sure that we’re connecting with the with people in the community and that we’re working in ways that work for communities rather than in ways that
Traditionally have worked for say mental health support services so I I think that’s a real area of growth for the Future and then if there are perinatal practitioners listening I’m wondering what your advice would be to them you know summarizing the findings of your study and I suppose I’m not just thinking people who work in these teams I’m thinking about people who work you know in primary care or people who work
In the education system or the social care system people who often come into contact with these parents who are struggling who haven’t yet been reached so I would say the first thing is listen really listen I think we hear too many stories of women who say I tried to get
Help and I was I felt like I was pawned off and I wasn’t listened to it takes a lot for a woman to talk about their problems um so if they’re talking to you about their problems there probably is a problem and it’s better I think to make
The reference or the referral onto the service and and let them do an assessment rather than to not do that to believe what they’re saying um and to listen to them so I I guess that would be a key thing I think in increasing and improving access to appropriate treatment
And then what about the message from the work for other people in the system what about policy makers what about people that are commissioning Services their findings that are relevant to them the NHS has committed funds to these services and with appropriate investment it makes a real difference parents
Babies get the care that they need with significant kind of efficiency around treating two people you’re treating two people really so this is a very cost-efficient um service that serves long-term benefits so I think it’s really important there’s always pressures in the system but to remember where there’s long-term cost savings as
Well and that people don’t get this care unless there is this specialist provision in place so really important to continue to invest in these services and recognizing their importance particularly as the NHS is restructuring again into kind of more of these integrated care boards and there’s new
Folks at the helm and So speaking to those folks and saying this has worked so well it’s really a model of care this is something to continue to invest in something that works and has good cost benefits in the long term do you think these teams are under threat I think
Perin needles uh The Little Engine That Could I think it’s a small service and because of that it’s a voice that could get lost but it’s it’s a voice that shouldn’t get lost it’s a really important small voice you’re talking at the UK international maré Society for me perinal mental
Health meeting uh which is in London on the 25th of January so yeah why should people get a ticket and come along and listen to you speak come along and here we’ve got more of the detail about why these services are working so well um and come and hear from the voices of
Women themselves um because we have their voices um but come and get the detail around the data so you can take it back and um make those arguments for yourselves and clinicians come because you can see how the hard work you’ve been putting in has been Working