Protocol for a quasi-experimental study of the effectiveness and cost-effectiveness of mother and baby units compared with general psychiatric inpatient wards and crisis resolution team services (The ESMI study) in the provision of care for women in the postpartum period

Trevillion, Kylee; Shallcross, Rebekah; Ryan, Elizabeth G.; Heslin, Margaret; Pickles, Andrew; Byford, Sarah; Jones, Ian; Pawlby, Susan; Stanley, Nicky; Rose, Diana; Seneviratne, Gertrude; Wieck, Angelika; Jennings, Stacey; Potts, Laura; Abel, Kathryn M.; Howard, Louise M.

doi:10.1136/bmjopen-2018-025906

Cited by 14 publications

(14 citation statements)

References 43 publications

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“…This was a mixed-methods secondary data analysis of the ESMI (Effectiveness of perinatal mental health services) study. ESMI was a quasi-experimental cohort study embedded within existing service matrices, examining the effectiveness and cost effectiveness of psychiatric mother and baby units (MBU), compared with general psychiatric inpatient wards and crisis resolution teams (CRT) for mothers with psychiatric illness in the first postpartum year ( 23 ). The study obtained NHS Research Ethics Committee approval from the London-Camber well St. Giles committee (number: 14/LO/0765) and this secondary data analysis was conducted in accordance with the Declaration of Helsinki and General Data Protection Regulations.…”

Section: Methodsmentioning

confidence: 99%

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Factors Affecting Infant Feeding Practices Among Women With Severe Mental Illness

Baker

Potts

Jennings

et al. 2021

Front. Glob. Womens Health

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Background: The health benefits of breastfeeding are well-established but for mothers with severe mental illness (SMI), the decision to breastfeed can be complex. Very few prior studies have investigated the infant feeding choices of women with SMI, or the factors associated with this. Our aims were to examine antenatal infant feeding intentions and infant feeding outcomes in a cohort of women admitted for acute psychiatric care in the first postpartum year. We also aimed to examine whether demographic and clinical characteristics associated with breastfeeding were similar to those found in previous studies in the general population, including age, employment, education, BMI, mode of delivery, smoking status, and social support.Methods: This study was a mixed-methods secondary analysis of a national cohort study, ESMI-MBU (Examining the effectiveness and cost-effectiveness of perinatal mental health services). Participants had been admitted to acute care with SMI in the first postpartum year. Infant feeding outcomes were retrospectively self-reported by women during a 1-month post-discharge interview. Free-text responses to questions relating to infant feeding and experience of psychiatric services were also explored using thematic analysis.Results: 144 (66.1%) of 218 women reported breastfeeding (mix feeding and exclusive breastfeeding). Eighty five percentage of the cohort had intended to breastfeed and of these, 76.5% did so. Factors associated with breastfeeding included infant feeding intentions, employment and non-Caucasian ethnicity. Although very few women were taking psychotropic medication contraindicated for breastfeeding, over a quarter (n = 57, 26.15%) reported being advised against breastfeeding because of their medication. Women were given this advice by psychiatry practitioners (40% n = 22), maternity practitioners (32.73% n = 18) and postnatal primary care (27.27% n = 15). Most women stopped breastfeeding earlier than they had planned to as a result (81.1% n = 43). Twenty five women provided free text responses, most felt unsupported with infant feeding due to inconsistent information about medication when breastfeeding and that breastfeeding intentions were de-prioritized for mental health care.Conclusion: Women with SMI intend to breastfeed and for the majority, this intention is fulfilled. Contradictory and insufficient advice relating to breastfeeding and psychotropic medication indicates that further training is required for professionals caring for women at risk of perinatal SMI about how to manage infant feeding in this population. Further research is required to develop a more in-depth understanding of the unique infant feeding support needs of women with perinatal SMI.

