About the NSPCC
We’re leading the fight against child abuse in the UK and Channel Islands. We help children who’ve been abused to rebuild their lives, we protect children at risk, and we find the best ways of preventing child abuse from ever happening. Learning about what works in the fight against abuse and neglect is central to what we do. We are committed to carrying out research and evaluation to make sure the approaches we’re taking are the right ones and we share what we have learnt with partners.
Abuse ruins childhood, but it can be prevented. That’s why we’re here. That’s what drives all our work, and that’s why – as long as there’s abuse – we will fight for every childhood.
About the National Centre for Mental Health
The National Centre for Mental Health (NCMH) brings together world-leading researchers from Cardiff, Swansea and Bangor Universities to learn more about the triggers and causes of mental health problems. We aim to help improve diagnosis, treatment and support for the millions of people affected by mental ill-health every year, as well as tackle the stigma faced by many. Key to achieving these aims is to engage with services and their users, the third sector and the wider public to increase understanding of mental illness, and by supporting and undertaking mental health research.
About Mind
We're Mind, the mental health charity for England and Wales. We believe no one should have to face a mental health problem alone. We provide advice and support to empower anyone experiencing a mental health problem. We campaign to improve services, raise awareness and promote understanding.
1. Introduction
1.1. This response is on behalf of three organisations; NSPCC Cymru/Wales, The National Centre for Mental Health and Mind Cymru. NSPCC Cymru/Wales, National Centre for Mental Health and Mind Cymru are working together on a research project which is investigating perinatal mental health service provision across statutory and voluntary sectors within Wales, which provide support to women experiencing a range of perinatal mental health difficulties. Together we are pleased to be given the opportunity to contribute to The National Assembly for Wales’ Children, Young People and Education Committee’s Inquiry into Perinatal Mental Health. With increasing social and political recognition and commitment towards tackling perinatal mental health across the UK, we feel that this inquiry in Wales is both timely and welcome. However, as the new Welsh Government investment for improving perinatal mental health care has only recently been allocated, and some health boards are at the beginning of their perinatal service development journey, we believe that perinatal mental health needs to be a long-term priority for the Committee. An inquiry at this time will provide a partial picture of perinatal mental health provision as it is evolving. We believe it is important to carry out a follow up inquiry once new services are more established which will provide a more complete picture of perinatal mental health care in Wales.
|
1.2 Key Recommendation:
· We strongly recommend that the committee carries out a follow up inquiry into perinatal mental health in Wales in early 2018.
|
2. Background
2.1. 2017 marks an important and timely year to put a spotlight on perinatal mental health in Wales, as we have seen significant investment in improving perinatal mental health care. In June 2015, the Health and Social Services Minister announced more than £8million (per year) of new Welsh Government investment in adult mental health services across Wales. As part of this, £1.5million (per year) was allocated to improve better outcomes for women, their babies and their families with or at risk of, perinatal mental health problems. This investment represents an important component of the Welsh Government’s early years approach. This £1.5million is being used to establish new specialist community perinatal mental health services in each of the seven health boards across Wales, and will include the appointment of thirty community-based specialist staff (doctors, nursing staff and other healthcare professionals) offering prenatal and postnatal treatment, care and support for women and their families experiencing perinatal illnesses (Welsh Government, 2016). The All Wales Perinatal Mental Health Steering Group (AWPMHSG) has been established with representation from key stakeholders, all seven Health Boards, commissioners, third sector and those with lived experience to oversee this process and monitor progress, share good practice, and to give people a voice. The Welsh Government has also demonstrated its commitment to tackling perinatal mental illness in Wales, through the introduction of a mental health strategy ‘Together for Mental Health’.
2.2. NSPCC Cymru Wales, The National Centre for Mental Health and Mind Cymru welcome these developments and the Welsh Government’s focus on improving maternal mental ill-health. However, we feel there is a need to understand more about the levels of perinatal mental health service provision, and women and their partner’s experiences of having a perinatal mental health condition identified and managed in Wales. NSPCC Cymru Wales, The National Centre for Mental Health and Mind Cymru have developed a one year research project which aims to address this gap in knowledge by investigating the provision of services for perinatal mental illness within Wales, which provide support to women experiencing a spectrum of perinatal mental health difficulties. What we find out from this project will help us to understand whether mums and their families are getting the support they need to live with and manage perinatal illnesses in Wales.
