ESMI-III: The Effectiveness and Implementation of Maternal Mental Health Services

Background

In recent years, significant investments have been made to improve perinatal mental health care in the UK. The most recent initiative to achieve this goal was laid out in the NHS Long-Term Plan, with the implementation of Maternal Mental Health Services (MMHS). In 2021, the MMHS will be implemented across 30 sites in all areas of England – referred to as ‘Early Implementer’ and ‘Fast Follower’ sites, before a national scale-up and sustainability phase in 2022-24.

The MMHS will provide multidisciplinary integrated care and support to women experiencing moderate to complex mental health difficulties arising from trauma or loss related to childbirth (e.g., post-traumatic stress following childbirth, tokophobia, miscarriage, stillbirth, neonatal death, pregnancy termination and loss of custody), whose needs are not currently met in other services.

The ESMI-III study will help identify the most optimal service delivery models and context-specific barriers to implementation across the pilot sites to inform the national roll-out.

Research Questions:

We will take a critical realist approach to understand which MMHS model works, for whom, in what circumstances, how and why (i.e., what are the underlying mechanisms?)
Specifically, the research aims to understand:

• the variation in MMHS service delivery models in Early Implementer and Fast Follower sites across England
• the factors (challenges and solutions) affecting the implementation of MMHS
• how effective MMHS are in improving mental health for women who have experienced trauma or loss related to childbirth
• the impact of MMHS on staff psychological, knowledge, skills, and confidence

Research Plan

The ESMI-III study will be conducted in two phases:

Phase 1: We will conduct an organisational mapping of MMHS service delivery models across England, and hold focus groups with Early Implementer and Fast Follower sites. This phase aims to understand the core components of MMHS service delivery models in different areas, and early lessons from setting up these new services.

Phase 2: In the second phase, we will conduct in-depth organisational case studies of 3-4 Early Implementer or Fast Follower sites using a realist approach. This phase aims to understand the experiences of staff and women, the barriers and facilitators to implementing MMHS, and how the services are working to improve outcomes for women.

Findings will be shared throughout the study to help facilitate learning across the sites, and inform further development, scale-up and sustainability of MMHS nationally.