iHV welcomes the Maternal Mental Health Alliance (MMHA)’s latest briefing on specialist perinatal mental health (PMH) community services in the UK which highlights the significant progress made in all four nations since 2013. The latest MMHA maps offer a snapshot of the state of UK specialist PMH care in 2023 and evidences significant ongoing workforce challenges and the postcode lottery that families face in accessing specialist PMH care.

Though the progress is fantastic, the updated maps in the report show that inequalities continue – access to life-saving mental healthcare for pregnant women and new mothers remains inequitable, with many regions still lacking the necessary resources. Mental health-related deaths during pregnancy or up to six weeks after birth are increasing – and it is particularly significant to health visitors that even more women died in the period between six weeks and a year after the end of pregnancy – emphasising the urgency of addressing this issue.

The previous PMH maps, shared as part of the “Everyone’s Business Campaign”, mapped services against the quality standards created by the Royal College of Psychiatrists’ Perinatal Quality Network and led to a collective ambition to “#TurnTheMapGreen”.  Since then, there has been rapid expansion and much needed progress in specialist PMH services across the UK. As a result of the pandemic, cost-of-living crisis, widening inequalities and global instability, there has been major challenge to family mental health and wellbeing, and need has soared. These new updated maps are intended to ensure progress in specialist PMH provision is sustained and progressed.

Alongside updating the maps, the MMHA also conducted a Freedom of Information (FOI) request to gain better understanding of funding for specialist PMH community services across the UK and to picture how services in England are meeting the ambitions of the NHS Long Term Plan for PMH. The FOI found that, although 89% of the 70 areas that responded had seen their budget increase from 2020/1 to 2022/3, 66% indicated there would be an underspend for 2022/3. Workforce-related issues were the most frequently cited reason for underspending (58% of respondents), but many teams provided evidence indicating this was due to unclear or late budget allocation, with no guarantee of continuation. This is inevitably resulting in women, babies, and families not receiving the care they need.

The most recent iHV annual survey also confirmed that families are facing a postcode lottery in universal services. This new briefing by the MMHA makes a clear statement on the importance of joined up integrated care across the system to address these inequities in service provision and focus efforts on addressing the stark health inequalities, particularly for black and brown women and those living with severe and multiple disadvantage.

The MMHA briefing acknowledges that health visiting is an essential part of the PMH system and that specialist PMH teams alone cannot meet the needs of most families, who in the main, will be seen and cared for in universal services. The briefing calls for proper resourcing for all the essential services needed to deliver high-quality care.

Melita Graham, iHV Head of Mental Health, said:

“At the moment, too many families are still facing a postcode lottery and not receiving the care that they need as services struggle to prevent and identify cases of perinatal mental illness and facilitate and offer treatment to meet the scale of need. The role of health visitors needs to be maximised as an important part of the solution. When adequately resourced, health visitors can make a significant contribution to the timely identification of perinatal mental health problems and risks in the community, as well as reducing the burden on primary care and specialist teams through their work in prevention and early intervention.

“Strong local leadership is important for maximising the HV contribution and to join the junctions between services. Specialist Health Visitors in Perinatal and Infant Mental Health are therefore a crucial element of an integrated PIMH care system. Through their leadership role, they have the potential to drive clinically and cost-effective high-quality evidence-based PIMH care across the whole system. As part of Maternal Mental Health Awareness Week, the Institute was delighted to share our own maps of such a vital part of the system in our latest report: Specialist Health Visitors in Perinatal and Infant Mental Health: where they are and what they’re doing.”

All families want and deserve high-quality and joined up care for their mental health. The latest MMHA maps offer key stakeholders good intelligence on their relative performance and provide a sound base for services and systems to build and progress from. It is crucial that momentum is maintained and Government commitments to improving specialist PMH are fulfilled. The iHV is committed to continue working alongside the MMHA to make sure that there is a confident, well-equipped system delivering excellent, compassionate, safe care for all families across all four nations of the UK.

3 ways to help #TurnTheMapGreen 

  1. Download and share MMHA maps with your networks
  2. Tweet about the maps using #TurnTheMapGreen
  3. Talk about the maps with those in a position to help change them

Let’s end the postcode lottery, together! 

Specialist Health Visitors in Perinatal and Infant Mental Health: where they are and what they’re doing.

