Peer support in perinatal mental health: evidence review

1. Introduction

This report provides information on research and evidence about perinatal peer support, existing practice in Scotland and potential areas for future development^[1].

1.1 Background

Estimates suggest that around 20% of mothers (Prevatt et al., 2018; Geller et al., 2018) and up to 10% of fathers (Cameron et al., 2016) experience poor mental health in the perinatal period. This experience will range from mild to moderate mental health difficulties to more severe and enduring mental illness, and evidence suggests that vulnerable populations are disproportionately affected (Scottish Government, 2017b). Death by suicide remains the leading cause of maternal death in the year following the end of pregnancy (Knight et al., 2018).

The Scottish Government is aiming to improve the recognition and treatment of perinatal mental health difficulties, through commitments in both the Mental Health Strategy 2017-2027 (2017a) and the Programme for Government 2018-2019 and 2019-20 (2018; 2019b). In March 2019, the First Minister announced £50 million of investment for perinatal and infant mental health services over 4 years. The Perinatal and Infant Mental Health Programme Board is guiding the investment of this additional investment based on the recent perinatal and infant mental health Delivering Effective Services Report (Scottish Government, 2019a).

The Delivering Effective Services Report on perinatal and infant mental health services across Scotland made the recommendation to enhance access to peer support as part of a wider range of services for women, infants, partners and families in the perinatal period. Peer support ranges from support groups with other parents, to volunteer befriending and peer workers in inpatient settings. Ministers have accepted the recommendations from the Report and are working towards enhancing peer support for women and families during pregnancy and after birth.

1.2 Aims

The aim of this research is to review the evidence base for peer support in perinatal mental health by responding to the following questions:

• What evidence is there on the effectiveness of peer support in the perinatal period?
• In Scotland, what models of perinatal peer support can be identified using currently available evidence?
• What evaluation evidence exists on the effectiveness of current models of peer support in Scotland?
• Based on the above evidence, what may be the best ways to develop peer support models in perinatal mental health in Scotland?

1.3 Methodology

This research was based on two different methods: a rapid literature review and primary data collection on perinatal peer support services available in Scotland.

A range of search terms were developed for the literature review, covering the fields of peer support and perinatal mental health. Database and website searches were carried out for peer-reviewed academic literature, third sector and government literature.^[2] Additional relevant evidence was collected through contact with stakeholders. Due to limited Scottish specific evidence the search was expanded to include the rest of the UK and international evidence. The specific focus was on Europe, North America and Australasia, as these were perceived to be more comparable with UK due to healthcare systems and income distribution. The report is based on a rapid review of the literature, rather than using systematic review methodologies. A total of 122 journal articles, evaluation reports and other resources inform this report.

To develop a picture of perinatal mental health peer support services in Scotland, a list of 112 relevant stakeholders was developed, with input from subject experts. Through desk based research and email contact, the researcher identified 53 organisations that offered peer support for parents in the perinatal period. Twenty-two organisations provided further information, either by responding to a short questionnaire about peer support provision (n=16) or providing free-text comments (n=6). Organisations who represent specialist services or marginalised groups (e.g. support for fathers, ethnic minority groups, school-age parents and bereaved parents) were among those contacted, to ensure that their perspectives were taken into account. This information was collated and synthesised with the literature on peer support to inform section 3 of this report.

1.4 Definitions

For the purposes of this report, the perinatal period is defined as the period from conception, through pregnancy and up to one year after birth.

Peer support has no fixed definition, but commonly has the following characteristics:

people who have experienced adversity offering support, hope and encouragement to those in a similar situation (Jones et al., 2014). The activities of peer supporters vary widely, but the 'peer principle'(Mead and MacNeil, 2006) is that peer supporters have an equal relationship with the person they are supporting and an affiliation based on similar life experiences. Peer support can be paid or voluntary. The most significant aspects are that the support is delivered by a non-professional with a shared experience.