The Effectiveness and cost-effectivenesSof Mother and Baby Units versus general psychiatric Inpatient wards and Crisis Resolution Team services (ESMI)

Study ID: 17573
Short Title: The effectiveness of perinatal mental health services
Organisation: Dorset Healthcare University NHS Foundation Trust
Location: Dorset Healthcare University NHS Foundation Trust
Condition: Psychosis
Main Specialty: Mental Health
Expected End Date: 28/02/2018
Postcode: BH1 4JQ
Contact Name: DHUFT Research & Development
Contact Email: dhc.research&
Active: Yes

Inclusion Criteria

Women, with capacity to consent, admitted to MBUs, general wards or CRTs for acute perinatal psychiatric disorders in the first year post-delivery

Exclusion Criteria

1. Women under these services “prophylactically” (i.e. for close monitoring in high risk cases or for statutory parenting assessments (i.e. not for acute illness).

2. Women whose baby is permanently removed from their care prior to the index admission.

3. Women without mental capacity to consent one month post-discharge.

Study summary:

The Royal College of Psychiatrists state that women needing psychiatric admission post-delivery should be admitted to Mother and Baby Units (MBUs). MBUs aim not only to care for the mother's psychiatric needs but also to support the mother and baby relationship, which may be at risk in this group. However, there has been little research on the effectiveness of MBUs and no data comparing MBUs with other services for acutely ill women in the postnatal period. Many areas of the UK do not have access to MBUs and their size and operational characteristics vary considerably. NICE guidance recommends further development of, and research into, services for women with acute postnatal severe disorders. Data are, therefore, urgently required for commissioners of perinatal mental health services if access is to become more equitable.

People with acute disorders not necessitating detention under the Mental Health Act can be cared for by Crisis Resolution Teams (CRTs) in their home. This may be offered instead of MBU or general psychiatric ward admission and, therefore, also needs to be included in any comparison of services for acute severe perinatal disorders. A strength of CRT care is that the mother may be able to be at home with her infant and share care with the child’s father/other family members. However caution has been expressed about the use of CRTs for women with acute severe postnatal disorders, because postnatal psychotic episodes can develop into very serious disorders within hours, leading to an increased risk of suicide and infanticide.

We will conduct a quasi¬experimental cohort study of women with acute severe mental disorders who need intensive treatment urgently following birth. This study aims to investigate the effectiveness and cost-effectiveness of MBUs compared with general psychiatric wards or care from CRTs for acute severe postnatal disorders.

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