Authors' objectives: Perinatal mental health disorders affect one in five mothers during pregnancy or within 2 years post childbirth. These disorders can lead to poor pregnancy and childbirth outcomes and maternal deaths. Additionally, they negatively affect a child’s cognitive, social and emotional development. Stigma and a lack of specialised services have limited access to mental health care. National Health Service England invested £365M in community perinatal mental health teams, but their impact on women and infants’ outcomes are not known. Develop a taxonomy of community perinatal mental health teams (work package 1). Compare and validate two assessments of quality of mother–infant interaction for use by community perinatal mental health teams (work package 2). Evaluate the effectiveness and cost-effectiveness of community perinatal mental health teams (work packages 3 and 4). Perinatal mental health (PMH) disorders (mental disorders occurring in pregnancy or 2 years after childbirth) are widely prevalent, affecting one in five mothers. Women with PMH have distressing symptoms and poor functioning that can affect their relationships with their families and infant. There is growing evidence that PMH disorders are associated with pregnancy complications, poor childbirth outcomes, maternal deaths in the first postnatal year and long-term negative effects on child cognitive, social and emotional development. Stigma, lack of specialist services and trained staff, and lack of clinically feasible assessments, particularly for the parent–infant relationship, have meant access to mental health care has been poor. In the ‘Five Year Forward’ and ‘Long Term Plans’, NHS England invested over £365M to improve access to community perinatal mental health teams (CPMHTs), but the effectiveness of these services on women and children’s health and well-being is not known. Develop a taxonomy of variations characterising CPMHTs [work package (WP) 1]. Compare and validate two observational assessments of quality of mother–infant interaction for use by CPMHTs (WP2). Evaluate the effectiveness and cost-effectiveness of CPMHTs (WPs 3 and 4). WP3: Which CPMHT components promote access to treatment and which components work, for whom, in what circumstances, how and why to reduce PMH problems? WP4: In women with pre-existing severe disorders are CPMHTs (compared with generic services) associated with: higher levels of access to secondary care mental health services (generic and CPMHTs)? lower risk of relapse? improved birth outcomes? greater cost-effectiveness?

Authors' results and conclusions: Objective 1: Community perinatal mental health team typologies revealed in 2020, 84% had basic staffing levels and 63% had more multi-professionals. Objective 2: The ‘Parent Infant Interaction Observation Scale’ and ‘National Institute of Child Health and Human Development’ assessments of mother–infant interaction were reliable and valid; the National Institute of Child Health and Human Development is more suitable for community perinatal mental health teams. Objective 3: Work package 3: Interviews with 139 women, 55 partners/close others and 80 health workers highlighted the importance of specialist perinatal knowledge, responding in a warm and non-judgemental way, working closely with other healthcare providers, optimising medication, supporting mothers to reduce conflict and improve social support, helping mother–infant bonding, and teaching emotional management. Work package 4: Analysis of linked health data revealed higher risks for obstetric and neonate problems in women with severe mental health disorders, particularly recent or very serious episodes. Work package 4: Areas with community perinatal mental health teams saw increased mental health access among perinatal women and reduced need for acute care, albeit at a higher cost and with greater neonatal risks. Community perinatal mental health teams can support perinatal women with complex, moderate/severe mental health disorders, but further attention to women’s physical needs is essential. The use of observational assessments of parent–infant relationships will enhance the evaluation of community perinatal mental health teams’ impact on infant outcomes. Work package 1/RQ1 In 2020, there were 55 CPMHTs. This represented coverage across 94.8% of mental health trusts in the country. Using staff configurations that captured variations in service provision relative to the programme theory, we created a hierarchical taxonomy consisting of a basic, foundational classification of services based on presence of a psychiatrist, nurse and psychologist (84% of CPMHTs), and a secondary, comprehensive level with greater service differentiation in line with key domains in the long-term plan (63% of CPMHTs). These included the basic classification as well as occupational therapists and nursery nurses. Between 7% and 9% of women had a history of serious and complex PMH problems and they were at increased risks for negative obstetric and neonatal outcomes. The availability of CPMHTs, relative to areas without CPMHTs, increased overall use of specialist mental healthcare services and reduced postnatal risk of acute relapse. This was associated with overall higher costs in areas with CPMHTs. Our results also suggest the risks of stillbirth/neonatal death and babies born small for gestational age may increase with a CPMHT. There was considerable variation in CPMHT configurations. Those with comprehensive provision provided greater access to a wider range of evidence-based care across mental health problems but many still lacked parent–infant and family treatment offers. CPMHTs were often not serving expected numbers from diverse communities. Feasible parent–infant assessments are available and may help to highlight need and ensure parent–infant dyads get appropriate care. We found both the PIIOS and NICHD-3 were valid and reliable assessments of the parent–infant relationship, but the NICHD-3 may have greater clinical utility due to its brevity to train (2 days vs. 3 days) and code (~15 minutes vs. 20–30 minutes), its predictive validity to attachment security and externalising problems, and application from 3 to 24 months of age.

Authors' methods: Mixed-methods study. Community perinatal mental health teams in England. Women who were pregnant or within 2 years postnatal. Work package 1: Typology of community perinatal mental health teams in England. Work package 2: Reliability and validity of two observational assessments of parent–infant interaction. Work package 3: Realist evaluation interviews with women, partners/close others, and staff to determine effective community perinatal mental health team components. Work package 4: Analysis of linked data: Association of community perinatal mental health teams with access to secondary care mental health services. Risk of acute relapse and improved obstetric and neonate outcomes for women with pre-existing severe disorders in areas with community perinatal mental health teams compared to generic services. Economic analysis of cost of community perinatal mental health teams. High levels of missing data on diagnosis and mental health outcomes in existing health and service data. Lack of data on child outcomes. Evaluation occurred during community perinatal mental health team changes and the coronavirus disease discovered in 2019 pandemic limiting a full assessment of the impact of community perinatal mental health teams on maternal and child outcomes. Work package 1/RQ1 To characterise service variations [research questions (RQ1)], we created a taxonomy classifying CPMHT elements. Using published data, expert and patient consensus, we created a programme theory on optimal service provision. A programme theory explains how, when and why a programme is expected to work. We used service-level data gathered from CPMHT annual reports to NHS England (2020), NHS Benchmarking (2015–8), Royal College of Psychiatry Perinatal Quality Network, and National Maternity and Perinatal Audit (2017 and 2019) to develop the taxonomy relative to the programme theory.

Project Status: Completed

URL for project: https://www.journalslibrary.nihr.ac.uk/programmes/hsdr/17/49/38

Year Published: 2025

URL for published report: https://www.journalslibrary.nihr.ac.uk/hsdr/RRAP0011

URL for additional information: English

English language abstract: An English language summary is available

Publication Type: Full HTA

Country: England, United Kingdom

DOI: 10.3310/RRAP0011

Organisation Name: NIHR Health Services and Delivery Research programme

Contact Address: NIHR Journals Library, National Institute for Health and Care Research, Evaluation, Trials and Studies Coordinating Centre, Alpha House, University of Southampton Science Park, Southampton SO16 7NS, UK

Contact Name: journals.library@nihr.ac.uk

Contact Email: journals.library@nihr.ac.uk