Improving Postpartum Outcomes of Severe mental Illnesses in Ethnically diverse mothers (POSIE)

Introduction: Disparities in care experiences contribute to inequalities in perinatal mental health and maternal deaths. In the first year after birth, poor mental health is common and suicide is the leading cause of maternal death. Improving perinatal mental health care for mothers in a mental health crisis can protect mothers and babies from harmful outcomes. Research question: This research aims to identify and understand ethnic inequalities in care experiences and outcomes through analysing healthcare records and gathering lived experiences of postpartum SMI of people from diverse backgrounds living in rural and urban areas of England. Aims and objectives: 1. To quantify ethnic and socioeconomic inequalities in the treatment and outcomes of postpartum SMI episodes and understand associated costs (WP1) 2. To gather lived experiences (WP2) to inform the co-design (WP3) of an effective and culturally safe care pathway for specialist Perinatal Mental Health (PNMH) services, and evaluate health impacts and healthcare costs (WP4) 3. To develop a guidance for broad adoption of the care pathway (WP5) that we co-designed (WP3) and evaluated (WP4) Methods: We will analyse a nationally representative cohort constructed via healthcare records from 6.7 million mothers in the Clinical Practice Research Datalink Pregnancy Register(WP1). This will include all cases of postpartum SMI (including psychosis, personality disorders, eating disorders, and severe anxiety and depression), and maternal death occurring in CPRD-registered practices in England 2011-2021. We will hold workshops with 40-60 people with lived experience of postpartum SMI and, through photovoice methods, capture their experiences of services and understand their priorities for how perinatal specialist mental health services could better support their needs (WP2). Workshops will be co-facilitated with people with lived experience and undertaken in Manchester, Sheffield, Oxford, and South London. The results from WP1&WP2 will then be presented to workshops including service users and health and social care practitioners, and stakeholders, to co-design a culturally safe care pathway (WP3). We will then implement and evaluate the care pathway in diverse settings in the North and South of England (WP4), in the places where co-design took place but also in two other independent areas, with at least 40 patient participants at each site (n=240 total). The findings will inform the development of a guidance to support adoption at scale (WP5). Lived experience contributes to all aspects of the design and delivery. PPI lead and partner organisations to support involvement of peer researchers. Peer researchers will help ensure representation by diverse identities, places, intersectional vulnerabilities. Year 1-2: Cohort analysis(WP1), photovoice study(WP2) Year 2-3: Co-design care pathway(WP3);implementation study(WP4) Year 3-3.5: Guidance co-development Impact and dissemination: The co-designed guidance will be distributed through perinatal networks, health and social care partners, and shared through a celebratory national meeting including all partners and research teams, and wider public stakeholders. We will also generate policy briefings and short video narratives and seek to influence NICE guidelines. We will also convene policy and commissioner roundtables. We anticipate impact on practice and policy and raise professional capabilities to reduce inequalities.