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
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.
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.
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.
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 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 shares her experiences, as both a member of the public and as a professional within maternity services. Her experiences extend across nearly thee decades.
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.
As part of its commitment to improving Maternity and Neonatal Services, the NHS Long Term Plan outlined the introduction of the Maternity Outreach Clinics (subsequently renamed Maternal Mental Health Services) to: “integrate maternity, reproductive health and psychological therapy for women experiencing mental health difficulties directly arising from, or related to, the maternity experience”. The target is to have MMHS in every area of the country by 2023/24.
Who can access maternal mental health services?
The MMHS is intended to treat moderate to severe mental health difficulties presenting in four main pathways:
Maternal Mental Health Sites within London – there are four sites accepting referrals in London including The Maple Team based in North Central London, Maternity Trauma and Loss Care Service (M-TLC) in North West London, The Ocean service and the Tulip Service in North East London.
Please note that the sites in South East London and South West London are preparing to open services in 2023.
How to make a referral
Referrals can be made by any health or social care professional and self-referrals are being accepted by some sites. Not all pilot sites are offering all four pathways.
Partners are also able to be referred to an MMHS for assessment only, after which they will be signposted appropriately to other support services within their areas.
Each pilot site has its own referral form and criteria. Please see links and contact email addresses for each service.
Support across London
Below you’ll find a list of services available across London.
Maternity Trauma and Loss Care Service (M-LTC) for women and birthing people who live in North West London. Please view the following links for more information:
The Helix service is for women and birthing people who live in the boroughs of Lambeth, Southwark, Bexley, Bromley and Greenwich who are experiencing emotional distress, or mental health difficulties following a perinatal loss.
To make a referral to Lambeth or Southwark please access referral and leaflets here: Service Detail – South London and Maudsley (slam.nhs.uk) or contact the team directly here: Helixreferrals@slam.nhs.uk
To make a referral to Bexley, Bromley, and Greenwich please access referral and leaflets here: Our services | Oxleas NHS Foundation Trust or contact the team directly here: Oxl-tr.Helix@nhs.net
*The service will be opening in Lewisham and Croydon boroughs in 2023, please watch the SLAM Helix website for updates.
Regional Evaluation of The London Pilot of Maternal Mental Health Services
February 2023
In 2016, the independent Mental Health Taskforce published its Five Year Forward View (FYFV) on behalf of NHS England, which stipulated that women required access to specialist perinatal mental health services at the local level. NHS England recognised there was a gap in service provision for those requiring psychological intervention specifically related to their birthing experience.
In 2019, NHS England published its Long Term Plan, which set out the need to provide appropriate care to women and birthing parents who develop moderate to severe mental health difficulties due to certain maternity experiences (birth trauma, tokophobia, loss, and child removal due to safeguarding concerns) through the development of Maternal Mental Health Services (MMHS) as this had not previously been provided within existing services.
In 2020 MMHS came into being, to address the gap in provision between specialist services designed to address severe and complex maternity-related psychological difficulties on the one hand, and generalist services designed to address common mental health problems on the other.
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.
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 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.
The perinatal period is usually defined as the time between conceiving a baby and one to two years after giving birth. About one in every five women experience mental health problems during this time, making this a relatively common experience. Women may experience mental health problems prior to pregnancy and/or develop mental health problems during pregnancy or in the postnatal period.
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 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.
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.
Pre-conception advice
Every woman should think about her physical and mental health when planning a pregnancy, to support her health and the health of her future baby. This toolkit aims to provide practitioners supporting women with mental illness with information and resources to help answer the many questions that women and their partners have in relation to this very important decision, such as:
Do I have to stop taking my psychiatric medication while pregnant?
If so, will I be able to function without it?
If I keep taking the medication, what are the risks to my baby?
What is the chance of my mental health getting worse?
How might my condition and its treatment affect parenting?
What are the chances of my mental health affecting my child’s mental health?
Are there any risks associated with not treating my condition?
What mental health services are available for pregnant women in my area?
What kind of support is available after my baby is born?
Ensuring women and their partners are equipped with information and specialist advice when needed, will help them make the choice that is best for them and their family and to avoid rushed decisions that can result in tragic outcomes.
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.
A pre-birth planning meeting
To ensure that pregnant women who have a current or previous severe mental health problem and their families have the best possible care, support and outcomes, many different professionals need to contribute to their care during the perinatal period.
Having a pre-birth planning meeting facilitates this information sharing and the collaborative development of an individualised plan covering all aspects of the woman’s care during pregnancy, birth and the postnatal period.
Doing so helps ensure each woman can be confident that all these professionals have a shared understanding of her and her family during this crucial time, the reasons for any concerns or potential risks and also her strengths.
The toolkit includes guidance on:
Who to invite to the pre-birth planning meeting
What to discuss at the meeting
What to include in the Perinatal Mental Health Care Plan
The following resources are included:
Sample invitation letters for women and families
An information leaflet about pre-birth planning meetings for women and families
A template for recording the meeting and the Perinatal Mental Health Care Plan
