Making maternal mental health work: lessons from a collaborative, stepped-care model in primary maternity care

Aim This paper describes the components of the Perinatal Mental Health Project’s Maternal Support Service model, highlighting adaptions made over time to address real-world challenges and opportunities. Method Each component of the service model and its refinements are described. This includes: (1) collaboration with maternity staff; (2) mental health promotion, prevention and service preparedness; (3) initial screening of women with a locally validated, ultra-brief tool; (4) engagement, assessment and triage sessions; (5) on-site psychotherapeutic and social support interventions based on levels of need; (6) collaborations with other providers for holistic case management; (7) monitoring and evaluation, and (8) prioritisation of staff wellbeing and supervision. Monitoring and evaluation data were collected to describe care pathways. Data for 2024 are provided. Findings Over time, we made several modifications to the service design to optimise uptake, relevance, efficiencies, and quality of care. In 2024, 3 059 women attended the unit for antenatal care. Maternity staff referred 450 of these women to the Maternal Support Service for further assessment, based on their mental health screening results and/or being part of a pre-defined target group. Mental health counsellors conducted 415 sessions for engagement, assessment and triage. Psychotherapy and social support were offered to 392 women, of whom 348 accepted. A total of 275 new service users were seen, with a mean of 3.4, a median of 3, and a mode of 2 therapy sessions. Of these women, 29%, 37% and 34% required low-, medium-, and high-intensity care, respectively. A postnatal follow-up assessment was completed for 69 women, with 37% reporting complete improvement, and 23% reporting partial resolution of their presenting problems, across all problem categories. Conclusion The model provides a promising example for the planning, organisation and integration of maternal mental health services at primary care level.