Perinatal And Infant Mental Health Programme Board Delivery Plan: September 2021 – September 2022

Joanne Smith, Chair, Maternal Mental Health Scotland

We know that the pandemic has posed additional challenges for women’s perinatal mental health (PMH), especially for women from minority ethnic and socially disadvantaged groups, and placed additional strain on services and the staff who work in them. Services that were already stretched, and that are so important to new mothers, babies and families, have been further reduced.

So it is within this challenging context that we must evaluate the Perinatal and Infant Mental Health (PIMH) Delivery Plan 2021 – 2022.

The delivery plan shows some progress across many tiers of service delivery, with particular advances in participation and peer support. But it will not create the required culture shift towards prevention without sustained national investment to create the local partnerships required to embed integrated local systems.

Despite some progress, there remains a lack of local, specialist support meaning PMH problems are not being identified early, causing unnecessary suffering for women and their families.

Mental health care for expectant and new mothers remains fragmented and specialist support in the community for mothers and babies is still only available in some areas.

We welcome the Programme Board’s commitment to establish clear regional structures for the delivery of perinatal and infant mental health services.

We are slowly beginning to build the local infrastructure but there is still neither sufficient knowledge or expertise within primary or secondary care to ensure that every woman and her baby receive the best care in the perinatal period. Women with serious mental illness need specialised knowledge and skills on the part of the professionals who care for them and their babies.

While important investment has been made to expand acute inpatient care, to develop guidance to inform local planning and to bolster third sector support, in the short term, we have yet to see sufficient promotion and investment in developing the specialist skills required within psychiatry, psychology, nursing and social care to develop service provision to fully implement the SIGN guideline across the country.

Skills shortages in specialist nursing, psychiatry and psychology and the ongoing problem of recruiting outside of Scotland persist. Yet, without the appropriate skills mix and staffing levels, how do we ensure the recommendations in ‘Delivering Effective Services’ are realised locally?

Identifying and addressing perinatal and infant mental illnesses requires there to be a range of high-quality services in place in every area. Integrated Joint Boards are central to this work. A high-quality local offer requires joint working between mental health services, psychiatry, midwifery, primary care, children’s services, obstetrics, paediatrics, adult services and the voluntary sector.

The Government are currently consulting on the creation on a National Care Service which would potentially transform how we deliver health and social care to women and families in the perinatal period. It is within this context that the delivery plan must be tested. Where will perinatal services sit with a National Care Service and, critically, how will they be resources? We require more information from the Government before we can make an informed assessment about the likely implications of a National Care Service on women and families.

The recent appointment of a Perinatal and Infant Mental Health Development Adviser is an important advance and should assist in building the local relationships required to create high quality, joined up services and clear care pathways in each area. We look forward to working with the adviser, and in partnership with statutory and voluntary organisations, and experts by experience to develop local strategies with women and babies at the heart. 

We were pleased to see the commitment to revise the Mental Health Strategy for Scotland 2017-27 in this year’s Programme for Government.

This provides an important opportunity to better reflect the evidence on prevention by placing perinatal and infant mental at the heart of the national approach. 

The Scottish Government has also committed to £8 million pounds reoccurring funding for health boards beyond the life of the Programme Board, but will this address the chronic and historic lack of investment into specialist perinatal and infant mental health services in Scotland?

If the Government is serious about delivering on its commitment to develop consistent and high-quality specialist and community care, then it must place a higher priority on perinatal and infant health within the national health budget.

The level of investment must reflect the weight of evidence identifying spending on perinatal and infant mental health as the key to preventing poor mental health outcomes across the life course. 

The Scottish Government’s budget-setting and spending decisions following the pandemic must take account of women’s right to access these services. It is important to recognise that women and babies have been hit harder than others by the pandemic. Many of whom already experience significant barriers to accessing their rights. Important lessons must be learned.

The evaluation of all the Board’s work will be critical to establish what the enabling factors and barriers are for local areas.

We await publication of the Evaluation Implementation Framework and would be keen to be part of the ongoing evaluation work.

We need to understand what is working to better protect women and babies, then we need to upscale it. This will require sustained and significant investment in perinatal and infant mental health to turn the tide on rising rates of perinatal mental illness following lockdown.

We need to see a renewed commitment to perinatal and infant mental health from the Scottish Government that recognises the impact of the COVID pandemic on women and families. As this week’s MBRRACE report demonstrates once again, the cost of inaction is simply too high.

Joanne Smith, Chair, Maternal Mental Health Scotland

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