Experiencing severe mental illness can be deeply isolating for women during pregnancy and after birth. As part of Maternal Mental Health Awareness Month, we are reflecting on the powerful role of peer support for women admitted to Mother and Baby Units - an approach that aligns closely with this year’s theme of “Stronger Together.” Peer support offers invaluable one-to-one and group-based connections, and it also has the potential to contribute to a broader shift toward a healthcare system that centres lived experience. Yet, despite its promise, peer support is often implemented without a clear evidence base to determine what works best, for whom, and in which contexts.
The Realist evaluation of Action on Postpartum Psychosis peer Support model (RAPPORT) study brings together researchers, practitioners, and women with lived experience to explore this issue. It focuses on the Action on Postpartum Psychosis (APP) peer support model, as it is embedded in three Mother and Baby Units in England in Birmingham, Lancashire and Manchester. The study seeks to fill key evidence gaps and improve our understanding of how peer support should be delivered to improve outcomes for this underserved population.
Whilst we refer to 'women during pregnancy and after birth' in this blog, reflecting the focus of our research and the current evidence base and policy framing, we are mindful that not all birthing people identify as women, and recognise this as an important gap in the evidence that warrants our attention.
Why do women with severe perinatal mental illness need peer support?
The perinatal period, spanning pregnancy up to two years postpartum, is critical in the lives of birthing parents as they go through substantial physical, emotional, and social changes. One in five women experience some form of perinatal mental health problems. A small proportion will experience severe symptoms: 1-2 in every 1,000 women giving birth experience mania and psychosis following childbirth. Without appropriate treatment and support, severe perinatal mental illness can have many adverse, short- and long-term effects on families: Families are at higher risk of struggling with divorce, unemployment, and are more likely to become mentally unwell again. There are also economic reasons for investing in appropriate treatment. We estimated previously that the lifetime cost of untreated perinatal mental health problems are £8.1 billion per UK birth cohort. This included £53,000 per woman giving birth linked to short- and long-term cost consequences of psychosis, such as income losses.
Women experiencing severe perinatal mental illness may be admitted to a Mother and Baby Unit, where they can stay with their baby whilst receiving care. There are only 22 Mother and Baby Units in the UK, which is not enough to ensure all women can access this from of specialist care. In England, two-thirds of Mother and Baby Units offer some form of peer support, which is delivered by volunteers or paid peer support workers, who are employed either by a Community and Voluntary Sector organisation or by the National Health Service Trust hosting the Mother and Baby Unit. Their work conditions, and much training and support they receive varies. There are substantial disparities in how and when peers support is offered (e.g. one-to-one, in groups), what it entails (e.g., practical, emotional support), and how it is integrated with the Mother and Baby Unit. These factors influence how effective peer support is and the benefits for women.
How can peer support help people with severe perinatal mental illness?
There is little evidence on how peer support specifically works for this population. However, research from other groups suggest that receiving emotional, social and practical support from someone with shared experiences can improve mental health symptoms.
The mechanisms through which peer support works are complex. Still, evidence highlights processes such as social-emotional learning, regaining an identity, and the development of trust. Peer support workers may provide a mix of emotional, informational and practical support to rebuild relationships and navigate support systems, enhance access to treatment and encourage engagement with services. By offering authentic lived experience, peer support may reduce isolation and offer a sense of solidarity that promotes recovery and resilience. Conversely, if those receiving support do not relate to their peer support workers, it can create negative feelings.
What can we learn from the ‘Action on Postpartum Psychosis’ peer support model?
There is no consensus on how to best deliver a sustainable model of peer support that addresses the short- and long-term needs of women experiencing severe perinatal illness from different ethnic groups and underserved populations.
The model provided by the charity ‘Action on Postpartum Psychosis’ offers a valuable opportunity to learn from an established approach to delivering peer support embedded in Mother and Baby Units for women with severe mental illness. It has several ‘Stronger Together’ features which we will be investigating in the RAPPORT study:
- Personalisation: A range of engagement opportunities within and outside the Mother and Baby Unit (e.g., one-to-one, group, café or activity-focused groups, online options).
- Lived experience: All services are co-produced with women and families with lived experience. All peer support workers have lived experience and receive advice from a network of peer support workers.
- Ongoing access: Women and families can access support indefinitely at local café groups and become part of the charity’s community after discharge, which offers many wellbeing-focused opportunities to stay engaged with peers.
- Diversity: The model includes dedicated outreach teams and culturally adapted offers for people from ethnically and sexually/gender diverse communities; substantial efforts is made to recruit peer support workers from these groups.
- Sustainability: Those who receive support are provided with opportunities to become peer supporters or volunteers themselves. In addition to certified training, peer support workers receive a wide range of ongoing learning and support.
- Career development: Peer supporters are paid and offered flexible working and personal development opportunities, enabling them to develop careers in the sector.
These insights suggest that peer support is better understood as a model of practice rather than a standalone intervention; one that requires evaluation methods suited to complexity and real-world settings. The RAPPORT study uses a realist evaluation approach to examine how context and processes shape peer support, while also exploring the resource implications of its delivery.
‘Stronger together’: What next for peer support?
Whilst the UK has invested in specialist perinatal mental health services and prioritised peer support for women with severe mental illness in national policy, there are still barriers to access. The estimated need for these services exceeds current provision and geographical locations of Mother and Baby Units mean that people living outside of catchment areas have limited access. Access barriers are exacerbated for Black and other historically marginalised ethnic groups.
Creating communities of peer support workers has value beyond the support they offer others in their one-to-one or group work. When embedded in healthcare systems, peer support might contribute to sustainable, person-centred mental health care. Peer support workers could help transform specialist mental health services in England, including through newly introduced lived experience-supported Provider Collaboratives. Many women with severe mental illness who receive peer support go on to become peer workers themselves, motivated by a desire to ‘give back’. This presents opportunities for workforce integration. But doing so equitably requires evidence on how best to design and deliver these models. The RAPPORT study will provide insights that might can inform future guidance.
If you are interested in the research or in Action on Postpartum Psychosis, please contact:
This Research Award (award number: MH084) was funded as part of the Three NIHR Research Schools Mental Health Programme. The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care.