The process for a woman who needs psychological therapy support to access it:
Funding which was made available to each Health Board in 2015 has been utilized to develop specialist community based teams within each Health Board in order to provide support to women, their infants and families. The challenge faced by these new teams, is the provision of care and treatment required for women with moderate to severe perinatal mental health problems, whilst liaising with and providing training for staff in primary care. The Health Board has successfully developed a Perinatal Mental Health Service and has recruited a multidisciplinary team which includes a Perinatal Consultant Psychiatrist (O.3wte), Perinatal Specialist Lead Nurse (1.0wte), Occupational Therapist (O.5wte), Psychology Assistant (O.5wte), Perinatal CPN (1 .4wte) and a Clinical Psychologist (O.2wte).

All women within the Health Board area, upon the receipt of their All Wales Handheld Antenatal notes, will also be provided with a Health Board Perinatal leaflet clearly outlining the purpose of the service. The leaflet contains details of any relevant contact numbers and useful websites. The leaflet also aims to normalise Perinatal Mental Health problems by its use of language and discussion on how every woman has the propensity to be affected by the increase in hormone levels during the perinatal period. It also clearly outlines what is offered by the service and how this is achieved.

There is a clear pathway for accessing Psychological Therapy within the Health Board. The Integrated Perinatal Service is fully functioning in Pembrokeshire and will be fully operational in September 2017 across Carmarthenshire and Ceredigion.

Specialist Perinatal interventions are offered within Primary Care, with priority given to all Perinatal clients, in order that they may receive intervention in a timely manner. Within the Health Board's Therapeutic Day Service, the 'Emotional Coping Skills' module from Dialectical Behaviour Therapy (DBT) has been specifically adapted, with assistance from Midwifery and Health Visiting, to offer a pertinent range of coping skills during the perinatal period for women who experience emotional dysregulation. Within the local Primary Mental Health Support Service, a specialist antenatal template for group work to utilising the principles of Cognitive Behaviour Therapy (CBT) has been created. The purpose of this group is to alleviate antenatal anxiety. Work is currently progressing to create a group for Perinatal post natal problems and the team plans to initiate a specialist group, the focus being to enhance the 'first attachment relationship' between mother and infant.

Women with a diagnosis of a serious mental illness (SMI), can be offered an assessment by the Perinatal Clinical Psychologist, the resulting formulation, (a theoretically-based explanation of the information obtained from a clinical assessment), is then shared with the psychology team in each Community Mental Health Service (CMHS). All young women under 18 years of age, if they meet the criteria of a mental health disorder which may require intervention, medication or both, and are assessed to be in need of Perinatal Service assistance alongside S-CAMHS intervention and support, will receive Care Coordination in S-CAMHS.

The Primary Care Service within the Health Board provides the majority of the Perinatal Service's psychological interventions, which have been created in collaboration with the Health Board Midwifery and Health Visiting services. All Perinatal women are given priority to ensure timely intervention in order to help prevent problems occurring or reduce further deterioration.

Where Psychological assessment is needed following an initial psychological intervention at a low intensity level (Matrix Cymru 2017), a referral will be made to the Integrated Psychological Therapy Service (lPTS). The IPTS includes a range of psychological modalities such as Cognitive Behavior Therapy, Psychodynamic Psychotherapy, Systemic Psychotherapy or Integrative Psychotherapy. These therapies are usually delivered as a high intensity intervention for complex presentations.

Waiting times for access to psychological therapy services

Within the Perinatal Mental Health Service there is access to a Specialist Perinatal Clinical Psychologist (0.2wte) and a Psychology Assistant (2.5wte). There is no waiting list for assessment and intervention within the Perinatal Mental Health Service. The Perinatal Service works in collaboration with Local Primary Mental Health Services and the Integrated Psychological Therapy Service for the provision of Psychological Therapy, as due to the limited clinical resource, the Clinical Psychologist prioritises assessment and support to the multidisciplinary team.

Referrals for Psychological interventions are directed to Primary Mental Health Services and the Integrated Psychological Therapy Service for more complex presentations, where a specific intervention such as CBT or Systemic Psychotherapy is required.

Within the Integrated Psychological Therapy Service (lPTS), waiting times vary according to the therapy modality. The waiting time for psychodynamic therapy is 18 months; however The Health Board has recently appointed three CBT therapists in addition to Integrative Therapists to the team which will lead to a reduction in this waiting time.

The number of individual and group Perinatal clinical psychological sessions provided by your Heath Board weekly

The following individual and group Perinatal clinical psychological sessions are offered within the Health Board:

· Individual Perinatal Clinical Psychology sessions, 2 sessions per week offered.

· Individual sessions by Psychology Assistant, 5 sessions per week offered.

· Baby in Mind CBT Group Sessions, 22 patients have been referred referred, there isno waiting list for this.

· Emotional Coping Skills -Low Intensity Group, 18 people have been referred, there is currently no waiting list.

In addition to the Specialist Perinatal Psychologist and Psychology Assistant, the Adult Psychology Service also provides psychological interventions where there is co morbidity and or complex presentation.

A breakdown of the proportion of time spent by each of your psychologists on providing:

a. 1-to-1,

In the Health Board the proportion of time spent by the Clinical Psychologist in the provision of one to one treatment is 25%, and the Assistant Psychologist is 25%.

b. Group, psychological therapy sessions for women requiring Perinatal support.

In the Health Board the proportion of time spent by the Clinical Psychologist in the provision of group psychological therapy sessions for women requiring Perinatal support is 25%, and the Assistant Psychologist: 25%.

Additional Comment

Three members of the Health Board Perinatal team have received training in the Introduction to Video Interactive Guidance (VIG); however VIG cannot be delivered until the clinicians have completed Levels 1 and 2, and specialist supervision is in place. This, therefore, would seem to be a key priority for the Committee to support, in respect of increasing access to further training and supervision on a national level.

I hope that this information on the provision and waiting times for services in the Health Board is sufficient for your inquiry.