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PRP (38-01-02) Perinatal Mental Health Care - what works for who and in what circumstances?

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Published: 09 January 2024

Version: 1.0 - December 2023

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Timetable and Budget

DescriptionDeadline/Limit
Deadline for Stage 1 Applications 13 February 2024, 1 PM
Notification of outcome of Stage 1 Application April 2024
Deadline for Stage 2 application 04 June 2024, 1 PM
Notification of outcome of Stage 2 Application November 2024
Earliest Potential Project Start January 2025
Project Duration Up to 18 Months
Budget £300,000

Introduction

The National Institute for Health and Care Research (NIHR) Policy Research Programme (PRP) invites applications for a single research project to determine which perinatal mental health interventions are most effective, and for which population groups, to deliver the best outcomes for parents and their babies.

We are also looking to build a stronger understanding of any existing barriers to accessing support and which groups might be most impacted by the experience of these.

Background

Supporting delivery of the Best Start for Life vision: In March 2021, the Best Start for Life: Vision for the 1,001 critical days [1] set out a vision that every new parent and carer has access to compassionate and timely mental health support and effective support to develop a secure bond with their baby. For every one-year cohort of births in England, the NHS has estimated that the long-term cost from lack of timely access to quality perinatal mental health care is £1.2 billion to the NHS and social services and £8.1 billion to society. [2]

A lack of reliably collected and readily available data was also a finding of the 2021 Early Years Healthy Development Review [3] which informed the Best Start for Life Vision. The review heard wide-ranging concerns that the data currently collected does not help us understand variation and disparity of outcomes across the country.

Supporting perinatal mental health through the Family Hubs and Start for Life programme: The Family Hubs and Start for Life programme is a £300m programme [4] looking to deliver a step-change in outcomes for babies, children, parents and carers across 75 selected local authorities. £100m of this has been allocated specifically to look at perinatal mental health and parent-infant relationships.

In developing the perinatal mental health and parent-infant relationship elements of the programme, it became apparent that data around perinatal mental health was not readily available. In particular, it was not clear whether particular groups are more commonly affected and which interventions were helping who and at what point. This was more commonly the case for mild to moderate mental health difficulties.

DHSC conducted desk research followed by a gap analysis to further understand what perinatal mental health data is currently collected and how it is used to deliver support to parents and carers who need it. This work was not published, however, the findings showed that data in this space is not reliably collected or readily available with prominent gaps around who is impacted by perinatal mental health, as well gaps around which interventions are working for who and when. This is consistent with the findings from the aforementioned Early Years Health Development Review. This work will be shared with the successful applicant.

Rich, good quality data are essential for the development of robust policy that meets the needs of the intended audience and promotes strong outcomes. Through improving our understanding of the issues via stronger, more robust data there is the potential to create significant improvements in the mental health of families - improving outcomes and reducing disparities.

We are therefore looking to commission a piece of research to address the gaps identified through the 2021 Review and our desk research to help us to improve the lives of families.

This is an exciting opportunity to begin building an evidence base that will be the basis for future decision making as well as addressing significant gaps in this policy area.

The outcomes of this piece of work will be essential in strengthening the offer of the Start for Life programme and for directing the shape of perinatal mental health services. This in turn will help to ensure that all parents and carers are able to access appropriate and effective perinatal mental health support and interventions at the right time.

Research priorities

Applicants are invited to submit research proposals for projects that would help to build the evidence base on effective perinatal mental health interventions. We are seeking research to understand which interventions are working most effectively, for who, and how they are best applied. This research will be expected to inform national perinatal mental healthcare policy decisions so applicants are expected to outline how their proposal will deliver policy relevant findings and impact.

This research will support policy in addressing key policy gaps and build a clear understanding of ‘what works’ in supporting parents with mild to moderate perinatal mental health problems. The National Institute for Health and Care Excellence (NICE) defines ‘mild’ mental health problems as when a person has a small number of symptoms that have a limited effect on their daily life. A ‘moderate’ mental health problem is defined as when a person has more symptoms that can make their daily life much more difficult than usual. We would expect applicants to also consider the experiences of fathers and co-parents in their research proposals. We do not expect an in-depth analysis of any specific intervention or setting.

This research should consider the following questions:

  • What are the range of interventions and support offered to support perinatal mental health? This could include those offered by the NHS, a local authority or third sector organisation
  • What are the different pathways to access perinatal mental health support through the health and social care system? This could include understanding when support is offered alongside the type of support provided.
  • What factors contribute to disparities in access to perinatal mental health services and how can they be addressed?
  • What are the features of effective interventions to support perinatal mental health for different population groups?