3. Research Project
3.1. Project Name
Investigating Perinatal Mental Health Services for Women and their Families in Wales
3.2. Project Overview
NSPCC Cymru/Wales, National Centre for Mental Health and Mind Cymru are working together on a project which is investigating the provision of services for perinatal mental illness across statutory and voluntary sectors within Wales, which provide support to women experiencing a spectrum of perinatal mental health difficulties (ranging from mild, moderate, severe). The project also seeks to explore what it is like for women and their partners in Wales to live with, and manage these types of illnesses. This is a multiphase project, which will run from March 2017 to March 2018. The sample for the project will be midwives and health visitors; mental health teams or perianal mental health teams; third sector organisations delivering perinatal mental health services in Wales; and women and their partners with lived experience of perinatal mental health difficulties in Wales. The project will be mixed methods in design and draw on qualitative and quantitative methods, including self-completion surveys and semi-structured interviews. What we find out from this project will help us to map out what services are available for women and their partners in Wales experiencing perinatal mental health problems. It will help us to understand whether mums and their partners are getting the support they need to live with and manage these types of illnesses. The findings will be written up into a report and disseminated at a launch event in March 2018 (TBC).
3.4 Project Aims
The central aim of this research is to investigate the provision of services available for women and their families experiencing a range of perinatal mental health difficulties across Wales. In doing so, this project plans to:
3. Illustrate examples of best practice in perinatal mental health services across Wales, and identify where enhancements are needed to better support women and their families experiencing perinatal mental health difficulties in Wales.
4. Explore the lived experiences of women and their partners who have had a perinatal mental health problem identified, managed and treated in a Welsh context.
3.5 Project Design
3.5.1 Method
In order to gain a more informed picture of the services available for women and their partners experiencing perinatal mental health problems in Wales, a qualitative and quantitative mixed methods research design is being implemented.
A survey method has been developed to capture health professionals and third sector organisations experience of identifying, responding to and managing perinatal health problems of women and their families in Wales. The surveys focus upon confidence and knowledge of perinatal mental health, identification, perinatal mental health services offered, referrals, training and education, partnership working, gaps in perinatal service provision and ideas for service development. *Please note that the surveys are currently in development and question topics many change over the coming weeks. Snap survey technology will be used to develop the online surveys and collate the data. Semi-structured interviews with mental health teams, specialist community perinatal mental health teams or third sector organisations may also be drawn upon to gather some more detailed information about the type of service being delivered and examples of best practice.
A survey method has been designed to explore women and their partners experiences of having a perinatal mental health condition identified, managed and treated in Wales. The survey focuses on mental health problems experienced, contact with health professionals, support services and interventions received, challenges to accessing services, gaps in service provisions and ideas on how to develop perinatal mental health services in Wales. *Please note that the surveys are currently in development and question topics many change over the coming weeks. Snap survey technology will be used to develop the online surveys and collate the data.
3.5.2 Sampling
The project will draw upon a non-probability sampling approach, and use a combination of purposive sampling, convenience sampling, and snowball sampling.
The participants in this project will be:
The criteria for participation for health professionals and third sector organisations will be that they are practicing within Wales or delivering perinatal mental health services within Wales. The criteria for participation for women and their partners will be based upon being over the age of 18 and having experienced a perinatal mental health problem while living in Wales. Extensive effort will be made to ensure that the project is inclusive and that the lived experience participants involved will have experienced the range and severity of perinatal mental health conditions (e.g. anxiety and depression, OCD, eating disorders, PTSD, psychosis). Extensive effort will also be made to ensure that the participants included in this project will be from across Wales, as it is important to represent the needs of women and their partners living in urban and rural areas.
3.5.3 Recruitment
The main recruitment method for this project will be through online advertising, key stakeholder networks, relevant blogs and newsletters. Research adverts will also be distributed at key perinatal conferences and events. We will also be drawing upon a snowball sampling technique, by asking existing participants to pass along the email survey invite, the research advert or link to the survey to anyone they think might be interested in taking part in the project.
3.5.4 Ethics
This project has been approved by the NSPCC Research Ethics Committee in April 2017.
3.5.5 Data Management, Reduction and Analysis
All qualitative and quantitative data will be collected and analysed by NSPCC Cymru/Wales. Early analysis will be shared with project partners, and the advisory group for feedback and suggestions. Where appropriate and feasible, the analysis will also be shared with some participants in the project.
