Up to one in four women experience mental health difficulties during pregnancy or in the year after giving birth. For some women, existing services do not meet the specific needs associated with experiences such as birth trauma, pregnancy or baby loss, or severe fear of childbirth.
Maternal Mental Health Services (MMHS) were introduced to help fill this gap, providing specialist psychological support integrated into maternity care. But as new services were being established across England, there was an important question: what would make them work effectively in different places and for the women who needed them?
The ESMI-III study, led by a collaboration of NIHR Applied Research Collaborations including ARC South West, looked at how MMHS were being implemented across England. The research team mapped 18 Early Implementer and Fast Follower sites and held focus groups with 25 staff and service delivery managers from 12 sites. They identified considerable variation in how services were being delivered, including referral routes, staffing, the types of interventions offered and how closely services were integrated with maternity care.
The research identified practical challenges, including developing the right workforce, working across integrated care systems and managing demand. It also highlighted what could help services succeed, from strong leadership and clear communication to co-design with service users and better integration between maternity and mental health services.
Importantly, the research provided real-time learning while services were being developed. Findings from ESMI-III informed national implementation workshops led by NHS England and helped shape service delivery plans during the pilot phase of the maternity and perinatal mental health transformation programme. The team’s recommendations also provided practical guidance for services planning and developing MMHS. The research has contributed to recommendations supporting the national implementation and sustainability of Maternal Mental Health Services, helping local teams understand how services can be developed around the needs of their populations.
The wider ARC maternal mental health research programme has also informed national clinical guidance and NHS England policy. Research findings have been cited by the Royal College of Psychiatrists and NHS England, while research into preconception care has directly influenced care reaching around 8,000 women nationally each month.
The impact of ESMI-III is ultimately about helping women access the right psychological support at the right time. By identifying what helps or hinders implementation, the research is helping health and care services develop maternal mental health provision that is integrated, personalised and responsive to local needs.
Further research is now examining four MMHS sites in greater depth to identify optimal models and support national scale-up and sustainability. Together, this work is helping turn a national ambition for better maternal mental health care into services that can meet the needs of women and families across England.