Report to the Children, Young People and Education Committee


This paper has been prepared to provide the Committee with information on the All Wales Perinatal Mental Health Steering Group and its associated Community of Practice.


All Wales Perinatal Mental Health Steering Group (AWPMHSG)


In 2016 the Welsh Government announced funding to support health boards deliver community perinatal mental health services across Wales. The ‘All Wales Perinatal Mental Health Steering Group’ (AWPMHSG) was established with representation from all key stakeholders to offer advice and information as well as support the development of all Wales standards and pathways for the delivery of services. This group is chaired by Prof Ian Jones National Centre for Mental Health (NCMH) and Dr Sue Smith, Cardiff & Vale University Health Board with project support from Lisa Kinsella, who has been seconded into the position of ‘National Clinical Lead for Perinatal Services’ Public Health Wales, 1000 lives, and overseen by Dr Leslie Rudd Public Health Wales and Andrea Gray, Public Health Wales.


The AWPMHSG reports to the Children and Adolescent Mental Health Services/Eating Disorder Network Steering Group (CAMHs/ED network steering group) in the form of a regular agenda item reporting progress on a quarterly basis to the network steering group. This facilitates the reporting of perinatal mental health service developments to the NHS Wales Collaborative to inform the chief executives of the seven health boards in Wales.    


Membership of the group includes those with lived experience, third sector organisations including the NSPCC and MIND, the NCMH, midwives, health visitors, obstetricians, psychiatrists as well as specialist perinatal practitioners.



In 2016, perinatal services in Wales were limited in scope and coverage, there was the

-          Cardiff & Vale community perinatal service

-          PRAMS (perinatal response and management service) in Bridgend and

-          Pembrokeshire Perinatal Pilot in Pembroke dock


There are now 5 fully functioning community perinatal services across Wales with another imminently introducing a community perinatal service and the 7th exploring preventative pathways between midwifery and local primary mental health support services directly after perinatal training.


The current steering group held its first meeting in early 2016 and for the rest of that year met bi monthly. Since 2017 it has convened on a quarterly basis.


The group has supported the development of perinatal services throughout Wales by for example:


·         Initiating the agreement between all health boards to adopt the Royal College of Psychiatrists community perinatal service standards[1] and work towards their implementation.


·         Supporting the work of the NCMH research regarding perinatal mental health.


·         Receiving and disseminating research and current good practice presentations which have ranged from, the importance of intervening in the early years to SSRI antidepressant’s in pregnancy and the congenital anomalies.


·         Supporting the ongoing work of MBRRACE-UK[2] - to facilitate further research.


·         Assisting in the launch and full integration of the Maternal Mental Health Campaign, (MMHA)[3] in Wales. The campaign has highlighted the significance of perinatal mental health in England and Scotland, promoting the importance of ‘early identification’ of those ‘at risk’ of perinatal mental health problems, with an emphasis on prevention. The MMHA has also pioneered the provision of perinatal service delivery through multi agency/multi discipline approaches, naming the campaign ‘Everyone’s Business’[4].


·         Championing and facilitating the provision of perinatal training by bidding for additional monies from Welsh Government for example: Video Interactive Guidance(VIG) which, which was a two day introductory training held in Cardiff and attended by 15 perinatal health professionals from the 7 different health boards.. All participants found this perinatal intervention useful, expressing an interest in further training to become fully accredited in VIG.


A further proposal for additional funding will be submitted to Welsh Government shortly in order to train a further 10 staff so that in two years, Wales will have its own cohort of fully accredited VIG trainers to further cascade this fully evidenced based perinatal intervention to all identified relevant perinatal health professionals in Wales.  Video Interactive Guidance has been designed to enhance and support the development of the mother and baby bond, which has significant implications for the future generations.


·         Another ‘Once for Wales’ funding application was made to Welsh Government for 5 Welsh psychiatrists to attend the Royal College of Psychiatrists, Specialist Perinatal Psychiatrist’s training in England. This 3 day course provided the latest evidence and research regarding diagnosis and treatment. It also enabled the participating psychiatrists to further enhance their links/relationship with their English and Scottish peers, and gather further ideas on process and systems already in use elsewhere.


Feedback has been very good, with most Welsh psychiatrists now feeling more confident regarding their own facilitation of specialist perinatal clinic’s, where to obtain further support and Information, if required, and relevant networks/forums that they are eligible to join to further enhance their perinatal practice.


·         Promoting the Maternal and Infant Mental Health (MIMH) training, across Wales to increase awareness of perinatal mental health and in particular the importance of maximising mothers’ mental health and the relationship between mother and baby. This fully accredited and Agored certified training is a ‘trainer train’s a trainer’ course with qualifications at two levels. By ensuring the quality and standard of the MIMH’s training is consistently maintained, it is hoped that this will enable a standardised perinatal awareness and training to continue to be ‘rolled out’ across Wales. Several health boards have adopted this as their formal perinatal training with members of fully accredited trainers increasing.


