Perinatal mental health services: Where are we in Wales?

In January 2019, Cabinet Secretary for Health and Social Service, Vaughan Gething AM, met with the Children, Young People and Education Committee to discuss the progress of recommendations provided in the October 2017 report on perinatal mental health services.[1]

What is the perinatal period?

This extends from conception to the end of the first year of the baby’s life. This is a crucial time in a woman’s mental health and that of her baby. One in four women experience mental health difficulties during this period.[2]

Main issues identified in 2017:

  • Lack of a mother and baby psychiatric unit in Wales
  • Inconsistencies in the existing services
  • Lack of continuity in care
  • Need to de-stigmatise and normalise the mother’s experience

In a letter to the committee published in October 2018, Mr Gething outlined plans for each of the recommendations. This included a deadline for June 2019 to extend the ‘More Than Just Words’ initative to increase the presence of Welsh language options in the service.

Progress in relation to the recommendation for all Local Health Boards to have a specialist perinatal mental health midwife as five of the seven Health Boards in Wales have implemented this, while one has a specialist perinatal health visitor.

Mother and baby unit

A key focus of the meeting held in January was the fact that there is still no mother and baby psychiatric unit in Wales. Mr Gething explained that in South Wales one cause for the delay was difficulty in agreeing the location of the unit and how it is to be run. Initial interest in housing the unit has reduced to only the Abertawe Bro Morgannwg Health Board.

Meanwhile, in North Wales a lack of women who require a unit is a cause for the delay with ongoing conversations with NHS England to block book beds. Currently women in North Wales have to travel to Manchester or Birmingham to attend a unit with facilities to host them and their babies. NHS England is unwilling to create a unit closer to the border and the success in a similar scheme in England has resulted in a decrease in the number of women referred.

Committee members noted that the mother’s support network are included in the perinatal mental health initiative and removing the mother from her family and partner may be counterproductive.

Future requirements for Local Health Boards

The Assembly currently expects Health Boards to publish data concerning perinatal mental health. However this is not mandatory. This was questioned by the committee and Mr Gething explained that this was a period in the run up to mandatory publication.

Information that would be collected included time frames from referral, assessment and treatment, the experience of the mother and her improvement.

Practical take away

NHS England began a later but similar review which has been more successful. Mr Gething stated that NHS England itself is uncertain as to why its scheme has been more successful in a shorter period of time.

It could be suggested that the perinatal mental health services are another example of the differences between the devolved health care systems.

Footnotes
[1] http://www.assembly.wales/laid%20documents/cr-ld11234/cr-ld11234-e.pdf
[2] Maternal Mental Health Alliance, Anna France-Williams < https://maternalmentalhealthalliance.org/news/new-mums-face-gaps-in-vital-specialist-mental-health-services-in-wales/ > 12.06.18, accessed 23.01.19


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