A rising number of newborns are becoming part of care proceedings after new research has shown higher levels of mental health difficulties with new mothers.
Born into Care research based on data from Cafcass and Cafcass Cymru has demonstrated the rising numbers of newborn babies becoming subject to care proceedings in England and Wales. Linked studies in the Born into Care series have shown high levels of mental health problems among mothers whose babies are involved in care proceedings at or shortly after birth. Other research has found similar high levels of mental health problems among such mothers.
The Born into Care studies (Griffiths L J et al. 2020 and Griffiths L J et al. 2021) were able to link data about 1,111 mothers involved in care proceedings with their babies in Wales (from Cafcass Cymru) with health data collected on mothers and babies. This showed that over half of the 1,111 mothers (53 per cent) reported an existing mental health condition at their initial antenatal assessment, while three-quarters (77 per cent) had a mental health-related general practice (GP) or hospital contact or admission recorded in their health records prior to the child’s birth.
This is a markedly higher level than mothers not involved in care proceedings. The most common mental health problem was depression (41%). Anxiety was also common (indicated for one quarter). Much less common, but higher than in the comparative group of mothers not involved in care proceedings, were severe mental illness and autism spectrum disorders.
Research funded by the Nuffield Foundation linking mothers involved in care proceedings with mental health data held by the South London and Maudsley Hospital (covering four south London boroughs) found that half (54.2 per cent) of mothers involved in care proceedings had a diagnosis of mental illness requiring secondary or tertiary mental health services, and more than one-third had two or more diagnoses (34.0 per cent) (Pearson R et al. 2021 and Ireland G et al. 2024).
Some new research is now focusing on exploring perinatal mental health care for families at risk of having a baby removed through care proceedings. This is being led by Dr Billie Lever Taylor at King’s College London, as part of an NIHR Advanced Clinical and Practitioner Academic Fellowship.
The aim of the research is to improve understanding of families’ experiences and identify how mental health services can best support them.
Describing the research, Dr Lever Taylor says:
“Mothers involved with children’s services during pregnancy or postnatally often also have contact with mental health services, but children’s services involvement can put more pressure on mothers’ mental health, causing difficulties to spiral. Mental health practitioners say they find it hard to engage with families at risk of care proceedings and often do not feel well equipped to support them. In earlier research (Lever Taylor et al. 2023), the team at King’s found these mothers were less satisfied with their mental health care than other mothers and had more needs left unmet after discharge.
“Many also face issues such as poverty, lack of social support, housing problems, domestic violence and substance use, suggesting a wider context of inequity. But feedback suggests services do not focus adequately on addressing these wider difficulties. Mothers who have a baby removed from their care describe this as a time of acute crisis but struggle to access therapeutic support.
“The team will be interviewing around 30 mothers across England who accessed mental health support perinatally and had child protection involvement. Interviews will explore in-depth their experiences of motherhood; how they understand their needs; their perspectives on the difficulties they may face; their experiences of interacting with mental health and children’s services; and how they believe they and their babies can best be supported. We will also interview a partner or other family member for each mother, wherever possible, and carry out focus groups and interviews with mental health, social care and family court practitioners.
“Additionally, we will examine anonymised mental health records of a cohort of around 1,000 mothers who went through care proceedings in South London. We will look at what these records tell us about mothers’ characteristics and needs, their pathways through services, where engagement difficulties arise, and what influences engagement and outcomes.
“A lived experience advisory group and practitioner advisory group will meet regularly to support the research. Working with lived experience advisors, alongside artists and others, the team will co-produce creative good practice resources to support professionals working with this population. There is currently little in the way of good practice resources for perinatal mental health services working with this population.”
Maternal Mental Health Services have a role to play in supporting mothers who have been or are at risk of being separated from their babies close to birth due to safeguarding concerns.
The NHS Long Term Plan set out the intention to develop and implement Maternal Mental Health Services (MMHS) across England by 2024. MMHS combine maternity, reproductive health, and psychological therapy for women experiencing moderate to severe or complex mental health issues related to their maternity experience. The specification for MMHS indicated that such services could include support to mothers who have been or are at risk of being separated from their babies close to birth due to safeguarding concerns (safeguarding pathway).
Following the publication of the Born into Care research series by the Nuffield Family Justice Observatory, the Lancaster team that led the research was invited to support the MMHS national evaluation team (ESME-III), led by King’s College London, in developing this element of support.
Research conducted by the ESMI-III team in 2023 on the MMHS safeguarding pathway found that only seven out of the 27 MMHS sites had developed any form of support for this group of women, with an additional eight sites planning to do so. Earlier interviews and surveys with MMHS practitioners revealed a desire to offer a service, but barriers included a lack of clarity regarding the pathway, limited resources and knowledge, and the complexities of multidisciplinary collaboration. Despite these challenges, there remains significant interest in further exploring possibilities, including the potential role of MMHS in implementing and supporting HOPE Boxes, a co-produced innovation developed by Lancaster University in collaboration with the charity Birth Companions.
The findings from the work to date are currently being consolidated, and a new resource to support MMHS to develop their offer to mothers in this situation is due to be published by the team later this year. A pilot project is also underway with three MMHS to consider their role in supporting the implementation and use of HOPE Boxes as part of a multi-agency offer.
