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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A service of the National Library of Medicine, National Institutes of Health. < Prev Next > 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 Health and Social Care Delivery Research, No. 13.38 Heather O’Mahen , Louise Howard , Helen Sharp , Antoinette Davey , Louise Fisher , Ipek Gurol-Urganci , Margaret Heslin , Julia Langham , Ebun Makinde , Emma Tassie , Silia Vitoratou , Jo Brook , Gina Collins , Chris McCree , Dharmintra Pasupathy , Andrew Pickles , Sarah Morgan-Trimmer , Geoffrey Wong , Katie Atmore , Debra Bick , Laura Bozicevic , Clare Dolman , Jill Domoney , Jessica Gay , Chloe Hayes , Jennifer Holly , Miriam Refberg , Sarah Byford , and Jan van der Meulen . Author Information and Affiliations Authors Heather O’Mahen , 1 ,* Louise Howard , 2 Helen Sharp , 3 Antoinette Davey , 1 Louise Fisher , 3 Ipek Gurol-Urganci , 4,5 Margaret Heslin , 6 Julia Langham , 4,5 Ebun Makinde , 1 Emma Tassie , 6 Silia Vitoratou , 7 Jo Brook , 8 Gina Collins , 1 Chris McCree , 9 Dharmintra Pasupathy , 10 Andrew Pickles , 6 Sarah Morgan-Trimmer , 11 Geoffrey Wong , 12 Katie Atmore , 2 Debra Bick , 13 Laura Bozicevic , 14 Clare Dolman , 2 Jill Domoney , 2 Jessica Gay , 3 Chloe Hayes , 7 Jennifer Holly , 2 Miriam Refberg , 3 Sarah Byford , 6 and Jan van der Meulen 4,5 . Affiliations 1 Mood Disorders Centre, Faculty of Life and Health Sciences, University of Exeter, Exeter, UK 2 Section of Women’s Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK 3 Department of Primary Care and Mental Health, Institute of Population Health, University of Liverpool, Liverpool, UK 4 Department of Health Services Research and Policy, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK 5 Royal College of Obstetricians and Gynaecologists Centre for Quality Improvement and Clinical Audit, Royal College of Obstetricians and Gynaecologists, London, UK 6 King’s Health Economics, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK 7 Psychometrics and Measurement Lab, Biostatistics and Health Informatics Department, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK 8 Tavistock and Portman NHS Foundation Trust, London, UK 9 Centre for Parent and Child Support and Community Perinatal Services, South London and Maudsley Foundation Trust, London, UK 10 Reproduction and Perinatal Centre, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia 11 Faculty of Health and Life Sciences, Institute of Health Research, University of Exeter, Exeter, UK 12 Nuffield Department of Medicine, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK 13 Warwick Clinical Trials Unit, University of Warwick, Warwick, UK 14 Faculty of Health and Life Sciences, Department of Primary Care & Mental Health, Institute of Population Health, University of Liverpool, Liverpool, UK * Corresponding author ; Email: [email protected] Southampton (UK): National Institute for Health and Care Research ; 2025 Oct . Copyright and Permissions 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. Search term Abstract Background: Perinatal mental health disorders affect one in five mothers during pregnancy or within 2 years post childbirth. These disorders can lead to poor pregnancy and childbirth outcomes and maternal deaths. Additionally, they negatively affect a child’s cognitive, social and emotional development. Stigma and a lack of specialised services have limited access to mental health care. National Health Service England invested £365M in community perinatal mental health teams, but their impact on women and infants’ outcomes are not known. Objectives Develop a taxonomy of community perinatal mental health teams (work package 1). Compare and validate two assessments of quality of mother–infant interaction for use by community perinatal mental health teams (work package 2). Evaluate the effectiveness and cost-effectiveness of community perinatal mental health teams (work packages 3 and 4). Design: Mixed-methods study. Setting: Community perinatal mental health teams in England. Participants: Women who were pregnant or within 2 years postnatal. Methods and outcome measures: Work package 1: Typology of community perinatal mental health teams in England. Work package 2: Reliability and validity of two observational assessments of parent–infant interaction. Work package 3: Realist evaluation interviews with women, partners/close others, and staff to determine effective community perinatal mental health team components. Work package 4: Analysis of linked data: Association of community perinatal mental health teams with access to secondary care mental health services. Risk of acute relapse and improved obstetric and neonate outcomes for women with pre-existing severe disorders in areas with community perinatal mental health teams compared to generic services. Economic analysis of cost of community perinatal mental health teams. Results Objective 1: Community perinatal mental health team typologies revealed in 2020, 84% had basic staffing levels and 63% had more multi-professionals. Objective 2: The ‘Parent Infant Interaction Observation Scale’ and ‘National Institute of Child Health and Human Development’ assessments of mother–infant interaction were reliable and valid; the National Institute of Child Health and Human Development is more suitable for community perinatal mental health teams. Objective 3: Work package 3: Interviews with 139 women, 55 partners/close others and 80 health workers highlighted the importance of specialist perinatal knowledge, responding in a warm and non-judgemental way, working closely with other healthcare providers, optimising medication, supporting mothers to reduce conflict and improve social support, helping mother–infant bonding, and teaching emotional management. Work package 4: Analysis of linked health data revealed higher risks for obstetric and neonate problems in women with severe mental health disorders, particularly recent or very serious episodes. Work package 4: Areas with community perinatal mental health teams saw increased mental health access among perinatal women and reduced need for acute care, albeit at a higher cost and with greater neonatal risks. Limitations High levels of missing data on diagnosis and mental health outcomes in existing health and service data. Lack of data on child outcomes. Evaluation occurred during community perinatal mental health team changes