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Perinatal mental health schemes 'should run in every area'

Long-term cost of perinatal mental health problems about £8.1bn per year of births in UK

Louise Prime

Thursday, 14 May 2015

A perinatal mental health service commissioned by South Devon and Torbay Clinical Commissioning Group (CCG) has helped thousands of women in the area to access the support they need. In the wake of its success NHS England has called for similar services to be run in all areas, benefiting both patients and the NHS – in the UK, perinatal mental health problems carry an estimated total economic and social long-term cost to society of about £8.1bn for each one-year cohort of births.

The CCG was paying about £750,000 in 2011-12 for services for women who, because they had not been able to access locally commissioned perinatal care, ended up needing more serious interventions – including stays in intensive care, medium secure units, admissions to antenatal wards or mental health units – or more regular visits to the GP because of mental health problems during or after pregnancy.

To improve local services and avoid further such cost escalations, the CCG commissioned a new team, initially costing around £150,000 for four members of staff. One of the team’s initial challenges was getting upfront commissioning, because evidence of savings is often from reduced urgent care admissions or other areas – which can be harder to quantify. But in the first year the scheme had already dramatically reduced costs, as well as improving outcomes for women and their families.

The service is run by Devon Partnership NHS Trust at three acute hospitals – Torbay Hospital, Royal Devon and Exeter and North Devon District Hospital. The teams help women from the pregnancy planning stage through to postnatal support, and ensure they are monitored closely during pregnancy. All of the women who give birth in these hospitals are asked by midwives about their mental health, and those who report concerns or are at risk are referred to the team.

Consultant perinatal psychiatrist Dr Jo Black, who leads the scheme, said: “We’re picking up that one third of women are concerned about their mental health – this can be women who have never disclosed their problems before, people with pre-existing disorders or survivors of sexual abuse in childhood.

“We make it very easy for women to tell us what they are worried or concerned about. The women don’t have to go to a mental health unit to see us, they can see us at their antenatal clinic or at home after the birth and we provide them with information, treatment, reassurance and normalisation.

“It might be a woman who has been so ill she has needed an admission postnatally to a psychiatric ward in the past. We will plan with her, her midwife, her partner, GP and health visitor to create a plan to reduce the risks of this happening again.”

She suggested that similar schemes should be run in every area because of the clear benefits to the NHS, as well as dramatically improved outcomes for mum and baby.

Dr Geraldine Strathdee, NHS England’s director for mental health, agreed. She said: “It is fantastic to see such a successful example of integrated physical and mental health care, one of the Five Year Forward View priorities. This type of service is not seen in every area of the country but it could be replicated in other areas where more women, their partners and children could benefit.”

The perinatal team has also worked with families and a local film maker to make an internationally successful short film to break down stigma and support others.

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