What are Perinatal Mental Health Services?

Most of us expect to feel happy, excited and positive during pregnancy, and when our baby is born. But it doesn’t always happen like this.  You can feel many different emotions during pregnancy and after birth.  These can range from love, pride and joy, to worry, sadness and frustration. It is natural to feel stressed or anxious at times during pregnancy - or when you have a new baby. These emotions are quite normal.

Up to 1 in 5 women have mental health problems in pregnancy or after birth.^1-3 Some of these are mild and some are more severe. You may:

• Already have a mental illness when you get pregnant.
• Worry because you have had such problems in the past – this may make it more likely that you will become unwell during your pregnancy or after birth. However, with the right help, this can often be prevented. 
• Develop a mental health problem for the first time in pregnancy or after birth. 

It is a service for any woman, with mental health problems, who is planning a pregnancy, pregnant or who has a baby up to one year old.⁴ These services aim to:

• Help you stay as well as possible during pregnancy and after your baby is born.
• Make sure that you, your family and other professionals can recognise if you become unwell - as soon as possible.
• Give the best possible care, treatment, help and support to you and your family.
• Help you to enjoy having your baby, and to develop confidence in being a mum.
• Make sure that you, your partner and family have the information you need - and can get advice - about mental health problems and treatments.
• Work together with you, your partner and family and the professionals involved.

A perinatal mental health service will usually look after someone who has a more serious or complex mental health problem. So, no, not every woman with a mental health problem during pregnancy, or after their baby is born, will need this service. You can get good care from your GP for mild to moderate mental health problems in pregnancy and after birth. If help from your GP is not enough, he or she can refer to you a perinatal mental health service.

You may already be seeing a community mental health team but you should still be referred to a perinatal service for expert advice and support. The teams can work together with you, your family and any other professionals involved.

If you have a more severe mental health problem, you might need to come into hospital. This should usually be a specialist psychiatric Mother and Baby Unit (MBU) where you, and your baby, can be admitted together. MBUs admit women in late pregnancy and up to one year after birth. An MBU can help you to care for your baby and gain confidence as a mum, while having treatment you need yourself. Your perinatal mental health service will have links with the nearest MBU, so your perinatal psychiatrist or nurse can arrange admission if you need it. They will keep in touch while you are in hospital and help with plans for your discharge. After you leave hospital, they will carry on seeing you.

See our page about mother and baby units for more information.

You might find it helpful if:

• You have, or have had, a serious mental illness (like Bipolar Disorder, Schizophrenia or another psychotic illness) and want to get pregnant.  You can have preconception counselling.  See our page on Planning a Pregnancy for more information.
• You have had Bipolar Disorder, Schizophrenia or another psychotic illness, and are pregnant – you may be more likely to have a mental health problem around the time of your birth.
• You have been under the care of a mental health service for another serious mental health problem, such as severe Depression, Obsessive Compulsive Disorder or Post Traumatic Stress Disorder.
• You have a family history of Bipolar Disorder or Postpartum Psychosis. This can increase your risk of developing Postpartum Psychosis.
• Treatment from your GP is not helping enough.

• Advice about your risk of developing a mental health problem in pregnancy or the postnatal period - and how to reduce this risk.
• Helping you to weigh up the risks and benefits of using medication during pregnancy and breastfeeding.
• Psychological treatments (talking therapies).  These vary quite a lot - some offer group therapies as well as individual treatment. Talking therapy can look at your past or how to cope with a current problem. It can help you to develop new ways to manage your symptoms. Some services offer “parent-infant” therapies to help bonding.
• Support and advice to help you build both a positive relationship with your baby and a sense of confidence in being a mum.
• They will work closely with midwives, health visitors, adult mental health teams and GPs.
• Referring you to other services which offer practical help and support for families. This could be a local voluntary service or charity.
• Helping you to plan for your care during pregnancy, birth and the postnatal period.
• Giving advice and information about mental health problems to your partner and other family members. They will want to understand your illness, your risk of becoming unwell, and now how best to support you.
• Arranging admission to a Mother & Baby Unit.
• Providing support for anyone discharged from a Mother & Baby Unit.
• Teaching and advising GPs, midwives and other professionals, so they can give better care.

•  Antenatal clinics
• Children’s Centres
• Health Centres
• Your home
• Maternity wards

•  GP
• Midwife
• Obstetrician
• Health Visitor
• Psychiatrist
• Care co-ordinator (community mental health team).

You are likely to meet one or more of the following:

Perinatal psychiatrist – this is a psychiatric doctor who will oversee your care.  They can discuss your diagnosis with you, tell you what treatments might help and what risk might be of you getting unwell during pregnancy or after birth.  They can help you to decide about using psychiatric medication in pregnancy or when breastfeeding. They can also help you to use talking therapies.

Specialist perinatal mental health nurse – these are nurses who specialise in looking after women during pregnancy and the postnatal period. They can help you look out for signs of mental illness. They can teach you how to cope with any symptoms or worries you may have. They can also help you to develop your relationship and confidence with your baby.  

