The Healthcare Commission undertook a major review of maternity services in England in 2007.

• Healthcare Commission (2008) Towards better births: A review of maternity services in England. London: Healthcare Commission.

In respect of the identification and management of mental health needs, the review found that:

• recording of mental health needs by maternity staff in trusts is inconsistent, and it is therefore difficult to gauge how common such problems are;
• all trusts reported that they covered mental health at the booking appointment, and just over half (55%) used the specific questions recommended by the NICE guidance (NICE 2007);
• approximately one third of trusts had joint clinics with mental health teams for previous perinatal mental health disorders;
• only a fifth had specialist midwives for women with pervious postnatal psychosis (19%) or to support women with a psychiatric disorder (21%), compared with nearly two thirds (63%) of trusts which had specialist midwives supporting women who misuse substances;
• only 40 out of 148 trusts were able to provide data on the prevalence of mental health problems at ante-natal clinic booking;
• only 29 trusts could give data on mental health referrals.

The Maternity Service Review recommended that trusts need to improve their provision for women with mental health needs in several ways:

• Trusts and PCTs should secure access to a specialist perinatal mental health service with acceptable waiting times for referral. Midwives should be authorised to make referrals;
• Trusts need to incorporate NICE guidelines into their booking appointment checklist;
• Trusts need to review their provision of specialist midwives for mental health needs;
• All trusts should have access to a psychiatric mother and baby unit providing care for mothers with serious mental health needs and their babies.