Options to increase mother and baby unit capacity: consultation analysis

Executive Summary

In Scotland, there are currently two regional Mother and Baby Units (MBUs), one located in Glasgow, and one in Livingston, which cater for women from across Scotland.  Each can take up to six women and their babies.  One of the recommendations of Perinatal Mental Health Network Scotland in their report ‘Delivering Effective Services: Needs Assessment and Service Recommendations for Specialist and Universal Perinatal Mental Health Services’ was to create an additional 2-4 Mother and Baby beds, either within existing services or by creating a new MBU in the north of Scotland.  Delivering Effective Services also noted that an options appraisal should be conducted to help determine where the additional MBU beds should be sited.

The options appraisal will evaluate potential alternatives based on equity of access, affordability, safety and sustainability. As part of the process, the Scottish Government launched a public consultation in February 2022.

Respondent Profile

In total, there were 236 responses to the consultation, of which 16 were from organisations and 220 from individuals.  Respondents were classified according to a wide range of different sub-groups.  However, given the very small base sizes across many of these sub-groups, it is often not possible to make meaningful comparisons, although where possible, differences between sub-groups are highlighted throughout the report.

Key Themes

Overall, respondents were very supportive of the service offered by the existing MBUs and would like to see access to these extended to more service users.  Views were positive about having an increased number of beds within MBUs and there were high levels of support for the creation of a new MBU in the north of Scotland, principally from respondents located outside the Central Belt who were from the north of Scotland, particularly the Grampian health board area.  Aberdeen was the most frequently suggested location.  That said, there were some concerns over the likely costs of setting up a new unit as well as concerns over staff recruitment and retention in creating a new unit from scratch.  The key advantages to creating a new unit for women in the north of Scotland, aside from access to specialist staff across a range of disciplines and a nurturing environment, were reduced travel distances for service users and proximity to their local support networks.  The creation of a new unit or adding beds to existing units is particularly important given the numbers of respondents who disagreed that there are other ways to provide care for women with severe mental health issues and their infants. The specialist nature of a unit solely catering for mothers and babies is seen to be the best way forward, rather than a general mental health unit.

A number of key themes were evident across questions as well as across respondent groups. These are summarised below.

• A higher proportion of organisations claimed to be ‘very’ or ‘quite familiar’ with MBUs, when compared to individuals.  Individuals with lived experience of mental health problems in pregnancy or after childbirth who received care and treatment in an MBU, and clinicians in MBU care had higher levels of familiarity with the MBUs than did other individuals. 
• The qualitative findings suggest that awareness levels of MBUs are relatively low, both among professionals and the general public and the consultation findings suggest a need to increase awareness among both professionals and the general public.  
• A key positive feature of an MBU is that a mother and her baby can be kept together, thus helping to foster the bond and build attachment between mother and baby within a safe and nurturing environment.  They are also seen to offer benefits to the wider family with the potential for visits and the availability of family rooms.  These elements of service are seen as extremely important and unavailable in other general adult mental health inpatient wards. 
• The MBUs are seen to be staffed by well trained and knowledgeable staff who offer specialist perinatal care in a multi-disciplinary team, offering advice and support that are not perceived to be available in other general adult mental health inpatient wards or within community teams.
• The main disadvantage cited by respondents was of the distance some mothers have to travel to access services offered by an existing MBU.  There was a perception that some mothers would refuse admission to an MBU because of the distance from other family members and their own support network.  As such, significant numbers of respondents would prefer to see a new unit created in the north of Scotland than to have capacity increased in the existing units.  While both options would increase capacity, it was felt that regardless of the logistics or cost of creating a new unit, this would improve equity of access for all mothers, while extending the existing units would not.  
• There were some calls for consistent admission criteria to be used across both existing MBUs as well as improvements to the discharge process.  
• While the service provided within the MBUs was praised by respondents, and the capacity to access links to community health teams on discharge was also perceived to be very useful, there were some concerns about a lack of follow up services for some mothers and a lack of access to specialist support on discharge.  Suggestions were made for upskilling existing staff and recruiting new staff to enable the setup and provision of specific perinatal mental health regional or community teams to meet the needs of more mothers with perinatal mental health issues. 
• There was low awareness of the Mother and Baby Unit Family Fund (MBUFF) and only four respondents had used this, all from the Grampian health board area (although it is possible that other respondents who had used an MBU had done so before the MBUFF was launched).  Given the distance some mothers had to travel to access services at an MBU, there were some requests for the cap of £500 to be extended and made more flexible.  Another issue highlighted was that funds are paid in arrears and some women cannot afford to make financial outlays in advance of receiving funding.
• In relation to creating a new MBU unit in the north of Scotland, a few organisations and individuals felt creating a six bed unit would be more cost effective than a four bed unit, with a health board noting that units smaller than six beds are likely to be less viable.   A small number of organisations felt that if there were times where this was not running at capacity, staff could provide specialist outreach services, for example, offering community-based support.