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Taxonomy of community perinatal mental health team provision in England - Effectiveness and cost-effectiveness of community perinatal mental health services on access, experience, recovery/relapse and obstetric and neonate outcomes: the ESMI-II mixed-methods study - NCBI Bookshelf An official website of the United States government Here's how you know The .gov means it's official. Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you're on a federal government site. The site is secure. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely. 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Southampton (UK): National Institute for Health and Care Research; 2025 Oct. (Health and Social Care Delivery Research, No. 13.38.) Effectiveness and cost-effectiveness of community perinatal mental health services on access, experience, recovery/relapse and obstetric and neonate outcomes: the ESMI-II mixed-methods study. Show details Health and Social Care Delivery Research, No. 13.38. O’Mahen H, Howard L, Sharp H, et al. Southampton (UK): National Institute for Health and Care Research ; 2025 Oct. Contents Search term < Prev Next > Chapter 2 Taxonomy of community perinatal mental health team provision in England Background In recognition of the unique treatment needs and heightened and complex risk factors in PMH , small CPMHTs consisting of at least a specialist consultant psychiatrist and mental health nurse, began in the 1980s. With growing awareness of the need and success of these teams, the 5 Year Forward Plan provided £365M to ensure CPMHTs were equitably provided across England. 22 Further investment in 2019 in the Long Term Plan supported the expansion of teams to provide a comprehensive mental health service delivered by multidisciplinary staff, with a particular aim to extend the treatment time period to 2 years postnatally and increase evidence-based psychological and parent–infant intervention provision. 23 In 2015, the Royal College of Psychiatrists published a report (CR-197) outlining a service and staffing model (per 10,000 deliveries) for CPMHTs. 18 The proposed multidisciplinary team structure incorporated the need for a range of psychiatric and psychological and relational interventions, with an emphasis on strong collaborative and integrative working with other health services. At the time of publication, it was estimated that 85% of localities did not have specialist PMH services to the level recommended in NICE guidelines. The aim of this WP was to develop a taxonomy of CPMHTs across England which would inform sampling in subsequent WPs. Methods Developing a programme theory of change in community perinatal mental health teams To develop the taxonomy, we first developed a programme theory describing proposed mechanisms in CPMHTs that support improving perinatal women’s mental health and their relationships with their baby ( Figure 1 ). The development of the programme theory followed the first two steps described by Pawson: 24 eliciting the implicit theories and formulate the initial middle-range theory. To elicit implicit programme theories, we undertook the following: FIGURE 1 ESMI-II programme theory. PREM, patient reported experience measure. Synthesised relevant policy documents on CPMHT structures, including the 5 Year Forward Plan, 22 the Long Term Plan, 23 Royal College of Psychiatry CR197, 18 2014 NICE Antenatal and Postnatal Mental Health Guidelines, 19 Health Education England Perinatal Mental Health Competencies, 25 NICE Antenatal and Postnatal Quality Standards, 26 RC Psychiatry Perinatal Quality Network for Perinatal Mental Health Services Standards for Community Perinatal Mental Health Services , 4th edition, 27 British Psychological Society Position Paper 8, ‘What does good perinatal mental health provision look like?’ 28 Compiled information from systematic reviews about: barriers and facilitators to PMH treatment access to PMH treatment effectiveness of PMH interventions. Conducted iterative stakeholder and patient and public involvement (PPI) discussions, including: NHS England perinatal team members NHS England Perinatal Strategic Network members Health Education England Members of: Royal College of Psychiatry British Psychological Society Royal College of Midwifery Royal College of Obstetrics Institute of Health Visiting Perinatal Mental Health Academics Perinatal Advisory Group (PAG) A preliminary list of components relevant to understanding what makes a good perinatal service was developed, discussed among the team and with our stakeholders and PAG group, and organised into a conceptual framework (see Figure 1 ). Data collection We aimed to characterise CPMHTs along the relevant dimensions outlined in the programme theory. With input from our Patient Advisory Group (PAG) we operationalised domains from the programme theory using system-related factors in CPMHTs and created a typology matrix ( Table 1 ). We contacted the 55 CPMHTs in England asked them to complete the typology matrix. To supplement information we received from services, we also obtained data from NHS Benchmarking (2015–8), the Royal College of Psychiatry Perinatal Quality Network, the National Maternity and Perinatal Audit (2017 and 2019) and from the web pages of CPMHTs (e.g. service specifications). Data were collected between July 2019 and April 2020. TABLE 1 Typology matrix with components of care Data analysis We conducted descriptive analyses on service area birth population, workforce and whole time equivalent (WTE) percentages to determine if services met CR197 staffing requirements, a component underpinning the programme theory. The following formula was used: Service area birth rate/10,000 × CR197 WTE . Results In 2020, there were 58 mental health trusts across England, and 55 of them had CPMHTs. We were able to obtain data from 33 of the 55 CPMHTs for the typology matrix. The data collected were characterised by a large amount of missing information and were largely descriptive and qualitative in nature, so we were unable to quantify and reliably compare information across services. The most consistently reported and quantifiable information was on workforce. We therefore used this information to develop typologies. Of note, at the time of data collection none of the services met full CR197 workforce WTE for a comprehensive CPMHT . We consequently characterised CPMHTs in terms of: offering a ‘basic’ service, consisting of the presence of a psychiatrist, psychologist and