We expect the research to assess the effectiveness of existing interventions, rather than designing de novo interventions. This approach will enable us to ensure that we can use the outcomes of this research to inform practice more quickly by replicating and scaling up existing practices that demonstrate, or show promise of demonstrating, effectiveness in supporting parents with mild to moderate perinatal mental health problems.

Applicants are welcome to suggest suitable approaches, however; we anticipate that this research is likely to involve a mixed methods approach, drawing on primary qualitative fieldwork, case studies, quantitative data analysis and literature reviews. We are open to the inclusion of international evidence should it be able to demonstrate relevance and applicability to the English context.

Researchers should be aware of the NIHR funded research project - National evaluation of Start for Life: What works for whom under what circumstances? [3] - and look to engage with the team to ensure complementarity of the research. Officials in DHSC will support the successful research contractors to engage with the commissioned research team. Researchers will also want to consider links to research that NHSE are undertaking relating to prevalence to avoid duplication.

Areas out of scope for this programme of work

For the purpose of this research, we are interested in mild to moderate perinatal mental health difficulties as defined above. Acute and severe perinatal mental health difficulties and the interventions used to address these are out of scope for this programme of work.
For the purpose of this research, the ‘perinatal period’ is defined as conception to one year after birth. Interventions targeted at time points or developmental stages outside of this definition are out of scope for this programme of work.
Furthermore, we are not seeking new prevalence estimates or data collections to help understand prevalence, so such methodology would be out of scope for this programme of work.

Eligibility

Eligibility for the NIHR PRP is laid out in our Standard Information for Applicants and applies to all calls unless otherwise stated in the individual research specification.

Technical requirements / Expertise required

Applicants should be able to demonstrate the following:

  • Expertise in perinatal mental health
  • Interest in start for life/perinatal mental health care policy
  • Expertise disseminating research findings to different audiences.

Outputs

In terms of outputs, we expect the following:

  • An interim report/findings halfway through the project (~ 9 months). This could be in the form of a presentation to DHSC policy colleagues and relevant stakeholders.
  • A full research report that sets out methodology, key findings and a series of recommendations for taking work forwards in this space going forwards.
  • A final presentation of key findings and recommendations.

We also request regular project updates to discuss progress against agreed timelines. The appropriate frequency can be agreed with the successful applications, but we would anticipate updates in the region of every quarter as a minimum.

Applicants are asked to consider the timing and nature of deliverables in their proposals. Policymakers will need research evidence to meet key policy decisions and timescales, so resource should be flexible to meet these needs. A meeting to discuss policy needs with DHSC officials will be convened as a matter of priority following contracting.

Budget and duration

Applications will be assessed on value for money, we would not expect them to cost more than £300K.

The duration of the project should be as short as is consistent with delivering a high-quality study. In order to maximise the benefit from the findings, the research will need to commence as soon as possible following selection of the successful proposals and placing of contracts. Capability to start promptly will be an advantage and for this commissioning round, applicants should demonstrate that studies can start by the relevant date.

Costings can include up to 100% full economic costing (FEC) but should exclude output VAT. Applicants are advised that value for money is one of the key criteria that peer reviewers and commissioning panel members will assess applications against.

Management arrangements

A research advisory group including, but not limited to, representatives of DHSC, other stakeholders [such as NHSE, local authorities, academics], and the successful applicants for the research should be established. The advisory group will provide guidance, meeting regularly over the lifetime of the research. The successful applicants should be prepared to review research objectives with the advisory group, and to share emerging findings on an ongoing basis. They will be expected to:

  • Provide regular feedback on progress
  • Produce timely reports to the advisory group
  • Produce a final report for DHSC sign off

Research contractors will be expected to work with nominated officials in DHSC, its partners and the NIHR. Key documents including, for example, research protocols, research instruments, reports and publications must be provided to DHSC in draft form allowing sufficient time for review.

Guidance on Health and Care Inequalities and associated data collection within NIHR PRP Research:

Health and care Inequalities is a high priority area within the Department of Health and Social Care and the NIHR and is often present in a majority of funded projects.We are now assessing all NIHR research proposals in relation to health inequalities. We ask that you please clearly identify in the research plan section of the application whether your application has an inequalities component or theme as well as how this research hopes to impact inequalities or not. Please also detail the core set of inequality breakdown data that will be collected, if applicable. More information on this request can be found in the Standard information for applicants.

References and key documents