The Improving Perinatal Mental Health Health Integration Team (IMPROVE HIT) is a team of mental health practitioners, women and children’s health practitioners, commissioners and academics, working together to improve the identification of, services and support for parents with mental health issues before and after the birth of their child.

Improving the mental health of mothers and fathers during pregnancy and in the first postnatal year is a health priority, not only because it’s important for parents but it’s crucial for the health and wellbeing of the next generation. Despite being the focus of a NICE guideline and many reports, progress to improve the mental health and wider emotional well-being of parents remains limited.

Out of the 12,000 women who give birth every year in Bristol, over 1,000 of these mothers will experience levels of depression and anxiety sufficient for them to benefit from treatment.

One of the biggest challenges is that many organisations are involved in the provision of services, including primary care, community midwives, maternity services, health visitors, mental health services, social services and non-statutory organisations. There are a number of areas the HIT will focus on:

  1. There is strong evidence that depression and anxiety disorders during pregnancy have adverse effects for child outcomes both through direct effects on the foetus and continuing postnatal poor mental health of mothers. Mothers are screened for depression (but not anxiety), but locally the subsequent care pathway is unclear to many clinicians and women.
  2. Midwives also collect information to identify those with past or current severe mental illness. These conditions occur perinatally and the risk of relapse is increased following childbirth. Management involves close liaison between services to minimise risk to the mother and developing foetus. It is unknown how effective midwives are at identifying these conditions and responsibilities for subsequent care can be unclear.
  3. The use of medication during pregnancy and following birth, in those wishing to breast feed, needs careful assessment of benefits versus potential harms. Helping parents make informed decisions is an area needing further development and one aim of this HIT.
  4. The role of fathers has been relatively neglected until recently and perinatal care pathways make limited reference to including men. There is a body of evidence suggesting that father involvement and mental health have a causal role in the health and well-being of offspring.

The development of IMPROVE HIT provides an excellent opportunity to tackle these issues by working together to implement existing evidence through the NICE guidance and to provide a framework to conduct studies, especially clinical trials, to develop the evidence base further and for Bristol to become a leading centre for perinatal mental health.

Aims and objectives

The overall aim of IMPROVE HIT is to improve the identification and subsequent care of parents with poor mental health before and following the birth of their child.

IMPROVE HIT will meet these challenges through:

  • Improving the pathways for women with mild and moderate mental health needs
  • Ensuring specialist and general workforce across the health care sector have access to training and continuing professional development opportunities
  • Focusing on universal prevention of mental health problems for women during the perinatal period and their babies
  • Evaluation of the new perinatal mental health service.

Who’s involved

The leading experts in perinatal mental health in Bristol are involved in the team. The HIT is led by co-directors Dr Jonathan Evans, University of Bristol (UoB) and Avon and Wiltshire Mental Health Partnership (AWP) and Ruth Jackson, CEO Bluebell Care. Find out more about who’s involved.

How patients and the public are involved

Through the partner charity Bluebell, the HIT will be able to involve parents from across Bristol with lived experience of perinatal mental illness. Bluebell now supports more than 150 parents each year who are experiencing both antenatal and postnatal depression and anxiety. The charity is managed and run by parents with lived experience who, along with parents being supported through Bluebell’s services, will be consulted and have opportunities to input into the development and activities of IMPROVE HIT.

Bluebell works with a wide range of parents from diverse backgrounds and cultures, including young parents, carers, black and minority ethnic communities and has a specific service for dads. All of these groups will be consulted and have the opportunity to input into the HIT.


To find out more, please contact:

IMPROVE at the HIT conference

The IMPROVE HIT presented this poster (PDF) at the 2018 Bristol Health Partners Health Integration Team conference.