The Hull and East Yorkshire Perinatal Mental Health Liaison Service is a multidisciplinary service which aims to help the women of Hull and East Yorkshire who experience mental health problems in the antenatal, labour and post-natal period. Figures from the Perinatal Mental Health Benchmarking Toolkit, highlight that 22% of women in the Hull and East Riding region with a severe to very severe perinatal mental health problem did not attend appointments with the Perinatal Mental Health Team during 2014/2015. In Hull alone this figure is 29.6%.
Co-Production
From start: No
During process: Yes
In evaluation: No
Evaluation
Peer: No
Academic: Yes
PP Collaborative: Yes
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Claire Marshall - Senior Nurse Humber NHS Foundation Trust: Hull and East Yorkshire Perinatal Mental Health Liaison Service
The Hull and East Yorkshire Perinatal Mental Health Liaison Service is a multidisciplinary service which aims to help the women of Hull and East Yorkshire who experience mental health problems in the antenatal, labour and post-natal period. Figures from the Perinatal Mental Health Benchmarking Toolkit, highlight that 22% of women in the Hull and East Riding region with a severe to very severe perinatal mental health problem did not attend appointments with the Perinatal Mental Health Team during 2014/2015. In Hull alone this figure is 29.6%.
The reasons for non-attendance in perinatal mental health care are complex and multifaceted, and may include reasons relating to the referral process, domestic, work related and geographical issues, and concerns relating to attitude and stigma surrounding the mental health of mothers. There are likely to be issues in correct identification and screening of women by universal services including accurate signposting to the appropriate service. Working collaboratively with researchers from the University of Hull we undertook a study which explored and interrogated existing data of women who attended and did not attend appointments with the service, with the aim of developing an understanding of some of the characteristics of women with perinatal mental health problems who fail to attend consultations following referral to the service.
Wider Active Support
We have existing strong links with our academic partners at the University, in particular Professor Julie Jomeen, Chair of the Maternal Mental Health Advisory Group within the School of Health and Social Work. We have a history of collaborative working with a team of University based researchers which extends across 10 years. We have worked in partnership to facilitate the development and successful delivery of a number of high quality funded projects relating to clinical practice and service development. Collaboratively we have a local, regional, national and international reputation for research and strategy work in perinatal mental health.
Co-Production
The work which we undertook to interrogate existing data of women who attended and did not attend appointments with the service was developed through from the inception to design stage with the support of the Maternal Mental Health Advisory Group (MMHAG) which is based at the University of Hull. The MMHAG is a multidisciplinary group, which supports and advises the Hull and East Yorkshire Perinatal Mental Health Liaison Service. The MMHAG is chaired by Professor Julie Jomeen and includes representation from the local Maternity Services Forum (lay member and service users), and Community based peer support groups (with user and service provider representatives), The IAPT service, Health Visiting, Midwifery Services and Mental Health services. The group were consulted on the utility of the project idea and identified the study as a priority area for research and service development.
Looking Back/Challenges Faced
The interrogation of the existing data of women who attended and did not attend appointments with the service has given us some indication of the profile of women who are most likely to fail to attend, however this has only provided one part of the non-attendance picture. The challenge is understanding non-attendance to improve the figures. In an attempt to understand the patterns, the reasons and the possible solutions, we intend to use the findings from this work to inform a larger study to explore the experiences of women with perinatal mental health problems in accessing and engaging with services in Hull and East Riding. We are in the process of developing this further work at present.
Sustainability
The findings from the interrogation of the existing data of women who attended and did not attend appointments with the service have resulted in the development of a number of strategies to improve attendance. These strategies have become embedded into the appointment making/referral and follow up processes of the perinatal mental health liaison team, and therefore in the event of a key person leaving the team the strategies are so embedded they will remain part of everyday practice.
1. Education and training will be an on-going component of the Perinatal Mental Health Liaison Team’s Role. In collaboration with the University of Hull, a 2 day Conference was delivered to delegates from across the county in March 2017, and a Level 6 /7 Perinatal mental health Module is currently being delivered, using the Virtual Learning Environment from the University. The study findings were disseminated here and this presentation included details of the profile of non attendance so practitioners are aware of those who are most likely to fail to attend after referral and can re-enforce the importance of accessing support to women who fit with the profile.
The Perinatal Mental Health Liaison Team will be delivering Perinatal Mental Health Champion Training from the Institute of Health Visiting, along with midwives, health visitors and practitioners from IAPT across the region.
When a woman is referred to the Perinatal Mental Health Liaison Team, she will be sent an appointment letter by post, but also attempts will be made to contact her by telephone in order to establish if the appointment is convenient. This telephone call will ideally be undertaken by the clinician that she has the initial appointment with. However due to clinical pressures a member of the administrative team may also make this telephone call.
An automatic telephone text reminder system will be investigated so that women can be reminded 48 hours before their appointment using this system (This requires development of the IT infrastructure and this work is on-going)
The Perinatal Mental Health Liaison Team will continue to work with The University of Hull in future research projects, to look at barriers to engagement in mental health care for women with perinatal mental health problems.
Evaluation (Peer or Academic)
Evaluation of the service itself has been embedded into our planned future project discussed above. We intend to follow women’s progress through the service and measure their improvements in emotional wellbeing at several points throughout their ‘journey’ In the meantime we have identified that since the implementation of the new strategies arising from the findings of the interrogation of the existing data of women who attended and did not attend appointments, the preliminary analysis of non-attendance data from January 2017 to April 2017 indicates that the non-attendance rate has been reduced to below 20%. This demonstrates an improvement since the new strategies have been in place.
Outcomes
Recent data illustrates an improvement in non-attendance in perinatal mental health care. The real impact of our work will become clearer in the next research project. Noteworthy is that while some of the women who failed to attend may have moved out of the area or have sought private treatment, many are still likely to be in need of care. Failure to be seen by the perinatal mental health liaison service may result in a worsening of mental health problems and this can have a serious impact on women’s mental health and well-being, as well as that of their children, partners and other family members. In addition to this, the high non-attendance rate also has an impact on the service in terms of wasted time and money. We are confident given the new figures for non-attendance that this work has already had an impact of the prevention of a worsening of mental health problems and the consequences of this on family members in those women who fail to attend. Further, by reducing the non-attendance rates of referred women, this work has also reduced the significant cost to the local Trust which is related to the unnecessary use of staff time when women fail to attend appointments.
Sharing
We always share our work with others. Dissemination of these findings have taken place as follows;
1. A report of the findings from this work was disseminated at 2 key forums; the Hull Maternity Services Forum and the Maternal Mental Health Advisory Group. Both forums are multidisciplinary in nature, and include representation from local commissioners, community based peer support groups, service users, perinatal mental health services, health visiting, midwifery services and mental health services.
2. Conference presentations locally have been undertaken (see box detailing sustainability work)
3. Abstracts of our work have been submitted for presentations at conferences on both a regional and national level
4. With the help of the University of Hull, we are in the process of submitting a manuscript detailing this work and its outcomes to a peer reviewed journal
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This work gained full ethics approval from the NHS Health Research Authority. REC reference: 16/NS/0089. IRAS project ID: 209233. and from the University of Hull, Faculty of Health and Social Care Research Ethics Committee.
