Thank you for the opportunity to contribute to the Children, Young People and Education Committee's Inquiry into Perinatal Mental Health. I should be grateful if you would find below a response on behalf of Aneurin Bevan University Health Board (ABUHB) to the key questions highlighted in your consultation letter and Inquiry Terms of Reference.

1. Mothers with severe mental illness who require admission in the Aneurin Bevan University Health Board area are required to be admitted to specialist mother and baby units (MBUS) outside Wales. Over the last 12 months the Health Board has admitted three mothers to MBUs including units in London, Derby and Nottingham. All the three women admitted to these specialist units were initially admitted locally to an acute adult inpatient ward (which is considered to be inappropriate and not recommended by NICE) until a MBU bed was available. For two patients, the admission to the acute ward was less than a week, but for one of the patients her admission to the acute ward was for over two weeks due to difficulty in finding a MBU bed. It can be very challenging to find a bed as in our experience some of the MBUs have been unwilling to readily accept patients from Wales. In addition, it has been very difficult for the women to be separated from their families and wider support network and this can cause more stress and can increase the risk of prolonged illness. There are also significant financial costs for families due to regular travel etc, which can further add to the distress of the woman and her family.

2. ABUHB's Specialist Community Perinatal Team is working towards meeting the Royal College of Psychiatrists' Quality Standards for Community Perinatal Services. We have recently joined the Royal College of Psychiatrists' Quality Improvement Network for Perinatal Mental Health Services and our local service will be reviewed by the Network in December 2017. We will also have the opportunity to review other community perinatal services nationally to assist with development and shared learning. This will greatly help us to reflect on our service and improve the quality of our service.

3. Our Health Board service has been operational since October 2016. Therefore, in these initial stages it is developing clear links with other Health Board services including Primary Care and our Primary Care Mental Health Service. All women in the perinatal period have access to primary care mental health groups including those that focus on stress control and activating your life. We are also planning to develop specific perinatal mental health training programmes including mindfulness and Cognitive Behavioural Therapy for all primary care mental health teams in ABUHB. This will improve the access for mothers to timely assessment and treatment through Primary Care Mental Health Teams.

Our services are also supported through initiatives such as Flying Start, which is a Welsh Government funded programme and is available in some targeted areas to provide intensive support to 0-3 year olds and their families. They provide health support and advice, parenting groups and in some areas free part-time child care. In some areas (with no flying start support) there is availability of another programme called Families First, providing similar services, but the access to these services will depend on which area of the Health Board in which the family lives.

All women also have access to third sector organisations in Gwent including Hafal, MIND and CRUSE. They also have access to an online website 'Two in Mind' with access to courses including 'Enjoy your baby' and 'Enjoy your bump'. However access to specific perinatal third sector support/charity groups in Gwent is not well developed.

4. Providing antenatal education and preconception counselling is an integral part of our service. A consultant psychiatrist in our team provides preconception counselling for women with severe mental illness on medication, who are thinking of starting a family. We have delivered training for midwives and health visitors in perinatal mental health and are in the process of developing a rolling training programme for them. We have also delivered training for GPs across all our area and we are working on building networks and links with our Neighbourhood Care Networks (NCNs)/GP Cluster in each locality. We also work very closely with obstetricians and have delivered training sessions for consultant and trainee obstetricians. Currently, we are in the process of organising training sessions on maternal mortality, risk assessment and management in the perinatal period for Mental Health Home Treatment Teams across Gwent

5. Supporting mothers to bond and develop healthy attachment with their babies is one of our key areas of development. The practitioners in our team are currently undertaking specialist training on attachment and bonding including video interactive guidance called 'Watch, Wait and Wonder' and an infant observation course. The team has established links with child psychotherapists for advice, support and supervision on managing mothers with attachment/bonding difficulties.

All mothers have access to breastfeeding support through their community midwives. A specialist mental health midwife in our team also provides support and advice on breast feeding.

6. It is suggested that developing a speCialist mother and baby unit an MBU in Wales should be considered to manage acutely unwell mothers locally so they are not separated from their support network, as this is seen to be key to their recovery. Also access to services similar to Flying Start across all areas in Gwent would give equal opportunity to mothers, children and families to access intensive support for the first three years and is likely to improve their health and social care outcomes.

I hope the response to helpful to your inquiry. Should you require any additional information, please do not hesitate to contact me or Richard Bevan, Board Secretary via e-mail at Richard.bevan@wales.nhs.uk