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Outcome Measures (DIALOG and DIALOG+)
Measuring outcomes provide a way for patients, clinicians and the health and care systems to understand the impact of the care provided. Outcome measures can be used to identify patient needs and understand the effectiveness of any care or treatment. They can also be used to measure health outcomes for a local population through ‘system process’ outcome measures.
In London, we are supporting the implementation of DIALOG as the London patient reported outcome measure (PROM) which is an assessment of health status and health-related quality of life that comes directly from the patient.
What is DIALOG?
DIALOG is a set of 11 questions where service users are asked to rate their satisfaction and needs for care across different parts of their life and treatment. It helps to guide a structured conversation between a health professional and service user that is patient centred with a focus on change.
Why does DIALOG exist?
DIALOG is simple to use and it enables proactive, personalised conversations at an individual level, supporting self-management and helping service users move forward with their journey of recovery. It has also been used to help inform the redesign of care planning processes within mental health services.
Capturing this information also gives a powerful indicator of patient satisfaction levels where health and social care services need to focus for improvement.
Outcome Measures (DIALOG and DIALOG+)
Service users are asked by health professionals to complete this survey using pen and paper, or on a computer, iPAD or phone.
Who is DIALOG for?
This survey was initially rolled out for people within early intervention services and for those receiving a Care Programme Approach (CPA) package of care. The use of DIALOG can be extended to other mental health services including adolescents, older adults and primary care.
How often should DIALOG be used?
As a minimum, it is recommended that DIALOG is completed at the start of an episode of treatment, at review and at the end of an episode.
What is DIALOG+?
DIALOG is the tool and DIALOG+ is a specific intervention that uses the DIALOG scale and a 4- step approach based on solution-focused therapy.
DIALOG+ helps the person and the clinician to structure a conversation to explore their needs and wishes, support their care plan and help service users to actively problem-solve to support their recovery.
Resources
The following resources have been developed to support the use and development of DIALOG as a patient relation outcome measure (PROM) and care planning tool for London. Please click on each tab for the resources.
New Models of Community Mental Health programme
What is the New Models of Community Mental Health programme?
The New Models of Community Mental Health (MH) Programme is a London-wide programme that supports all of London’s Integrated Care Systems (ICSs) to change the way that mental health services are delivered in the community so that it is more joined-up, uses whole-population approaches and supports care that is more personalised to a person’s mental health needs.
The programme has an overarching aim to support London ICSs to develop ‘robust models of community MH transformation’
Policy and background context
This programme of work has come from the Community MH Framework for Adults and Older Adults that was developed by NHS England that aims to support people with serious mental illness or complex MH conditions in the community. London Integrated Care Systems (ICSs) are committed to transforming the way community MH services are delivered to ensure that people with complex MH needs are supported well in the community.
To find out more read the NHS Long Term Plan
Overview of governance structures
The London MH Transformation Board agreed to establish this programme in July 2020. This Board has oversight and accountability for the delivery of this work.
Programme workstreams
There are a number of workstreams based on key themes. Click on the tabs below to find out more information about our work.
FAQs, Resources and Stories
On this page, you’ll find more information about perinatal mental health services in London, with answers to key questions about the service.
Frequently asked questions
A wide range of mental health conditions can occur during this time, most commonly depression and anxiety. There are some conditions specific to this time in a woman’s life such as tokophobia – a severe fear of childbirth, and post-partum psychosis – a severe but treatable illness that occurs after having a baby.
It is not always possible to predict whether or not a woman is likely to experience perinatal mental health problems. However, some groups of women are at much higher risk, for example, 1 in 4 women with bipolar affective disorder experience post-partum psychosis.
It is vital that women receive treatment and support as early as possible. If left untreated, mental illness can have a significant and long-lasting impact on women and their families.
Getting appropriate treatment and support for perinatal mental health problems can help prevent avoidable suffering and isolation, strengthen families, ensure children have a healthy start and help prevent suicide – which is a leading cause of maternal death in the UK.
Here you will find a wide range of information and resources on perinatal mental health support available across London.
This toolkit offers best practice guidance about identifying and treating tokophobia. It draws on the current evidence and recommendations of a group of experts in the field.
We would like to thank all the many people who have contributed to this toolkit in order that it can reflect the voices of women with lived experience and the realities of working in Maternity and Mental Health Services. In particular, Rebecca Webb and Susan Ayers at City, University of London, conducted systematic reviews of the literature.
Across London there are a variety of practitioners from different backgrounds, services and organisations who have been trained as Perinatal Mental Health Champions. Their role is to increase awareness and knowledge of perinatal mental health by cascading the training onwards to local colleagues, helping to improve engagement and access to services for those affected by, or at risk of perinatal mental illness; and promoting local integrated perinatal mental health care pathways. The training programme is designed to:
- Increase competence and confidence in perinatal mental health practice
- Develop place-based leadership for perinatal mental health across complex systems of care
- Raise awareness of the importance of perinatal mental health across the workforce
Resources
This regional evaluation was undertaken by the McPin Foundation and was commissioned and supported by the London Regional Perinatal Mental Health Programme. Mcpin is a research charity specialising in mental health research using peer research methodology.
The evaluation focuses on the personal experiences of staff working in the London pilot MMHSs and the women and birthing parents using these services. It draws on in-depth, semi-structured interview data – collected between February and May 2021 – in order to answer key questions around the needs of staff and women/birthing parents, the extent to which those needs are being met, and the lessons that can be learned from their experiences.
Read the full MMHS Evaluation Report here
This toolkit provides guidance for health care professionals involved in planning the care of women at high risk of severe postnatal illness.
A pre-birth planning meeting is key to ensuring everyone has a clear understanding of the care the woman will receive in the weeks surrounding the birth of her baby, so everyone knows what to do and whom to contact if there are concerns.
