Theme: Implementation

Project Description

Women with perinatal mental illness (PNMI) face stark geographical and ethnic inequalities in access to care, experience and outcomes in the NHS. Women in minoritised groups or living with socioeconomic disadvantage experience higher rates of PNMI but areas serving these communities often have below average service access rates. While there are established referral pathways, professionals and women describe them as inconsistent, inequitable, fragmented and unclear. There is a lack of granular evidence about these problems. Women and those who care for them need more equitable pathways, and NHS decision makers need to be able to plan and monitor their equity and impact. Aim To explore current evidence and practice relating to PNMH referral and coproduce recommendations for clearer thresholds, pathways and guidance for decision-makers to improve equitable access and outcomes for women. WP1 Review of PNMH pathway evidence Method: Systematic scoping review of peer reviewed and grey literature Question: What evidence exists regarding PNMH pathways, referral thresholds and equitable resource allocation in high income countries? Output: To inform subsequent primary research and work packages. WP2 Qualitative interview study exploring perspectives and practice in PNMH pathways Method: Qualitative interviews with key informants across the UK: professionals and support workers caring for women with PNMI; diverse women and families with lived experience of PNMI; individuals responsible for service planning and resource allocation. Questions: What are stakeholder experiences and perspectives of NHS PNMH referral pathways and thresholds? How do they vary? What are the challenges, strengths, and how can their consistency, clarity and equity be improved? How do decision-makers assess PNMH need, access, outcomes and equity at population level and allocate services, including using routine data? How could this be improved? Output: Evidence to inform WP3 and WP4. WP3 Quantitative study exploring opportunities to use routinely collected data PNMH Method: Analysis of routinely collected data in the Midlands Secure Data Environment to identify available measures and explore patterns of access at different stages of the PNMH pathway (drawing on the PAAM study). This will be used to develop a methodology which can be used by systems to benchmark, identify need and activity across the pathway, and support commissioning. Questions: What are current access patterns and inequalities in PNMH services? How can routinely collected data be used to measure and monitor access and equity in PNMH pathways? Output: Evidence of current needs and access, gaps and inequities in PNMH. Prototype methodology which health systems can adopt to underpin population needs assessment, commissioning and monitoring of services. WP4 Coproduction of PNMH pathway improvements and guidance Method: Modified Delphi study to establish consensus on referral pathway, criteria and thresholds. This will involve survey rounds informed by WP1-3, consensus workshops with stakeholders similar to WP2. Approaches to implementation and dissemination will be coproduced e.g. tools, guidance, accessible documents to support implementation. Aims: To establish consensus regarding the criteria, thresholds and pathway for equitable PNMH services in the NHS, and how they may be implemented. To co-design plans for dissemination of study findings.