In response to your letter of 24 July, regarding the inquiry into Perinatal Mental Health the following summarises the Health Board’s position relating to your specific questions. 

The Perinatal Mental Health Team for Aneurin Bevan University Health Board has been operational since October 2016.  The service accepts referrals for women with moderate to severe mental health problems from conception until they are 6 months postnatal.  

We currently have one Principal Clinical Psychologist in post for 18.5 hours per week.  Until June we also had a full time temporary Assistant Psychologist in post, but as other members of the specialist multi-disciplinary team have been appointed with the monies provided by Welsh Government, the service has recently appointed an Assistant Psychologist for 18.75 hours per week.   

1. The process for a woman who needs psychological therapy support to access it:

Following referral the clients are assessed by a borough clinician from the Peri-natal team within 28 days of referral to the team.  If the team member and the client believe they would benefit from group intervention, the client will be offered a space in the next available group therapy programme.  Currently as the newly appointed Assistant Psychologist has yet to commence post, the only group available is for Acceptance and Commitment Therapy (ACT) which is offered to any mothers residing in the 5 boroughs of Aneurin Bevan but is delivered in Newport.  Previously the Assistant Psychologist was co-facilitating the ACT group and running two mindfulness groups, one in Newport and one in Caerphilly.   

If the team member feels individual psychological intervention is needed then the team member will discuss the client in the multidisciplinary team meeting or arrange a consultation with the psychologist.  The psychologist will either support the clinician, through supervision, to provide a psychological intervention or offer an assessment appointment either individually or jointly with the borough clinician.  Following assessment, the psychologist then decides whether direct intervention is required from the qualified or assistant psychologist or whether the team clinician can deliver a psychological intervention with support through supervision with the qualified psychologist.  

For birth trauma the mental health midwife is also able to offer REWIND therapy following her assessment appointment.

2. Waiting times for access to psychological therapy services: 

There is not a waiting list for access to psychological services.  However due to only offering one group at present, some clients may have to wait up to three months to start a group.  When the assistant psychologist was in post all women requiring psychological intervention were offered a group intervention within a month of their assessment.

For individual therapy, the qualified psychologist will offer an assessment within a month of the referral from the team member.  The longest wait for individual intervention with the qualified psychologist is approximately two months.  

For birth trauma, the mental health midwife is able to offer REWIND therapy within 1-2 weeks of a referral.

3. The number of individual and group perinatal clinical psychological sessions provided by your Heath Board weekly:

The Principal Clinical Psychologist provides:

1 session group intervention

1.5 individual sessions (assessment or intervention) 

4. A breakdown of the proportion of time spent by each of your psychologists on providing a)1-to-1, and b) group, psychological therapy sessions for women requiring perinatal support [please provide disaggregated data for (a) and (b)

Principal Clinical Psychologist:

a) 1-1 16%

b) Group 11%

Assistant Clinical Psychologist (when in post):

a) 1-1 8%

b) Group 16%

The Health Board aims to provide psychological intervention to all women who need this support.  The Health Board does not hold a waiting list for psychological interventions as this would be unhelpful to mothers prenatally, moreover, it would also be detrimental to the infant if their mothers mental health goes untreated.  Therefore, where psychology staff have no capacity to deliver the intervention directly there is support and supervision to other clinicians to provide a timely approach to psychological intervention. The specialists are investing time in providing supervision, consultation and training to develop the skills of other clinicians to ensure a wider group of mothers are given effective psychological advice and support. 

There are unmet needs within this population. Within the perinatal team we can only offer brief and time limited interventions due to limited capacity.  This means clients’ needs may only be partially met if they require longer term interventions. Clients with longer term needs can be referred onto secondary care Adult Mental Health services, though the Health Board recognises there are long waits for psychological intervention in many of these services.  

The demand for psychological therapies is immense and growing. The service would like to further develop therapeutic groups focusing on the infant-parent attachment (e.g. the evidence based Watch, Wait and Wonder groups) and Dialectical Behaviour Therapy groups to address mothers with emotional dysregulation.  The Health Board would also like to develop an antenatal mindfulness group for couples and consider the provision of crèche facilities to make these services more accessible.

This will all be considered in are part of the development of the next Health Board’s Integrated Medium Term Plan for prioritisation for additional funding.

I hope this answers your questions and reflects the commitment of our clinicians to support mothers who require psychological therapies. If you would like any further information please do not hesitate to contact me.