Download the pre-birth planning toolkit
This toolkit is designed to offer advice to doctors and informs the multi-disciplinary team of best practice in providing preconception/family planning advice to women with a mental illness.
The document contains both information and resources and also recommendations that shift the clinical approach towards a collaborative model of care, using a strengths-based formulation.
This document is to provide guidance for health care professionals involved in the care of babies born to women who have taken medication for mental disorders (psychotropic medication) during pregnancy.
Its aim is to optimise and standardise the care of exposed babies and to provide guidance to health professionals (in particular neonatologists, paediatricians and midwives) on the appropriate assessment and management of the risks and needs of the newborn baby.
Any psychotropic medication that has been taken by the mother during her pregnancy and / or delivery should be documented in the baby’s notes. Babies who have been exposed to such medication should undergo a relevant assessment as set out in this document. This assessment will take place in the hospital, birthing unit or home (if home birth). Information on this process should be given to mothers during their pregnancy and at the time of the post-birth assessment, so they can feel confident about their baby’s wellbeing.
Stories
Chelsea’s story
Chelsea is mother of two young girls, a military wife, worked as Midwife for three years and now works as a Lived Experience Practitioner at Transformation Partners in Health and Care.
Shavarnah’s story
Shavarnah wanted to share her truths, the struggles she faced with her mental health as a young mum and how she created MumStyleLDN, which was her first step to healing.
Lynette’s story
Lynette shares her experiences, as both a member of the public and as a professional within maternity services. Her experiences extend across nearly thee decades.
Talking Therapies (perinatal mental health)
Having a baby can be joyful, exciting, and rewarding. However, it is also common for pregnant women/birthing people and new mothers or fathers/partners to experience anxiety, depression, or emotional distress.
As many as one in five women/birthing people experience emotional difficulties during pregnancy and in the first year after their baby’s birth. This can happen to anyone.
Every London borough has a Talking Therapies service which offers free, confidential talking therapy for people who have symptoms of anxiety or depression. They give priority to pregnant women/birthing people and fathers/partners.
Support across London
Below you’ll find a list of services available across London.
Mother and baby units in London
Mother and baby units (MBUs) provide specialist care and treatment when a mother is suffering from a mental illness and needs an admission to hospital.
These services allow for the mother and her baby to remain together, supporting their attachment and bonding, while the mother receives the care and treatment she needs to recover from mental illness.
Contact details for London Mother and Baby Units
A range of family focussed interventions are on offer, with staff including psychiatrists, nurses, psychologists, nursery nurses and occupational therapists. Women can be admitted from 30 weeks of pregnancy until the end of the first postnatal year.
There are three Mother and Baby Units that cater to the needs of all women and birthing people across London, regardless of where they live.
Community perinatal mental health teams
Community perinatal mental health teams support mothers who are experiencing moderate to severe mental health problems in the perinatal period to recover in the community. They also offer pre-conception advice to women with existing mental health problems who are planning a pregnancy.
They are staffed by a range of professionals and offer family-focused interventions, and work closely with maternity services, health visitors, IAPT, GPs, other community services and third sector organisations.
Support across London
Below you’ll find a list of services available across London.
Guidance for newborn assessment
This document is to provide guidance for health care professionals involved in the care of babies born to women who have taken medication for mental disorders (psychotropic medication) during pregnancy.
Its aim is to optimise and standardise the care of exposed babies and to provide guidance to health professionals (in particular neonatologists, paediatricians and midwives) on the appropriate assessment and management of the risks and needs of the newborn baby.
Any psychotropic medication that has been taken by the mother during her pregnancy and / or delivery should be documented in the baby’s notes. Babies who have been exposed to such medication should undergo a relevant assessment as set out in this document. This assessment will take place in the hospital, birthing unit or home (if home birth). Information on this process should be given to mothers during their pregnancy and at the time of the post-birth assessment, so they can feel confident about their baby’s wellbeing.
Perinatal mental health peer support in London
Perinatal peer support is an active intervention where people use their own experiences to work directly with women/birthing people and their families. Perinatal peer supporters or peer support workers have experienced some form of perinatal mental ill-health and recovery which they draw upon to offer a safe space, a listening ear and support to others going through similar experiences. Accessing peer support during the perinatal period has been shown to have a positive impact on women’s overall health and wellbeing.
There are several peer support options in London provided by both the third sector and the NHS. NHS services such as Community Perinatal and Maternal Mental Health Services provide this support to women with moderate to severe mental ill-health. Women and birthing people can access mental health and emotional wellbeing support flexibly through the third sector.
To help support women and professionals to understand and access peer support, TPHC and London’s third sector organisation have developed a directory of organisations that offer perinatal peer support across London.
Third sector organisations working with specific groups
Certain organisations from those already listed above provide support to women with special circumstances:
- Support in multiple languages – Manor gardens (NCL), Parents in Mind (NEL), Newham Nurture Programme (NEL), Maternity mates (NEL), The Ectopic pregnancy trust (Citywide)
- Support for women from Black and ethnic minority backgrounds – The motherhood group (SEL), Prosperity’s birth companion (SEL)
- Support for women in prison – Birth companion (Citywide)
- Support for women living with HIV – 4M Network (Citywide)
- Young mothers – YoungMumsAid (SEL)
- Women in high deprivation – Newham Nurture Programme (NEL)
Listening to experiences and voices
To ensure women and birthing people on the maternity pathway have their voice heard, a team of women and their families, commissioners and providers work together through Maternity Voice Partnerships (MVP) to review and inform the development of local maternity care. To contribute to developing your local maternity care services, click here to find your local MVP and their contact details.
Support across London
Below you’ll find a list of services available across London.