Maternal Mental Health Awareness Week 2023 (#MMHAW23) focuses on being ‘together in a changing world’. Today’s theme, Tuesday 2 May, offers an opportunity to ‘shine the spotlight on support’ – so what better time for the iHV to shine the spotlight on the unique role of Specialist Health Visitors in Perinatal and Infant Mental Health across all UK nations by giving a snapshot of where they are and what they are doing.

Seven years on from the seminal publication on the role of Specialist Health Visitors in Perinatal and Infant Mental health (Sp HV PIMH) by Health Education England1 and one year since the follow-on report by Homonchuk and Barlow2 made further specific recommendations for these practitioners, the Institute of Health Visiting (iHV) has compiled a snapshot of provision and practice across the UK – Specialist Health Visitors in Perinatal and Infant Mental Health: where they are and what they’re doing.

The good news is that there are now Sp HV PIMH in each UK nation, providing strategic leadership, undertaking pivotal training, education and supervisory functions, influencing service redesign and pathway development, and ensuring robust quality assurance through accurate data collection, analysis and audit. We regularly hear examples from Sp HV PIMH of how they continue to advocate for families and use their position and voice to influence local decision makers to ensure perinatal and infant mental health remains prominent in local policies and the political agenda.

A deeper dive at a regional level, however, reveals patchy provision and inconsistent commissioning arrangements for these specialists, with variations in:

  • job descriptions
  • clinical case-loading expectations
  • training and supervision for the practitioner
  • where the role sits – within universal health visiting or specialist perinatal and infant mental health services

In addition, the dire shortages in the health visiting workforce need to be urgently addressed by national government to enable Sp HV PIMH and the wider health visiting workforce to deliver clinically and cost-effective perinatal and infant mental health care.

Melita Graham, Head of Mental Health, says:

All families want and deserve high-quality and joined-up care for PIMH problems. This report highlights the unique leadership role that Specialist Health Visitors in Perinatal and Infant Mental Health have contribute to achieving this.  Furthermore, it shines a light on how specialist provision within health visiting services offers the opportunity to drive clinically and cost-effective high-quality evidence-based PIMH care across the whole system.

There is still work to be done but much to be celebrated. The leadership and commitment of these pioneering specialist health visitors ensures that families at risk of, and those impacted by, mental health problems have the best chance of receiving timely, high-quality, cost-effective care within health visiting services and beyond, helping to give all babies and young children the very best start in life.


Recommendations from previous reports on Sp HV PIMH still stand2, particularly that:

  • Sp HV PIMH should continue to be commissioned by every Local Authority in England, every Health Board in Wales and Scotland, and every Health and Social Care Trust in Northern Ireland. Such commissioning should include the provision of necessary resources to enable them to work both strategically and clinically
  • A national set of Perinatal and Infant Mental Health quality standards for Sp HV PIMH, health visiting and health visiting services are needed
  • The contribution and recognition of the Sp HV PIMH role would be strengthened by the development of credentials for Advanced Clinical Practice (ACP-health visiting)

In addition, this report recommends that:

  • All services should ensure there is a robust offer of reflective clinical supervision for Sp HV PIMH
  • Demand-driven workforce modelling with further exploration of workload weighting for Sp HV PIMH is needed to provide a benchmark for safer staffing and ensure equity of provision
  • Further research into the role of Sp HV PIMH within universal health visiting services compared to specialist services is needed to build a strong evidence base for the NHS and Local Authorities to make the best decisions in designing, commissioning and delivering services in the interests of local people
  • Further research is needed to support the translation of the evidence from the UK Confidential Enquiries into practice, focusing on public health aspects, inequalities and the Sp HV PIMH role
  • The health visiting service should be strengthened by national government through sufficient funding, a demand-driven, well-resourced national workforce strategy to ensure that all families receive high-quality, evidence-based support, regardless of where they live


  1. Health Education England. Specialist Health Visitors in Perinatal & Infant Mental Health. What they do and why they matter. 2016. Available from: https://www.hee.nhs.uk/sites/default/files/documents/Specialist%20Health%20Visitors%20in%20Perinatal%20and%20Mental%20Health%20FINAL%20low%20res.pdf [Accessed 19th April 2023]
  2. Homonchuk, O. and Barlow, J. Specialist Health Visitors in Perinatal and Infant Mental Health. 2022. Department of Social Policy and Intervention, University of Oxford. Available from: https://spi.web.ox.ac.uk/sites/default/files/spi/documents/media/specialist_health_visitors_in_perinatal_and_infant_mental_health_-_january_2022.pdf [Accessed 19th April 2023]