The evidence shows a significant decline in maternal mental health during the pandemic:

1. The pandemic has posed mental health challenges for women during pregnancy and early motherhood.
2. The impact has been unequal.
3. Perinatal mental health services had worrying gaps even before the crisis.
4. Informal support has been detrimentally impacted.
5. Changes to labour and birth because of the pandemic have increased stress and anxiety.
6. Concern for infants and babies has increased stress and anxiety.There have been missed opportunities for understanding / fully responding to what being classed as vulnerable really means in the perinatal period.
7. Whilst still awaiting data, significant concerns exist for women with pre-existing mental health conditions.
8. Despite the increased need, services supporting women and families were impacted detrimentally.
9. The workforce supporting women and families in the perinatal period is facing its own wellbeing challenges and needs support.
10. Increased demand for voluntary and community services, who themselves have been impacted.
11. Virtual contact massively increased with mixed potential consequences and a need for evaluation.

Recommendations for action

The report makes the following eight urgent recommendations for action:

• Recommendation 1: Assessing the true level of demand.
• Recommendation 2: We want to future-proof perinatal mental health services against future pandemics or similar public health crises.
• Recommendation 3: We need up-to-date data to understand the changing picture.
• Recommendation 4: We need to tackle racial discrimination within health systems and adverse outcomes for people of colour.
• Recommendation 5: We need better research.
• Recommendation 6: We need to understand the impact of ‘remote’ mental health care.
• Recommendation 7: Government and NHS must recognise the importance of voluntary and community organisations.
• Recommendation 8: We must support the mental health of all health and care staff.

• staff reported more positively on their relationships with service users.
• staff felt their attitudes towards the use of coercive practices such as restraint were changed.
• the service as a whole shifted in terms of restraint awareness and reduction.
• new policies, procedures and language were introduced despite barriers.

WHO QualityRights core training:

• Human rights. Course guide, course slides
• Mental health, disability and human rights. Course guide, course slides
• Legal capacity and the right to decide. For mental health and social services. Course guide, course slides
• Recovery and the right to health. For mental health and social services. Course guide, course slides
• Freedom from coercion, violence and abuse. For mental health and social services. Course guide, course slides

WHO QualityRights specialised training:

• Recovery practices for mental health and well-being. Course guide, course slides
• Strategies to end seclusion and restraint. Course guide, course slides
• Supported decision-making and advance planning. Course guide, course slides

WHO QualityRights guidance:

• Peer support groups by and for people with lived experience. Guidance module, module slides
• One-to-one peer support by and for people with lived experience. Guidance module, module slides
• Advocacy for mental health, disability and human rights. Guidance module, module slides
• Civil society organizations to promote human rights in mental health and related areas. Guidance module, module slides

Service transformation:

• QualityRights Assessment toolkit
• Transforming services and promoting human rights. For mental health and social services. Course guide, course slides

Self-help:

• Person-centred recovery planning for mental health and well-being self-help tool

Taking the learning from good practice, the CQC want to see tangible progress on four key areas. Below is a summary of the CQC's recommendations.

1. People with a learning disability and or autistic people who may also have a mental health condition should be supported to live in their communities. This means prompt diagnosis, local support services and effective crisis intervention.
2. People who are being cared for in hospital in the meantime must receive high-quality, person-centred, specialised care in small units. This means the right staff who are trained to support their needs supporting them along a journey to leave hospital.
3. There must be renewed attempts to reduce restrictive practice by all health and social care providers, commissioners and others. We have seen too many examples of inappropriate restrictions that could have been avoided. We know in absolute emergencies this may be necessary, but we want to be clear – it should not be seen as a way to care for someone.
4. There must be increased oversight and accountability for people with a learning disability, and or autistic people who may also have a mental health problem. There must be a single point of accountability to oversee progress in this policy area.

Jo Mildenhall is a Doctoral Research Student at Manchester Metropolitan University; and Paramedic Team Leader, South Central Ambulance Service NHS Trust, Newbury Ambulance Station. 

• Working age adult admission wards
• Old age functional and dementia wards
• Forensic (high and medium secure wards)
• CAHMS tier 4 wards
• Eating disorder wards
• Perinatal wards
• Psychiatric intensive care units
• Low secure and rehabilitation wards.

The MHOST is part of a suite of Safer Nursing Care Tools (SNCT), delivered by the Shelford Group chief nurses in partnership with Imperial College London, which include those for adult in-patient wards, acute medical units and children and young people’s wards. The SNCT is endorsed by NICE and supported by NHS Improvement and NHS England. The SNCT are widely used across NHS organisations in England, as well as in private health providers and in many overseas healthcare organisations.

Kenny Laing, deputy chief nurse at Midlands Partnership NHS Foundation Trust and national lead nurse of the MHOST, said:

“The Mental Health Optimal Staffing Tool is an innovative, yet simple to use, way of helping to ensure that mental health hospitals can make evidence based decisions on safe staffing levels that support patients’ needs. This new tool will not only help to improve the care and outcomes for some of the most vulnerable patients, it will also help to improve the working environment of staff in the mental health sector. I would urge all mental health hospitals to use the MHOST to guide them in their safe staffing decisions.”

It includes advice and information on:

• What happens after a sudden death?
• Post-mortem examinations and the rights of bereaved people
• The process before and during an inquest, including when you may need legal advice and how to fund it
• Coping with a death and an inquest
• Contentious deaths in police and prison custody, immigration detention, mental health settings and deaths involving multi-agency failings or where wider issues of state and corporate accountability are in question
• Contacts of voluntary, government and professional organisations working on mental health, criminal justice and immigration issues.

About INQUEST

INQUEST is the only charity providing expertise on state related deaths and their investigation to bereaved people, lawyers, advice and support agencies, the media and parliamentarians. Their specialist casework includes deaths in police and prison custody, immigration detention, mental health settings and deaths involving multi-agency failings or where wider issues of state and corporate accountability are in question.