Developing a Perinatal Mental Health Indicator (PMHI)
Mental disorders which are present during pregnancy and the postnatal period (known as perinatal mental disorders (PMD)) are common and can have serious consequences for mother, her family and the development of her baby. The 2014 NICE guideline sets out standards for the identification and care of women with PMD including anxiety disorders, depression, and psychotic disorders. However, service provision remains a concern with poor implementation of perinatal mental health networks. It is nevertheless important that women with PMD are recognised early, have access to effective treatment, feel supported by services and make an optimal recovery.
In order to be clear that services are identifying women, offering appropriate and accessible services and achieving outcomes acceptable to women and clinicians it is proposed to include an indicator in both the NHS and the public health outcomes framework from 2018. To give a rounded picture, it is desirable that this indicator would reflect information both from the women’s experience and from their clinical notes. This project aims to develop and pilot test a suite of perinatal mental health indicators (PMHI) which would reflect care at certain critical time-points in pregnancy and the postnatal period.
There are four main objectives of the project. These are to determine:
- What information should be collected?
- How feasible is it to collect and collate this information?
- What needs to happen to ensure this information can be collected?
- How best to aggregate the information and present it in a simple and meaningful way?
The following project stages and methods are being used for this project.
A. Use of a steering/advisory group.
The complexity of this project means that input is required from the start across a wide range of potential stakeholders. Advice has been taken on use of specific instruments, technical issues on information gathering, effective presentation of indicator data, clinical practicalities of data collection as well as strong user and voluntary groups’ representation and input.
A longlist of draft indicators were developed by the advisory group which were further developed and refined by a consultation process involving a number of stakeholder organisations and individuals who have worked in this area.
A rapid scoping review of the national and international literature on perinatal mental health indicators and their development was undertaken.
C. Pilot testing of questions
Questions to elicit information from women about mental health problems have tested as part of an audit of health visiting
D. Feasibility of collecting data to form indicator set
Work is being planned to develop indicators from existing data sets held by the Health & Social Care Information Centre (www.hscic.gov.uk/)We are requesting tabulated data which links Hospital Episode Statistics with the Maternity and Children's Data Set, the Mental Health Minimum Data Set and the Improving Access to Psychological Therapies Data Set We also hope to have some new questions (piloted as per section C above) included in the new Community Information Data Set.
E. Manualisation of data collection methods and indicator construction
The final stage of the project involves writing up the data collection methods and construction of the indicator in such a way as they can be meaningfully and easily collected form 2018/19 onwards.
Proposed Indicators (Updated to include feasibility)
1. Apex Indicator (asked by health visitors at a contact roughly 9 months following the birth.
a) While you were pregnant or since your baby was born, did you experience any problems with you emotional or mental health or have a period of feeling low?
b) What help did you get with this?
c) What more help would you have wanted?
These items have been proposed to the HSCIC for possible inclusion in the Community Dataset which is scheduled for release in April 2017.
2. Linked data from Hospital Episode Statistics dataset (HES), Improved Access to Psychological Therapies dataset (IAPT), and Mental Health Minimum DataSet (MHMDS)
At the moment the feasibility of creating the following indicators using HSCIC data is being explored.
Indicators being developed further
There is enough historical data currently available to create 4 of the proposed indicators for maternities for the years 2013/14 to 2014/15 using linked data from HES, IAPT, and MHMDS. It should be noted that such a linking exercise has not been undertaken by the HSCIC to date, and will be attempted for the first time for the indicator development work for the NPEU.
The following indicators can be constructed:
i. Number of treatment scores rated as “reliable improvement” for women referred to the IAPT programme between 40 weeks before birth and 52 weeks following birth per number of maternities (linked delivery records in HES/IAPT).
ii. Number of occupied bed days of women admitted to in-patient psychiatric wards between 40 weeks before birth and 52 weeks following birth per number of maternities (linked HES/MHMDS).
iii. Number of women seen between 40 weeks before birth and 52 weeks following birth by a member of a specialised perinatal mental health community team per number of maternities (linked HES/IAPT)
iv. Number of women seen by any mental health professional/psychiatric services between 40 weeks before birth and 52 weeks following birth per number of maternities (linked HES/MHMDS)
Indicators not being developed further at this time
As a result of delays in dataset implementation for the Maternity Dataset and Community Dataset, the indicators based on these datasets cannot be constructed at this time and would need to be revisited in 3-5 years’ time.
The indicators which cannot beprogressed at this time are as follows:
i. Number of women admitted to a mother and baby unit between the booking appointment and the 12 months following the birth per number of maternities (proposed data sources HES/MHMDS). *Please note there is currently no flag to indicate women admitted to Mother and Baby In-patient Psychiatric Units.
ii. Number of women detected as having significant psychological problems at antenatal booking appointment as a proportion of all women attending booking in a given 12 month period (proposed data sources Maternity and Children's Data Set)
iii. Number of women reporting personal history of severe mental illness and/or previous treatment by mental health services at booking as a proportion of all women attending booking in a given 12 month period(proposed data source Maternity and Children's Data Set)
As this is proof of concept, NPEU is applying to HSCIC for a one off set of tabulated data or failing that aggregate data file for each indicator. We do not require and are not requesting identifiable data on individuals.