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Section: Methodsmentioning

confidence: 99%

“…Short- and long-term follow-up assessments were undertaken at one- and 12-months post-discharge from psychiatric services. Detailed description of recruitment methods and study procedures can be found in the study protocol ( 23 ).…”

Section: Methodsmentioning

confidence: 99%

Factors Affecting Infant Feeding Practices Among Women With Severe Mental Illness

Baker

Potts

Jennings

et al. 2021

Front. Glob. Womens Health

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“…We have recently completed the first study using a quasi‐experimental design to examine the effectiveness and cost‐effectiveness of mother and baby units compared with generic acute psychiatric wards or crisis resolution teams (teams available daily providing intensive treatment at home) 207 . Analysis is underway to examine the effectiveness of mother and baby units in reducing readmission rates and other outcomes, including improving quality of mother‐infant interactions one month after discharge.…”

Section: Service Deliverymentioning

confidence: 99%

Perinatal mental health: a review of progress and challenges

2020

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Perinatal mental health has become a significant focus of interest in recent years, with investment in new specialist mental health services in some high‐income countries, and inpatient psychiatric mother and baby units in diverse settings. In this paper, we summarize and critically examine the epidemiology and impact of perinatal mental disorders, including emerging evidence of an increase of their prevalence in young pregnant women. Perinatal mental disorders are among the commonest morbidities of pregnancy, and make an important contribution to maternal mortality, as well as to adverse neonatal, infant and child outcomes. We then review the current evidence base on interventions, including individual level and public health ones, as well as service delivery models. Randomized controlled trials provide evidence on the effectiveness of psychological and psychosocial interventions at the individual level, though it is not yet clear which women with perinatal mental disorders also need additional support for parenting. The evidence base on psychotropic use in pregnancy is almost exclusively observational. There is little research on the full range of perinatal mental disorders, on how to improve access to treatment for women with psychosocial difficulties, and on the effectiveness of different service delivery models. We conclude with research and clinical implications, which, we argue, highlight the need for an extension of generic psychiatric services to include preconception care, and further investment into public health interventions, in addition to perinatal mental health services, potentially for women and men, to reduce maternal and child morbidity and mortality.

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“…For a full list of measures used see Trevillion et al (2019). This study draws its findings from the Perinatal VOICE (PV) questionnaire, a 27-item, self-report questionnaire, an adapted version of a service-user designed measure of views of acute care (Evans et al, 2012).…”

Section: Data Collectionmentioning

confidence: 99%

Mothers’ experiences of acute perinatal mental health services in England and Wales: a qualitative analysis

Powell

Bedi

Nath

et al. 2020

Journal of Reproductive and Infant Psychology

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Background/Objective: Perinatal mental health services are a current NHS priority and services are being increased for women. There is limited research on mothers' views of these services and most research focuses on mother and baby units. As part of an investigation into the effectiveness of acute perinatal mental health services in England and Wales, this study explored women's views of their experiences of generic wards, mother and baby units and crisis resolution teams.Methods: A qualitative thematic analysis was conducted on written feedback on a service user designed perinatal mental health questionnaire. 139 women recruited across 42 mental health trusts made written feedback comments.Results: Two key themes were identified: support networks and staff authority. Support networks included subthemes of family involvement; feeling understood by staff/peers, and staff and communication. The theme of staff authority included an overlapping subtheme of staff communication plus subthemes of lack of confidence in staff and service user autonomy.All of the themes contributed to whether mothers felt safe in these services. Mothers reported the benefits of positive, non-coercive relationships with family and staff for their mental health recovery. The findings highlight that the challenges women face in perinatal settings reflect the literature on general psychiatric services, particularly around the use of coercion.Conclusions: There are three specific implications for mothers accessing perinatal mental health services: 1) integrated mental health care and support with babies; 2) support with separation from babies for mothers in acute wards; 3) improvement of women's relationships with social services across all services.

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Protocol for a quasi-experimental study of the effectiveness and cost-effectiveness of mother and baby units compared with general psychiatric inpatient wards and crisis resolution team services (The ESMI study) in the provision of care for women in the postpartum period

Cited by 14 publications

References 43 publications

Factors Affecting Infant Feeding Practices Among Women With Severe Mental Illness

Factors Affecting Infant Feeding Practices Among Women With Severe Mental Illness

Perinatal mental health: a review of progress and challenges

Mothers’ experiences of acute perinatal mental health services in England and Wales: a qualitative analysis

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