6. Summary of recommendations
RECOMMENDATION 1. The Scottish Government and NHS boards should ensurethat MBUs are staffed at the recommended level to provide a comprehensive clinical service.
RECOMMENDATION 2. Specialist perinatal mental health services (MBUs andcommunity teams) should include peer support workers as part of their provision. The Scottish Government should work with NHS boards and third sector funders to review models of peer support to specialist services and develop an evidence and evaluation base. Implementation of this work and longer-term roll-out should be included in a national delivery plan as soon as practicable.
RECOMMENDATION 3. An additional two to four MBU beds should be provided onone or other existing MBU site, divided between both, or in a third MBU located in the north of Scotland. To be viable, a third MBU should have a minimum of four beds. The Scottish Government and NHS boards should conduct an option appraisal to meet this additional need as part of a national implementation plan.
RECOMMENDATION 4. All NHS boards should have equity of access to a regionalMBU for those women who require inpatient care. The Scottish Government should ensure that MBU beds are provided as a national resource and decisions on admission made exclusively on clinical need.
RECOMMENDATION 5. NHS boards should ensure provision for accommodatingpartners or other family members near to each MBU where they have to travel long distances.
RECOMMENDATION 6. All NHS boards should have community specialist perinatalmental health provision. The specific model will be dependent on birth numbers, socio-demographic and geographical needs and, for smaller boards, may be provided in part by boards collaborating together through regional structures. Sessional time for some highly specialised staff may also be provided through regional collaboration. The Scottish Government should ensure that implementation of this work and longer-term roll-out is included in a national delivery plan as soon as practicable.
RECOMMENDATION 7. All NHS boards with birth numbers over 5,000/year shouldhave a multidisciplinary community perinatal mental health team which has the skills and capacity to assess and care for pregnant and postnatal women (to 12 months) who require secondary care mental health services.
RECOMMENDATION 8. All NHS boards with birth numbers under 5,000/year shouldhave either a stand-alone or dispersed multidisciplinary community perinatal mental health team which has the skills and capacity to assess and care for, at a minimum, pregnant and postnatal women (to 12 months) who have more complex or high-risk presentations.
RECOMMENDATION 9. NHS Boards with very low birth numbers should collaboratethrough regional structures with neighbouring boards to ensure sessional time from core specialist staff to provide advice and supervision for staff in adult community mental health teams. This may be provided via telemedicine link.
RECOMMENDATION 10. NHS boards should ensure that perinatal mental healthservices identify a parent-infant mental health lead who will co-ordinate evidence-based interventions and provide clinical expertise to the specialist team. This resource may be provided on a regional basis.
RECOMMENDATION 11. NHS boards should ensure that, where they are provided,specialist perinatal mental health midwives have a clear job description outlining their roles, competencies and arrangements for clinical supervision from maternity and mental health and should have explicit links with the specialist perinatal mental health team and with maternity and neonatal psychological interventions services.
RECOMMENDATION 12. The Scottish Government should work with NHS boards toreview models for multidisciplinary psychological interventions provision to maternity and neonatal services, beginning in larger maternity units. These should be led by clinical psychology, with additional staffing from psychological therapists or midwives with additional psychological training. Implementation of this work and longer-term roll-out should be included in a national delivery plan as soon as practicable.
RECOMMENDATION 13. NHS boards should ensure that maternity hospitals withfewer than 3,000 deliveries per year have access to psychological therapies in local primary care psychological therapies services, adult mental health psychological services or perinatal mental health clinical psychology. Services should have sufficient psychological therapist provision to meet this need.
RECOMMENDATION 14. The Scottish Government should ensure that self-help anddigital resources are adapted to meet the distinctive needs of pregnant and postnatal women, and their families.
RECOMMENDATION 15. At the next revision of Mental Health Quality Indicators,the Scottish Government should introduce a Quality Indicator to measure how many women are seen for primary care psychological interventions in pregnancy, and the first postnatal year, within 6 weeks of referral. Systems should be put in place to record this at national level and the data used to drive service improvements. This should be included in a national improvement and delivery plan as soon as practicable.
RECOMMENDATION 16. The Scottish Government and NHS boards should developadditional workforce capacity to deliver timely psychological interventions for mild to moderate perinatal mental health disorders in women and men. This should be developed incrementally, with evaluation of local need conducted in parallel.
RECOMMENDATION 17. NHS boards should ensure that all parents, and parents tobe, are made aware of third sector counselling and support services which exist in their area and how to access them, including individual and couple counselling and support for the parent-infant relationship.
RECOMMENDATION 18. The third sector should be included in regional networks,with a specific remit to advise on the provision of counselling services and peer support worker development.
RECOMMENDATION 19. The Scottish Government should work with NHS boardsand third sector funders to review peer support models and develop an evidence and evaluation base. Implementation of this work and longer-term roll-out should be included in a national delivery plan as soon as practicable.
RECOMMENDATION 20. NHS Boards, Integrated Joint Boards, Local Authorities andother relevant organisations should ensure that all staff working with women during pregnancy and the postnatal period have the knowledge, skills and attitudes to ensure they deliver appropriate care. Staff should meet the requirements of the Curricular Framework for Perinatal Mental Health and undergo induction and regular updated training where appropriate.
RECOMMENDATION 21. The Scottish Government should work with NHS Educationfor Scotland and the Perinatal Mental Health Network to develop a suite of educational tools matched to the Curricular Framework competencies, and an induction programme for all staff new to specialist services. Implementation and roll-out of education and training should be included in a national delivery plan as soon as practicable.
RECOMMENDATION 22. The Scottish Government should ensure that educationand training is underpinned by a one-stop digital resource providing a hub for online training for professionals, and perinatal and infant mental health information for professionals, women and their families. This resource should be included in a national delivery plan as soon as practicable.
RECOMMENDATION 23. Each NHS board should establish a multi-professional groupto co-ordinate and lead service development and ongoing monitoring and evaluation. Perinatal mental health regional networks should be established in the north, east and west of Scotland, under existing regional planning structures and governance. The Scottish Government and NHS boards should ensure that perinatal mental health service development is included in regional delivery plans.
RECOMMENDATION 24. The Scottish Government and NHS boards should developa workforce plan to ensure that there are sufficient numbers of appropriately trained staff to support service development. Implementation of this work and longer-term roll-out should be included in a national delivery plan as soon as practicable.
RECOMMENDATION 25. NHS boards should ensure that there are clear carepathways for pregnant and postnatal women with mental distress or disorder to ensure ease of access to care and seamless provision between services. Information should be easily accessible to women and their families.
RECOMMENDATION 26. NHS boards should ensure that MBUs, and communityspecialist perinatal mental health teams providing care for delivered populations greater than 5,000 births/year, are members of the Royal College of Psychiatrists’ Perinatal Quality Accreditation Network.
RECOMMENDATION 27. NHS boards should ensure that all services contribute to acore perinatal mental health data set, identified by the Network, which is collected nationally, and should measure agreed quality indicators for clinical care.
RECOMMENDATION 28. The Scottish Government and the Perinatal Mental HealthNetwork should conduct a review of services and assessment of need for pregnant and postnatal women with substance misuse.
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