Impact case study database

Informing National Clinical Guidelines

O’Mahen’s research [3.1, 3.2] on perinatal mental health problems (PMH-P) interventions directly informed the 2014 NICE Antenatal and Postnatal Mental Health Guidelines [5.1] in three ways:

• Overarching guidance that psychological treatment should be adapted for perinatal specific concerns and delivered by perinatal competent providers (p.378).

• Guidelines for using CBT specifically for PND (p. 649).

• Two new recommendations for perinatal facilitated self-help (p.378, 649).

The lead of the guideline development group confirmed that “ This [Exeter] research has made a significant contribution to improving mental health treatment and access to women with PMH problems. These new recommendations in the NICE guidelines would not have been possible without the work produced by Prof O’Mahen.” [5.4]

O’Mahen’s research also informed the later 2017 Welsh Matrix Guidelines [5.2] which focuses on the need for improved access to perinatal mental health (PMH) services in Wales. O’Mahen’s trials were two of three studies underpinning the “A” research quality recommendation for guided self-help for mild antenatal or postnatal depression and was the singular study supporting the recommendation of Cognitive Behavioural Therapy for antenatal depression [5.2].

Figure 1: A schematic to illustrate the process of impact generation

Influencing clinical standard-setting in PMH psychological treatment provision in primary and secondary care

O’Mahen’s research on psychological interventions adapted for PMH-P has shaped government policy and guidance and influenced the structure of psychological treatment provision in both primary and secondary mental health care. O’Mahen was one of a small number of specialists that contributed to the development of NICE’s Antenatal and Postnatal Mental Health Quality Standards [5.3]. In her expert role, O’Mahen drew on the 2014 NICE guidelines, as described above, to ensure that prompt access to perinatally adapted psychological interventions was included as one of six key targets that providers of PMH-P care should meet.

Both the quality care standards and 2014 NICE guidelines inform the pathways to mental health care for perinatal parents in the UK and the government has recognised this as a priority area. Faced with considerable national disparities in the provision of care to perinatal parents, the UK government invested £365 million in the 5 Year Forward View (2016) and £1,015 billion in the Long-Term Plan (2019) to ensure parents in the UK received NICE guideline-concordant care for PMHP. NHS England projects 66,000 perinatal women will access perinatal community mental health teams each year (25% of women with PMHP problems). In addition, Improving Access to Psychological Therapies (IAPT) aims to treat 87,750 (25%) of mothers and fathers with PMH problems per annum.

O’Mahen’s work also then contributed to a wide-scale national transformation in the provision of perinatal specific psychological treatment. From her work, 980 therapists and 2,100 perinatal practitioners (80% already established and 100% of new psychologists) [5.7, 5.9, 5.10] have been trained in delivering evidence based perinatal treatment including Exeter-developed psychological interventions [3.3, 3.4, 3.5, 3.6], which offer cost-effective treatment for the NHS, treating over an estimated 61,163 people.

Shaping Clinical Competences Frameworks

Exeter headed the development of the national psychological clinical standards of practice and co-wrote the Health Education England (HEE) perinatal psychological assessment and therapy competencies [5.5]. O’Mahen led on NHS England and IAPT funded (£50,000) awards to develop a national IAPT perinatal competency framework, and national perinatal practice guide for IAPT practitioners [5.6]. These frameworks draw directly on O’Mahen’s research specifying how to adapt the content and delivery of treatments for PMH problems (e.g., PND, anxiety). The frameworks support identifying staff competency and training needs and set a foundation on which to develop training curriculum content. The PMH training lead for London stated that “...Prof. O’Mahen’s research on interventions for perinatal depression highlight the specific content and delivery adaptations needed to ensure the effective provision of mental health treatments during the perinatal period. As such, her research has made a significant contribution to the competences and training underpinning the competent delivery of evidence based mental health treatment to perinatal mothers...”. [5.10]

Creating a national training program for all new UK perinatal psychologists

With colleagues from the University of Liverpool, IAPT, the British Psychological Association Perinatal Faculty and Exeter, O’Mahen led the development and implementation of national training programmes in primary and secondary care with content developed from her research. She has now trained a national multidisciplinary cohort of psychological practitioners, clinical psychologists, psychiatrists, midwives, and health visitors.

O’Mahen’s training for perinatal clinicians has included a HEE national training program for all new UK perinatal psychologists in the NHS England expanded perinatal community mental health teams, which she led on with staff at Exeter and colleagues from the University of Liverpool. The course is highly rated (mean=8/10) on developing perinatal-relevant skills. This program has been recommissioned for additional psychologists (n=140) in 2020/2021 and 2021/2022. Assuming a 20-year career course, this training will influence the care of up to 1,320,000 perinatal women.  " Prof. O’Mahen, ...has led on the delivery of the national training program for perinatal psychologists, [which was] based on evidence-based interventions, drawn from perinatal trials in the 2014 NICE Antenatal and Postnatal Guidelines, which included Prof. O’Mahen’s research.” [5.10]

O’Mahen developed and delivered perinatal-bespoke training for IAPT primary care mental health providers, drawing heavily on the facilitated self-help materials O’Mahen trialled with Netmums. [5.8] As a service, we have found that the adaptations we now make (after your training and booklets) have made a huge difference in the positive feedback we get from new mums and pregnant women… and have made a difference in their clinical improvement and continued positive mental health”. [5.7]

This training has been far reaching, including:

• 650 IAPT clinicians from 66 services (50% of all services nationally, including 33 perinatal leads from each of the 33 IAPT services in London, treating up to 1400 women/each over career) who cascade training to their service which “.. .has been very helpful for all the IAPT Services treating mothers with PMH problems and their children, especially as it can be catered to their needs and personal goals.” [5.9] Feedback from this highly rated training (mean=4/5) indicated clinician attendees are using the training and booklets with a positive impact on women.

• O’Mahen’s perinatal self-help materials have been downloaded over 2,491 times, 648 by IAPT/primary care therapists.

Nationally, over 60% of IAPT services have used the perinatal guided self-help materials or received training based on O’Mahen’s research, treating up to 3,800 women/year.

Informing the development and production of a successful online self-help programme and face-to-face treatments

The Head of Support at Netmums stated in 2020 [5.8]: “ We were pleased to work with Prof. O’Mahen to offer one of the first online CBT courses for postnatal depression, raising considerable awareness of postnatal depression and supporting women to overcome their symptoms. Since its inception, over 37,000 women have benefitted.”

Further expanding the reach of O’Mahen’s perinatal “Netmums” intervention, Exeter, with a grant from FutureLearn, developed an online training programme for the mCBT aimed at healthcare professionals. Over 237,537 people joined the 3-week course in 2019-202 This course has given me the tools I need to implement treatment with my patients.” This innovative form of teaching is meeting a clear gap in accessible, online training, providing clinicians with the skills to support perinatal women.”

International Reach

The impact of O’Mahen’s research has now had international reach. In recognition of the success of the Netmums course, it has been adapted in the United States, and Japan, where it is offered in two major area hospitals providing care for over 10,000 mothers in the Tokyo/Yokohama areas. Others have also referenced this course in their own development of postnatal online courses in Spain, the Netherlands, and Canada. [5.8] Further, all perinatal psychologists in Gothenberg, Sweden now offer the antenatal anxiety intervention O’Mahen and colleagues developed.

The resulting impact is O’Mahen’s PMH-P research and interventions continue to inform & shape clinical guidelines and practice, and provide affordable and accessible mental health care for women with PMH-P both in the UK and internationally.