and the coronavirus disease discovered in 2019 pandemic limiting a full assessment of the impact of community perinatal mental health teams on maternal and child outcomes. Conclusions: Community perinatal mental health teams can support perinatal women with complex, moderate/severe mental health disorders, but further attention to women’s physical needs is essential. The use of observational assessments of parent–infant relationships will enhance the evaluation of community perinatal mental health teams’ impact on infant outcomes. Future work: Research should focus on prospective studies that gather mental health and child outcomes from community perinatal mental health teams and primary care mental health, to assess broader impacts of perinatal-specific treatment across care pathways. Study registration: This study is registered on Research Registry as researchregistry5463. Funding: This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme ( NIHR award ref: 17/49/38) and is published in full in Health and Social Care Delivery Research ; Vol. 13, No. 38. See the NIHR Funding and Awards website for further award information. Plain language summary We evaluated how well community perinatal mental health teams were working. The study had four work packages. Work package 1 created community perinatal mental health team categories in England. In 2020, 84% had basic staffing, and 63% had more multi-professionals involved in mother and baby care. Work package 2 evaluated two assessments of mother–baby interaction. ‘Parent Infant Interaction Observation Scale’ was better at predicting how babies would be developmentally at age 2, though is best used for babies 2–8 months old. ‘National Institute of Child Health and Human Development-3’ could be better for community perinatal mental health teams, because it can be used for babies 3–24 months old, is simpler to use and takes less staff training time. Work package 3 used interviews to look at what aspects of community perinatal mental health team care helped women. We interviewed 139 women, 55 family members and 80 health workers in 10 community perinatal mental health teams throughout England. Good community perinatal mental health teams were comprehensive and had staff who were relational, approachable and non-judgemental. They understood what new mothers needed. Mothers and babies were greatly helped by: community perinatal mental health teams working closely with other health providers perinatal-specific medication advice helping mothers connect with other mothers supporting mothers to reduce conflict and get more support helping mother–infant bonding teaching mums how to manage their emotions. Work package 4 evaluated National Health Service maternity and mental health data. We found women with serious mental health problems had a higher chance of having childbirth and newborn difficulties. The risk was greatest for women with very recent or serious mental health problems. In areas with community perinatal mental health teams, more perinatal women accessed earlier help with their mental health, with fewer women having highest levels of care. Areas with community perinatal mental health teams cost more money and newborns had greater health risks. Community perinatal mental health teams are good at helping perinatal women with mental health problems, but further work is needed to understand how to help their newborn baby’s health. Contents Expand All Collapse All Scientific summary Chapter 1. Overview of perinatal mental health Background Chapter 2. Taxonomy of community perinatal mental health team provision in England Background Methods Results Chapter 3. Work package 2: assessing validity of parent-interaction observational tools Background Original aims Additional aim addressed during course of work Methods Results Discussion and conclusions Chapter 4. Realist evaluation of community perinatal mental health teams Introduction Methods Results COVID-19 Cultural beliefs and expectations Discussion Chapter 5. Obstetric and neonatal outcomes in pregnant women with and without a history of specialist mental health care: a national population-based cohort study using linked routinely collected data in England Background Aim Methods Results Discussion Chapter 6. Community perinatal mental health teams and associations with perinatal mental health and obstetric and neonatal outcomes in pregnant women with a history of specialist mental health care in England: a national population-based cohort study Background Aim Methods Results Discussion Chapter 7. Economic analysis of areas with community perinatal mental health teams compared to those without Aim Results Discussion Chapter 8. Conclusions Patient and public involvement Equality, diversity and inclusion Impact and learning Implications for decision-makers Additional information References Appendix 1. Types of training received by professions and delivered by staff List of abbreviations List of supplementary material Expand All Collapse All About the Series Health and Social Care Delivery Research ISSN (Electronic): 2755-0079 Article history The research reported in this issue of the journal was funded by the HSDR programme or one of its preceding programmes as award number 17/49/38. The contractual start date was in June 2019. The draft manuscript began editorial review in September 2023 and was accepted for publication in March 2025. The authors have been wholly responsible for all data collection, analysis and interpretation, and for writing up their work. The HSDR editors and production house have tried to ensure the accuracy of the authors’ manuscript and would like to thank the reviewers for their constructive comments on the draft document. However, they do not accept liability for damages or losses arising from material published in this article. Last reviewed: September 2023; Accepted: March 2025. 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: NBK618816 DOI: 10.3310/RRAP0011 < 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.) doi: 10.3310/RRAP0011 PDF version of this title (3.2M) Other titles in this collection Health and Social Care Delivery Research Related information NLM Catalog Related NLM Catalog Entries Recent Activity Clear Turn Off Turn On Effectiveness and cost-effectiveness of community perinatal mental health servic... 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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