1. Background

The perinatal period begins at the start of pregnancy and runs until the end of the first year after a baby is born. Perinatal mental health is about the psychological and emotional health and wellbeing of pregnant women and their children, their partners and their families. During pregnancy and after the birth of a child, women are at a higher risk of experiencing mental health problems.

Perinatal mental health problems are defined by a spectrum of mental health issues, including anxiety, depression and postnatal psychotic disorders which have their onset during pregnancy or the first year after a baby’s birth.

While treatment is just as effective for women in the perinatal period as at other times, perinatal mental ill health is associated with a heightened need for prompt and effective care. This is because a mental health problem during the perinatal period not only has the potential to adversely affect the mother, but also has lasting consequences for the developing child. Linked to this, the separation of mother and infant can have serious effects on the mother and infant relationship and can be difficult to reverse.

Mother and baby units (MBUs) are specialist psychiatric wards in hospitals to which women with severe perinatal mental health issues can be admitted with their babies. MBUs provide treatment and support for women with perinatal mental health problems while also supporting them in developing parenting skills and bonding with their babies.

2. Welsh Parliament action

The Fifth Senedd’s Children, Young People and Education Committee (CYPE) held an inquiry into perinatal mental health in 2017. The aim of the inquiry was to consider how perinatal mental health services were provided and how the Welsh Government could improve services for mothers, babies, fathers and families.

At the time of the Committee’s inquiry being undertaken, there was no MBU provision in Wales following the closure of a unit in Cardiff in 2013. Women who required inpatient treatment for perinatal mental health problems were either admitted to acute mental health wards without their babies or had to travel to an MBU in England.

The Committee’s report on its inquiry was published in October 2017 and set out the evidence it heard on the need for an MBU in Wales and also made recommendations including the following:

Recommendation 6. That the Welsh Government, based on the evidence received, establish an MBU in south Wales, commissioned and funded on a national basis to provide all-Wales services, staffed adequately in terms of numbers and disciplines, and to act as a central hub of knowledge and evidence-based learning for perinatal mental health services in Wales.

Recommendation 7. That the Welsh Government, in light of the fact that an MBU in south Wales will not necessarily be suitable for mothers and families in mid and north Wales, engage as a matter of urgency with NHS England to discuss options for the creation of a centre in north east Wales that could serve the populations of both sides of the border. More certainty should also be established by the Welsh Government in relation to the ability of the Welsh NHS to commission MBU beds in centres in England where those are deemed clinically necessary.

The Welsh Government accepted both of these recommendations.

A new six-bed interim MBU based at Tonna Hospital in Swansea Bay University Health Board opened to patients in April 2021.

Updates on progress for north Wales patients

Following the publication of its report, the CYPE Committee received regular updates from the Welsh Government on progress relating to perinatal mental health services.

Most recently, on 7 October 2021, the Sixth Senedd’s CYPE Committee held a general scrutiny session with the Minister for Health and Social Services, Deputy Minister for Social Services and Deputy Minister for Mental Health and Wellbeing.

During the meeting, the Deputy Minister for Mental Health and Wellbeing noted that work was continuing on the provision of an MBU for north Wales, that she was ‘very much committed to’.

Following the general scrutiny session on 7 October, the CYPE Committee wrote to the Deputy Minister for Mental Health and Wellbeing asking for further information. In relation to an MBU in north Wales, the letter raises the Committee’s concern that women and babies in north Wales still need to travel significant distances to access specialist inpatient support. The Committee notes the statement from the Deputy Minister that work is continuing to ensure that provision is made available for mothers who live in north Wales and asked for more details on the options and timeframe for this.

The Deputy Minister for Mental Health and Wellbeing replied to the Committee’s letter on 22 November 2021. In her letter, the Deputy Minister explains that discussions are being held with NHS England to develop the option of a joint eight-bed MBU which would offer provision for women from north Wales. The rationale for pursuing a joint eight-bed unit is based on demand modelling undertaken by the Welsh Health Specialised Services Committee (WHSSC), which has been refreshed recently, and to provide a sustainable service provision for women in north Wales. The Deputy Minister stated that a further update on this work and the timeframe for implementation would be provided shortly.

The CYPE Committee also wrote to the Deputy Minister for Mental Health and Wellbeing on 17 December 2021 asking for regular six-monthly updates on perinatal mental health services.

3. Welsh Government action

In the letter to the Petitions Committee dated 14 December 2021, the Deputy Minister for Mental Health and Wellbeing states that the Welsh Government has committed to ensuring that MBU provision is made available for mothers living in north Wales and that she has had regular updates on this and recently met with the leads from WHSSC to discuss this development.

The letter explains that the modelling undertaken in Wales has evidenced that there is not enough demand for a standalone unit in north Wales. The Welsh Government has therefore been working collaboratively with NHS England to develop a joint unit in north west England which will be accessible from north Wales. It is stated that there continues to be ‘significant engagement’ between Betsi Cadwaladr University Health Board, WHSSC and NHS England regarding the development of this new unit.

The Deputy Minister goes on to say that she has asked for this work to be taken forward with ‘real urgency and pace’ and she will continue to receive regular updates. The Deputy Minister notes that she has offered her support to officials in the collaboration with NHS England in order to ensure that this is driven forward at pace. It is also confirmed in the letter that the Welsh Government is working with the provider to support the Welsh language needs of Welsh patients when developing the unit.

Every effort is made to ensure that the information contained in this briefing is correct at the time of publication. Readers should be aware that these briefings are not necessarily updated or otherwise amended to reflect subsequent changes.