Pregnancy planning for parents with mental illness

Research question: How can mental health professionals support people of reproductive age to improve their preconception decision making and physical and mental health for pregnancy?

Background: Women using mental health services experience significant multimorbidity and some of the worst obstetric and neonatal outcomes if they become pregnant.

However, there are many modifiable risk factors for these adverse outcomes, such as smoking, domestic violence and abuse and unplanned pregnancy, which are more common in people with mental illness, particularly varying by ethnicity, and which could be addressed prior to pregnancy.

There is also evidence that even before pregnancy, preconception (both paternal and maternal) health is associated with offspring outcomes.

There is a need to understand how clinicians working across different mental health services can support decision making around sexual and reproductive health, and holistic planning and fitness for pregnancy, if and when pregnancy is desired.

In addition to community mental health teams and drug and alcohol services that support people throughout the reproductive life course, 'perinatal' mental health services support those actively planning pregnancy.

Aims and objectives: To utilise mixed methods to investigate how best to support people of reproductive age using mental health services in improving planning and fitness for pregnancy.

Objective 1) To explore what current models of pregnancy planning support in mental health services are most useful for supporting decision making about planning and fitness for pregnancy and in what circumstances.

Objective 2) To co-design with clinicians and patients a feasible decision-making tool to support planning and fitness for pregnancy. Objective 3) To test the feasibility of a future effectiveness trial of the co-designed tool.

Methods: Realist evaluation utilising a) interviews and focus groups with patients and clinicians and b) routinely collected data on service use from a range of mental health services across the North East of England and South London.

This provides a pragmatic insight into how services are currently supporting patients with planning and fitness for pregnancy.

Co-designing and refining a decision-making tool then utilising interviews and focus groups with patients and clinicians to assess its acceptability, appropriateness and feasibility.

Cluster randomised feasibility trial utilising routinely collected data and focus groups on uptake and use of the tool across selected mental health services. Timelines for delivery: Years 1 and 2 are focussed on objective 1 and years 2, 3 and 4 objective 2. For 3-years, I will be requesting the support of a full-time research assistant.

I will work clinically one day per week.

Anticipated impact and dissemination: Findings will be used to inform a future effectiveness trial and have the potential to improve the health of a marginalised population with significant multimorbidity, and their children.

The findings could inform delivery of preconception care to those with mental disorder across a range of settings, including primary care.

The findings will be shared with patients, the public and policy makers, which will be facilitated by a policy lab and an arts-based public engagement project during the fellowship.