3.5.6 Collaboration
A key strength of our project design is that we have developed it in collaboration with the perinatal community of practice in Wales. We have spent a great deal of time identifying and consulting with relevant perinatal mental health stakeholders in policy, research, practice, the third sector and those with lived experience. The All Wales Perinatal Mental Health Steering Group have agreed to officially endorse this project and act as the advisory group for project. This is a significant development, as the AWPMHSG has representation from all seven health boards in Wales, as well as third sector, academic members and those with lived experience who are all directly involved in developing and informing the development of perinatal services in Wales. The endorsement of this group and their expertise has been an invaluable asset in the development of this project.
3.6 Output and Dissemination
The final research document will be in the form of a partnership branded report. A summary will be developed which will be translated into welsh. Prior to publication, the final report will be reviewed, edited and signed off by all project partners. The report will also be reviewed by our advisory group and where possible the participants that took part in this research. The final draft report will be submitted for peer review via the NSPCC. It is anticipated that the report will be disseminated at a launch event for policy makers, commissioners, health practitioners, those with lived experience and the third sector interested in perinatal mental health, in March 2018 (TBC)
4. How the Project Supports the Committee’s Calls for Evidence
4.1 We feel that our collaborative project is very important to the Committee, as it has the potential to inform the Perinatal Mental Health Inquiry. Our research will specifically address the Committee’s call for evidence around:
The level of specialist community perinatal mental health provision that exists in each Health Board in Wales and whether services meet national standards
Our project aims to identify and map out what services are available across statutory and voluntary sectors in Wales for women and their families experiencing perinatal mental health difficulties across the spectrum of need (ranging from mild, moderate, severe), and gauge whether statutory services in Wales are meeting national standards and recommendations (i.e. NICE Guidelines and CCQI standards).
4.2
Our project will also explore several areas with has the potential to support the Committees call for evidence on:
The Welsh Government’s approach to perinatal mental health
Our project will be outlining relevant Welsh Government policy on mental health/perinatal mental health. This includes seeking to identify funding for perinatal mental health services which have been allocated to each health board in Wales, and how this money has been used to develop additional services.
The pattern of inpatient care for mothers with severe mental illness who require admission to hospital across both specialist mother and baby units (designated mother and baby units in England) and other inpatient settings in Wales.
Our project will seek to identify what happens to women in Wales with severe mental illness who require admission to hospital. This includes seeking data on how many women have been admitted to mother and baby units outside of Wales (2015/16) and the process for this. To do this we will be working with perinatal mental health teams in Wales, and with the ‘Tier Four Perinatal Mental Health Services Task and Finish Group’ (chaired by the Director of Nursing of WHSSC) of the ‘All Wales Perinatal Mental Health Steering Group’. We hope that the report that the Task and Finish group are preparing on a shortlist of Tier Four Models and recommendations (June 2017) will feed into our project findings.
Consideration of how well perinatal mental healthcare is integrated, covering antenatal education and preconception advice, training for health professionals, equitable and timely access to psychological help for mild to moderate depression and anxiety disorders, and access to third sector and bereavement support.
Our project will be asking health professionals and third sector organisations who are delivering perinatal services about any training they have received and any areas they would like more training on. We are also asking about any perinatal mental health training that teams are delivering to other health professionals. Our project will also address facilitators and barriers to working in partnership across sectors (e.g. statutory and third sector), and draw out examples of best practice. We will also be exploring the lived experiences of women with perinatal mental health problems, and will address preconception advice from health professionals; routine questions about mental health and emotional well-being, service referrals, and treatments and interventions received.
Whether services reflect the importance of supporting mothers to bond and develop healthy attachment with her baby during and after pregnancy, including breastfeeding support.
Our project will be exploring whether or not perinatal mental health services identified (statutory & third sector) address infant attachment. We will also be asking our participants about whether they have received any training on infant mental health and if they feel they have any training requirements.
4.3 We feel that our collaborative project is very important to the Committee, as it has the potential to inform the Perinatal Mental Health Inquiry. As our project has recently started, we do not have findings we can share with the Committee at this time. However, we would very much like this project to inform the work that the Committee is doing on perinatal mental health in Wales. We would welcome the opportunity to present our findings to the Committee when they are available in March 2018.
We feel that perinatal mental health needs to be a long term priority for the Committee. We also strongly recommend that the committee carries about a follow up inquiry into perinatal mental health in early 2018, as we feel this will allow for more time to gather an up-to-date picture of all of the perinatal mental health service developments happening in Wales. This will present an opportunity to work across sectors to identify gaps in perinatal provision and determine what changes are needed to ensure that women and their families are getting high quality expert care at the right time to help them manage their perinatal mental health conditions in Wales.
We would be pleased to discuss any of the areas we have outlined in our response in further detail if this would be helpful to the Committee.