·         Acting as a specialist advisory group the National Society for the Prevention of Cruelty to Children’s project which is looking at the provision of perinatal services in Wales.


·         Proving advice and support to the Tier 4 specialised service provision task and finish group, which is considering the provision of in patients services (mother and baby unit) for women in Wales who need to be admitted to hospital with perinatal mental health problems.


·         Co producing a collaborative conference with the Royal College of Midwives, which clearly established and promoted the necessity of the ‘early identification’ of those ‘at risk’ of Perinatal Mental Health problems, and timely ‘prevention’ by working in close collaboration with Midwifery. Each health board presented either their current provision or shared their future delivery plan.



·         Supporting the equitable delivery of services for those with a learning disability including the development of appropriate documentation and interventions, this will delivered by learning disability nurses working with woman with a learning disability across Wales who may experience a perinatal mental health problem.


·         Initiating two task and finish sub groups which are:

o   developing all Wales unified pathways and associated documentation and criteria, which will also supported consistent data collection

o   developing an agreed competency perinatal training framework at difference level of service provision.



The AWPMHSG also facilitates the all Wales perinatal community of practice


All Wales Perinatal Community of Practice (COP)


A community of practice is defined as:


“A process of social learning that occurs when people have a common interest in a subject or area, collaborate over an extended period of time, sharing ideas and strategies, determine solutions and build innovations”.


To this end, each health board has identified its ‘community’ for improving perinatal mental health services in Wales, this includes a:-  

-       Perinatal ‘Champion’ at Executive/Board level

-       Perinatal clinical lead

-       Perinatal nurse specialist lead

-       Perinatal service improvement team – which will be a multi-agency, multi-professional ‘team’ operating across primary, secondary and tertiary care levels.



The clinical lead and/or nurse specialist lead for each health board is a member of the AWPMHSG. The service ‘teams’ (which may be actual specialist teams and/or wider ‘virtual’ teams) participate in national collaborative learning/conference events and webinars planned by the AWPMHSG. These will adopt the Institute of Health Improvement (IHI) Breakthrough Collaborative Improvement methods and members of the Perinatal Community of Practice will be invited to join the 1000Lives Improving Quality Together programme


Aims of the COP


The Perinatal COP aims to improve and develop community services across Wales by sharing learning, resources and materials to develop effective, efficient, empowering and equitable services to women in need of these services, and to promote pathways to the relevant stakeholders in Wales to ensure timely and appropriate access to care. It has facilitated the:


·         Sharing of resources such as operational policies, job descriptions and person specifications to assist the development of service models to an acceptable standard across Wales.


·         Agreement that health boards will attain and monitor compliance to at least type 1 of the standards set out in the Royal College of Psychiatrists CCQI Network for Perinatal Mental Health Service Standards (Second Edition April 2014).


·         Agreement to benchmark service data, when available, to compare service demand, performance and development across Wales.


·         Co-ordination of events as required to promote Community Perinatal Mental Health Services within specialist mental health services, primary care and with the wider network of relevant stakeholders.


·         Dovetailing of the work of the Community of Practice with other networks including the CAMHs/ED network steering group, the Maternity Network Wales and the Neonatal Network Wales.


·         The dissemination of relevant research and practice information.


·         Provision of reports as required to Welsh Government on progress in the development of services.


A three year improvement work programme will be developed with annual milestones in collaboration with the following 3national Programmes:-

-       Together for Mental Health Delivery Plan 2016-19 – National Programme Board

-       Together for Children & Young People’s Programme Board

-       Early Years Collaborative programme – the first 1000 days. PHW WLGA United in Improving Health Strategic Leadership Group

-       Maternity Services Improvement Network & Heads of Midwifery Advisory Group (HOMAG). 


Reporting and accountability of the Perinatal COP within the NHS will be to the CAMHS/Eating Disorders Network (Service Planning Group) chaired by Carol Shillabeer on behalf of Health Board Chief Executive’s, and facilitated by WHSSC. The AWPMHSG and Perinatal COP maintains a close relationship with perinatal voluntary services, across Wales, with relevant members participating on the national steering group. Since its foundation, the steering group has ensured that the voice of those with ‘lived experience’ maintains a consistent presence and position at steering group level, and within the Perinatal COP, contributing to all discussions and decisions made.

Paper developed by:

Lisa Kinsella: National Clinical Lead for Perinatal Services, Public Health Wales

Andrea Gray: Mental Health Development Lead for Wales, Public Health Wales

 3 July 2017