Psychologist – can offer short-term psychological treatments (talking therapies). These usually focus on how your mental health and pregnancy/parenthood affect each other. They can help you to work out ways to manage your difficulties.  They can also tell you about longer-term talking treatments that might help, and refer you to services that offer them.

Other professionals – some services have other professionals as part of the team.  These may include occupational therapists and nursery nurses.  They can provide support and practical advice to help you care for your baby and manage life as a parent.

• Midwives
• Obstetricians
• Health visitors
• GPs

• Mental health professionals from community mental health teams
• Social workers

• Specialist mental health midwife – offers support for milder symptoms of anxiety or low mood, particularly when these are related to pregnancy or anxiety about birth.  They also act as the link between perinatal mental health and maternity services.
• Improving Access to Psychological Therapies (IAPT) – offers short-term talking therapies. These can include guided self-help sessions with a therapist, cognitive behaviour therapy, couples’ therapy, counselling, individual or group therapies. If you are pregnant, or have recently had a baby, you would usually be given priority. You can often bring your baby to appointments. Some IAPT services also have groups just for women who are pregnant or for new mums.  You can refer yourself to your local IAPT service – or your GP, midwife or health visitor can do this for you.
• GP – can diagnose a mental health problem, prescribe medication if you need it and  refer you to other services.
• Health visitor - provides advice and support about caring for your new baby.  They can offer listening visits if you have Postnatal Depression.
• Children’s centres - offer advice, practical and social support.  They run mother and baby groups and drop-in sessions. You can meet other new parents and develop your confidence as a mum.
• Online resources – there are lots of websites which provide information and support for women with mental health problems during pregnancy and beyond.  Some of these are listed at the end of this page.

Your GP, midwife and health visitor will know what support is available in your local area and can help you access this.

1. Tommy’s - www.tommys.org/pregnancy-information/im-pregnant/mental-wellbeing  

Mental wellbeing in pregnancy – patient information written by midwives

2. Action on Postpartum Psychosis - www.app-network.org/ 

A national charity for women and families affected by postpartum psychosis.  Provides information and peer support, including online forums and workshops

3. Beating Bipolar - www.beatingbipolar.org 

An interactive internet based programme that aims to improve understanding of the condition. It includes video of professionals and people with lived experience of bipolar disorder.  Includes a module about pregnancy for women with Bipolar Disorder: www.beatingbipolar.org/women_and_bipolar/ 

4. Best Beginnings - www.bestbeginnings.org.uk/ 

Baby Buddy App – allows you to create a Bump Buddy avatar to guide you through your pregnancy.   Provides information about many aspects of pregnancy and parenting, including mental wellbeing, in the form of short video clips 

5. Best Use of Medicines in Pregnancy (BUMPS) - www.medicinesinpregnancy.org/ 

Information leaflets for women and their partners about use of a medication in pregnancy

6. Maternal OCD - www.maternalocd.org/ 

Support and Information for women with Perinatal Obsessive Compulsive Disorder

Twitter support group: #Bumpsandmumsocdhr 

7. Netmums- www.netmums.com 

Information and support on many aspects pregnancy and parenting, including local resources

8. PANDAS - www.pandasfoundation.org.uk 

Antenatal and postnatal depression information and support for women and families. Support groups and helpline 

9. PND and Me -www.pndandme.co.uk/ 

Website and online support group for sufferers of perinatal mental illness with links to information and a range of resources around this topic.  Set up by a mum who had postnatal depression. Includes peer support through Twitter: #PNDHour & #PNDChat 

1. Howard LM, Molyneaux E, Dennis C-L, Rochat T, Stein A, Milgrom J. Non-psychotic mental disorders in the perinatal period. The Lancet 2014; 384: 1775-88.

2. Howard LM, Ryan EG, Trevillion K, Anderson F, Bick D, Bye A et al. Accuracy of the Whooley questions and the Edinburgh Postnatal Depression Scale in identifying depression and other mental disorders in early pregnancy. Br J Psychiatry. 2018; 212: 50-56.

3. Jones I, Chandra PS, Dazzan P, Howard LM. Bipolar disorder, affective psychosis, and schizophrenia in pregnancy and the post-partum period. Lancet. 2014; 384: 1789-99.

4. Service standards: Third edition. Perinatal Community Mental Health Services (2016). Eds: Peter Thompson, Harriet Clarke and Hanna Moore. Royal College of Psychiatrist’s CCQI Perinatal Quality Networ.

This information was produced by the RCPsych Public Engagement Editorial Board.

The ‘Building Capacity, Psychiatry Leadership in Perinatal Mental Health Services’ project: commissioned by NHS England in partnership with Health Education England and delivered by the Royal College of Psychiatrists.

• Expert review: Dr Vanathi Kennedy, Dr Abigail Crutchlow and Dr Lucinda Green
• Service users and carers: Action on Postpartum Psychosis
• Series Editor: Dr Phil Timms 
• Series Manager: Thomas Kennedy