Options to increase mother and baby unit capacity: consultation analysis

Introduction

Background

1. Mother and Baby Units (MBUs) are designed to provide specialist inpatient support for severe mental health difficulties during the perinatal period, with a focus on keeping mothers and infants together in order to support the mother-infant relationship and promote infant development.  MBUs can admit women in late pregnancy and at any point until their baby is one year old.  

2. In Scotland, there are currently two MBUs; one at St John’s Hospital in Livingston (NHS Lothian) and one at Leverndale Hospital in Glasgow (NHS Greater Glasgow and Clyde).  Each can take up to six women and their babies.  Current data^[1] shows that, while there has been an average of 114 MBU admissions per year to these two units, there were another 124 admissions per year to other in-patient mental health beds.  Additionally, across health board areas not hosting an MBU, the data shows that women were more likely to be admitted to a non-Mother and Baby Unit if they required in-patient mental health treatment.  It is possible that some of these women would have benefitted from admission to an MBU, however there is no data to evidence this assumption.  There are a variety of reasons why it may not be clinically appropriate for a woman to be admitted to an MBU, for example when she is not the primary carer of the infant.  A woman may choose alternative treatment, for example if she would prefer to be treated away from her infant.  

3. One of the actions of the Mental Health Strategy 2017-2027 was to establish a Perinatal Managed Clinical Network in Scotland with the aim of improving both the recognition and treatment of perinatal mental health problems. The network was established in April 2017. Subsequently, PMHN Scotland published ‘Delivering Effective Services: Needs Assessment and Service Recommendations for Specialist and Universal Perinatal Mental Health Services’^[2] (March 2019) which assessed need and made recommendations for all tiers of service delivery for Perinatal and Infant Mental Health Services across Scotland. One of the recommendations to emerge from this was the need for 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 Mother and Baby Unit beds should be sited. Subsequently, the Perinatal and Infant Mental Health Programme Board was established to implement the recommendations of Delivering Effective Services.  The Board’s view was that in order to properly assess the need for additional inpatient beds, community specialist services should be established first.

4. In March 2019, the Scottish Government announced investment over four years to improve access to mental health services for expectant and new mothers.  The Perinatal and Infant Mental Health Programme Board was established in March 2019 to help drive implementation of the Scottish Government’s Programme for Government commitments on perinatal and infant mental health.  This board provides strategic management and oversight of this investment and the delivery of the recommendations in Delivering Effective Services.

5. In February 2022, the Scottish Government launched a consultation on Perinatal Mental Health, which closed on 31 May 2022.  This consultation sought views from stakeholders, including clinicians and those with lived experience, on the needs of women and families in Scotland in terms of perinatal mental health.  Alongside the online consultation, a number of consultation events were held and findings from these have been included in analysis of consultation responses. 

Respondent Profile

6. In total, there were 236 responses to the consultation, of which 16 were from organisations and 220 from individuals.  Respondents were asked whether they were responding as an organisation or individual and were then assigned to respondent groupings to enable analysis of any differences or commonalities across or within the various different types of organisations and individuals that responded.  

7. Each organisation was given a category based on its role; Health and Social Care Partnerships, NHS / Health boards, Professional Body / Association and Third Sector.  Of the organisations responding, the highest numbers were in NHS / Health Boards (6 of 16 organisations).

8. Individuals were asked to state the capacity in which they were completing the consultation, for example, an MBU service user, non MBU service user, clinician in MBU care or clinician in general mental health community team care and so on.  These respondents were also asked to provide details on their age and to provide postcode details so that the health board in which they live could be used in analysis.

9. The largest number of individuals (65) were women with lived experience of mental health problems in pregnancy or after childbirth who received care and treatment in the community from their GP, mental health service or other health professional including third sector services (service user).  This was followed by 28 women with lived experience of mental health problems in pregnancy or after childbirth who did not access treatment or services.  Only 14 respondents were women with lived experience of mental health problems in pregnancy or after childbirth who received care and treatment in an MBU (service user); and 4 were women with lived experience of mental health problems in pregnancy or after childbirth who received care and treatment in a general adult mental health inpatient ward (service user).

10. The majority of individuals were aged between 25 and 44.  In terms of health board area, by far the largest numbers of respondents were based in the Grampian region (121) and 33 lived in the Highland region.  

11. Tables A, B and C in Appendix 1 show the number of respondents in each sub-group.

12. A list of all organisations that submitted a response to this consultation is included in Appendix 2.