Perinatal mental health services: needs assessment and recommendations

3. The needs assessment exercise

3.1 NHS board visits

Beginning in October 2017, the Network visited all NHS boards in Scotland to meet with professionals from mental health, maternity, health visiting, primary care and the third sector, and with women with lived experience and their families. All others with an interest in perinatal mental health were also welcome to attend. Each meeting had three broad aims:

• to assess the need for, availability and uptake of education and training in perinatal mental health
• to explore local pathways to assessment and care for women experiencing perinatal mental health problems
• to identify any specialist service provision, including links to regional inpatient specialist care

In general, requests to visit were met with enthusiasm and excellent attendance, and staff universally welcomed the opportunity to hear about each other’s services and to have shared learning.

All boards had made efforts to address perinatal mental health issues. Larger boards had developed specialist teams and smaller boards had identified staff within existing community mental health teams (CMHTs) who had a special interest in perinatal mental health. The island boards, with very low birth numbers, had identified the importance of joint working between mental health, maternity and primary care, and of additional education and training in perinatal mental health. In most instances, special interest posts had been developed by individuals with enthusiasm and drive, but these were rarely supported by matched resources. In almost all board areas services were vulnerable to loss of staff members critical to effective functioning, leading, in a number of instances, to discontinuities or suspension of specialist care.

3.2 Professionals’ workshops

Half-day workshops were conducted with individual specialist groups, including midwives, health visitors, perinatal mental health nurses, mother and baby unit staff, clinical psychologists from perinatal mental health specialist services and from maternity and neonatology services, perinatal mental health occupational therapists, social workers and the third sector.

3.3 Online survey

An online survey of women’s experiences of services for perinatal mental health was undertaken in collaboration with the Maternal Mental Health Scotland Change Agents, a group of women (and, in some instances, other family members) with lived experience who campaign for improved services. It provided evidence that women most value consistency of care during their antenatal and postnatal period, that they want to have information on which to make decisions about mental health treatments in the perinatal period and that they wish to feel comfortable about discussing emotional issues with professionals who have an understanding of mental health.

If it wasn’t for a self-referral to [the counselling] service in Glasgow I wouldn’t be here. I’m still recovering but I’m stronger because of 3rd sector support.

The … MBU was fantastic but getting access to it was hard. My life has completely changed for the better after using these services. It has saved my mental wellbeing and the happiness of myself and my family.

The biggest single factor in my becoming unwell in pregnancy was the GP insisting that I had to come off my antidepressants, not replacing it with a more suitable one, not consulting a psychiatrist.