The commissioning of specialist mental health services for vulnerable mother-infant dyads in the UK: a study of stakeholder views

Part of our Departmental Colloquium series.

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Context: Infant regulatory disturbances are common, stable over time, and can compromise infant outcomes across a range of developmental domains. Many such problems have their origins within the parent-infant relationship and specialised parent-infant relationship teams provide support and intervention that is explicitly aimed at addressing such relationship difficulties.  However, there are currently only around 27 such teams across the UK, and just under half of CAMHS do not accept referrals of children under two years of age.

Aim: The aim of the current research was to examine the views of commissioners of children’s services regarding the reasons for commissioning (or not) infant mental health services.

Method: Fourteen in-depth interviews were conducted with a range of stakeholders involved in commissioning children’s services across fourteen areas of England, half of which were commissioning specialised infant mental health services. A thematic analysis was undertaken.

Results: A total of five themes emerged from the data as being key factors in the commissioning of infant mental health services: Pressure from local practitioners; policy transfer through policy networks; opportunity for long-term cost reduction; potential to embed the service model within existing services; and perinatal mental health funding.

Conclusion: As with commissioning more widely, the commissioning of infant mental health services is a complex process, with a range of factors influencing whether such services are commissioned or not. Data suggest that the process is currently driven by informal and contingent factors, as much as by the evidence regarding what works.