specialist community nurse offering a broader staff mix consistent with the aims of a ‘comprehensive’ service, defined as CPMHTs who had the presence of the following multidisciplinary staff members: psychiatrist, psychologist, specialist community nurse, nursery nurse and occupational therapist. Of the 33 services, the following met criteria ( Figure 2 ): FIGURE 2 Maps of basic and comprehensive CPMHTs within England. basic 28/33 (84.8%) comprehensive 21/33 (63.6%). We used the ‘basic’ definition to characterise the presence of at least minimal CPMHT services for WP4. For WP3, we also used the qualitative, descriptive data to purposively sample services for variation on domains from our programme theory that we hypothesised were related to women and babies’ outcomes (e.g. provision of parent–infant, collaborative care) ( Table 2 ). TABLE 2 Typology of selected sites for realist evaluation study Overall, the data suggested there was still considerable variability among CPMHT offer ( Table 3 ). In relation to the domains we specified in the programme theory, the following trends emerged: TABLE 3 Typology matrix of 33 CPMHTs across England Collaborative working: there were higher rates of collaborative working with statutory health providers compared to social care and the voluntary care sector. Delivery: there were high rates of providing care in women’s homes and children’s centres, some CPMHTs were also delivering joint maternity clinics. Few, pre-COVID, were using remote delivery. Psychological and parent–infant interventions (see Appendix 1 , Tables 21 and 22 for training in treatment): We only received data on these areas from 57% of services. Of these, most (41%) offered between three and five types of psychological interventions, but it is notable that 26% only offered up to two. The most common psychological interventions were cognitive–behavioural therapy (CBT), dialectical behaviour therapy, and eye movement and desensitisation and reprocessing (EMDR). Parent–infant interventions were rarely offered, although 63% provided Video Interaction Guidance (VIG). Outcome measures. There was wide variability in what was used. The Health of the Nation Outcome Scales (HoNOS), Patient-rated Outcome and Experience Measure (POEM) and Clinical Outcomes in Routine Evaluation – 10-item version (CORE-10) are recommended as a minimum set of measures for CPMHTs. 29 Of the reporting CPMHTs, 22% used the HONOS and CORE-10 and 50% used the POEM . Preconceptual Care: Only 46% of CPMHTs were offering preconceptual care. Wait times: Wait times for assessment from referral varied between CPMHTs, ranging from < 2 to 11 weeks. Strengths and limitations We had excellent engagement and responses from CPMHT services across the UK. The Maternal Mental Health Alliance also generally supported our data collection efforts. However, the quality and missingness of data across services and the mode of reporting were widely variable, limiting our ability to make reliable comparisons across services. We therefore adopted a conservative estimating approach, using consistently reported staffing data to discern service provision across the country. Conclusion The provision of perinatal care across England has grown substantially with transformational funding from only 10 services operational in 2013 to all Clinical Commissioning Groups (CCGs) providing the basic level of care by 2020. By 2020, none of the 33 services in our study met full CR197 criteria for staffing levels, and only 60% of the services had sufficient psychiatry, psychology, nursing and occupational therapy care in place. Workforce time did not meet CR197 standards, suggesting that, in many circumstances, provision performed by some staffing types was still minimal. The organisation, composition and delivery of community PMH services in England varied considerably. The categories used to map out service provision included nine areas and there was variation across services in all aspects apart from collaboration and coworking with maternity. Greatest uniformity existed across reported collaboration with other statutory services, though even this varied considerably, with few examples of joint clinics held with maternity, for example. There were notable gaps in collaborative working with social care and voluntary sector organisations, but best practice existed in some places. For example, some services provided examples of good collaboration between organisations through joint clinical meetings, assessments and/or clinics being run within the community through children centres or other public services (e.g. local libraries), and educational sessions provided to organisations. Copyright © 2025 O’Mahen et al . This work was produced by O’Mahen et al . under the terms of a commissioning contract issued by the Secretary of State for Health and Social Care. This is an Open Access publication distributed under the terms of the Creative Commons Attribution CC BY 4.0 licence, which permits unrestricted use, distribution, reproduction and adaptation in any medium and for any purpose provided that it is properly attributed. See: https://creativecommons.org/licenses/by/4.0/ . For attribution the title, original author(s), the publication source – NIHR Journals Library, and the DOI of the publication must be cited. Bookshelf ID: NBK618806 Contents < Prev Next > Share Views PubReader Print View Cite this Page O’Mahen H, Howard L, Sharp H, et al. Effectiveness and cost-effectiveness of community perinatal mental health services on access, experience, recovery/relapse and obstetric and neonate outcomes: the ESMI-II mixed-methods study. Southampton (UK): National Institute for Health and Care Research; 2025 Oct. (Health and Social Care Delivery Research, No. 13.38.) Chapter 2, Taxonomy of community perinatal mental health team provision in England. PDF version of this title (3.2M) In this Page Background Methods Results Other titles in this collection Health and Social Care Delivery Research Recent Activity Clear Turn Off Turn On Taxonomy of community perinatal mental health team provision in England - Effect... Taxonomy of community perinatal mental health team provision in England - Effectiveness and cost-effectiveness of community perinatal mental health services on access, experience, recovery/relapse and obstetric and neonate outcomes: the ESMI-II mixed-methods study Your browsing activity is empty. Activity recording is turned off. Turn recording back on See more... 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