Patterns of psychiatric admission in Australian pregnant and childbearing women

What is a Good Outcome of an Inpatient Perinatal Mental Health Admission? Developing an Innovative Evaluation Plan for a New Unit

RATIONALE

Developing a feasible and sensitive evaluation strategy for a new mental health service is a challenge that requires consideration of what a service is trying to achieve and what a 'good' outcome might look like. Perinatal mental illnesses are complex in their causes and treatment. Mother Baby Units provide specialist perinatal mental health care to parents experiencing mental illness in the perinatal period, with evaluations demonstrating clinical and social outcomes. There has however been remarkably little research on how MBUs achieve these outcomes.

METHOD

This paper outlines the process and components of designing an evaluation plan for a new perinatal mental health unit, summarising outcome measures considered and the methodology of the evaluation strategy.

RESULTS

A meaningful realist approach was designed. This innovative dualistic methodology is intended to develop theories of what might cause change while also considering what components of interventions parents experience as meaningful.

CONCLUSION

Articulating the approach to evaluation provides a contribution to evaluation knowledge for others evaluating complex public health interventions. The relational nature of perinatal mental health experiences challenges individualistic approaches to care delivery, funding and evaluation. As part of service establishment, there is a need to consider what a 'good' outcome of care might be and to develop evaluation approaches that capture the relational components of recovery as well as the factors that support families to sustain change.

Increases in use of Medicare Benefits Schedule mental health items among women who gave birth in New South Wales, 2009-2015

OBJECTIVE

To report rates of Medicare Benefits Schedule (MBS) mental health item use among a sample of women who gave birth in NSW (2009-2015) and examine if the SAFE START policy increased use of these items among perinatal women.

METHODS

Data was drawn from women participating in the Australian Longitudinal Study on Women's Health 1973-1978 cohort, linked to data from the NSW Perinatal Data Collection and MBS.

RESULTS

Use of Medicare-subsidised mental health items increased 2.7-fold among perinatal women (n=1,453) between 2009 and 2015 (4.1% versus 11.0% respectively), compared to a 1.3-fold increase among non-perinatal women (n=1,800, 6.3% versus 8.4% respectively). However, the increased use of MBS mental health items among perinatal women was not observed to be impacted by the SAFE START policy, after accounting for time trends.

CONCLUSION

There was a substantial increase in the use of MBS mental health items among women in NSW between 2009 and 2015, with a more pronounced increase among women who had given birth compared to those who had not. Implications for public health: This study provides important information about changes in mental health service use during a time of significant investment in perinatal mental health, and demonstrates the value of longitudinal survey data linked with administrative health data to evaluate the impact of health policy.