Maternal status and psychiatric inpatient care in England: a population-based cohort study using linked NHS administrative data

​​The Data will be used for the purpose of a research project: Maternal status and psychiatric inpatient care in England: a population-based cohort study using linked NHS administrative data.

​There is currently limited understanding of the prevalence, demographic and clinical characteristics of mothers being treated within inpatient mental health units. This study will investigate the characteristic and outcomes of a subset of the parents – mothers identified via HES birth and maternity records who have had an inpatient psychiatric episode between 1st April 2021- 31st March 2023.

​Analysis of the requested data will enable description of the cohort of interest, alongside investigation into the relationship between motherhood and service use outcomes, for example, are mothers more or less likely to be re-admitted. Sub-group analyses will investigate differences in service use and outcomes among mothers from different demographic and clinical groups (e.g., do mothers from a specific ethnic group experience higher levels of readmission than others?). In summary, this analysis will provide national-level quantitative evidence on mothers admitted to psychiatric inpatient services in England to address a major gap in understanding the characteristics and outcomes of women who are mothers compared to those who are not, and whether inequalities exist by age, ethnicity, region or deprivation, and generate valuable evidence to inform future resource allocation.

​The Data will be used to answer the following questions:

​Quantify and describe identified mothers among a two-year cohort of adult psychiatric inpatients in England.

​For Aim 1, women in the two-year cohort of adult psychiatric inpatients will be classified as established mothers if their index inpatient admission occurred at least 365 days after their first recorded live birth in HES maternity records. Subsequent pregnancies or births will not alter maternal classification for this aim. Descriptive analyses will summarise demographic characteristics (age, ethnicity, housing status, IMD quintile), diagnostic characteristics (primary ICD-10 mental health diagnosis and recorded neurodevelopmental conditions), and service characteristics (method of admission, legal status, ward type, and length of stay) at index admission.

​Describe prevalence of identified birth mothers (postnatal and established) and investigate clinical, demographic and service use characteristics of identified mothers compared with non-mothers.

​For Aim 2, all women aged 18–45 with an eligible adult psychiatric inpatient admission between 1 April 2021 and 31 March 2023 will be included, with the first qualifying admission treated as the index admission. Maternal status at index admission will be derived from HES maternity and delivery records and categorised as pregnant, postnatal, established mother, or non-mother using prespecified time windows. The prevalence of postnatal and established motherhood will be estimated as proportions of the full cohort. Demographic, clinical, and service-use characteristics of established mothers will then be described and compared with those of non-mothers at index admission, including diagnosis, ethnicity, deprivation, legal status, length of stay, and recorded adverse events.

​Examine associations between maternal status and key inpatient and post-discharge outcomes and assess whether these associations differ across demographic and clinical subgroups.

​For Aim 3, a retrospective cohort will be used to examine associations between maternal status and key inpatient and post-discharge outcomes, including length of stay, psychiatric readmission, and A&E attendance.​

​​No data will flow to NHS England for the purposes of this Data Sharing Agreement (DSA).

​NHS England will grant access to the Data via the Secure Data Environment (SDE). The SDE is a secure data and research analysis platform. It allows approved researchers with approved projects access to pseudonymised data and industry-leading analytics tools.

​NHS England will provide access to the relevant records from the [list of datasets] to [the controller] via NHS England Secure Data Environment (SDE). The Data will contain no direct identifying data items. The Data will be pseudonymised and individuals cannot be reidentified.

​SDE users can request exportation of aggregated analysis results (suppressed and summarised according to the NHSE SDE Disclosure Control rules) subject to review and approval by the NHS England SDE Output Checking team. The SDE Output Checking team will ensure that no output contains information which could be used either on its own or in conjunction with other data to breach an individual's privacy.

​Users must identify themselves via a multi-factor authentication mechanism and are only able to access the datasets detailed within this DSA. The access and use of the system is fully auditable, and all users must comply with the use of the Data as specified in this DSA.

​Users are only authorised to access the Data specified in this DSA and can utilise a variety of analytical tools available within the SDE platform. Users are not permitted to export record-level data from the SDE.

​NHS England will provide access to the relevant records from the HES, ECDS, mental health and deaths datasets to the University of Sussex. The Data will contain no direct identifying data items. The Data will be pseudonymised, and individuals cannot be reidentified through linkage with other data in the possession of the recipient.

​​The Data will be stored on servers at NHS England.​

​​The Data will be accessed by authorised personnel via remote access.

​The Controller(s) must confirm and provide evidence upon audit by NHS England that access via any remote device complies with the data security obligations within this DSA and the Data Sharing Framework Contract.

​​For remote access:

​• Remote access will only be from secure locations situated within the territory of use (as further restricted elsewhere within the DSA if so done) stated within this DSA.

​• Access controls granting users the minimum level of access required are in place.

​• Remote access is only via secure connections (e.g., VPNs or secure protocols) to protect data.

​• Multifactor authentication (MFA) is required for remote access.

​• Device security, including up-to-date software and operating systems, antivirus software, and enabled firewalls are utilised for the remote access.

​• All remote access is undertaken within the scope of the organisation’s DSPT (or other security arrangements as per this DSA) and complies with the organisation’s remote access policy.

​​The above applies in addition to any condition set out elsewhere within the DSA (e.g. who may carry out processing, and for what purpose). ​

​The Data will not be linked with any other data outside of this agreement

​​The expected outputs of the processing will be:

​• Two peer reviewed, open-access journal papers submitted to relevant high impact journals (e.g. Lancet Psychiatry, BJPsy). Audience: Clinical and academic professionals working in mental health. Target dates: July 2027 and July 2028

​• Presentation at national and or international conferences (minimum two) appropriate conferences (e.g., Royal College Psychiatry International Congress). Funding for this is available within the award-holders grant. Audience: clinical and academic professionals working in mental health and psychiatry, experts by experience. Target dates: Between June 2027 and Oct 2028

​• Presentation of report of findings results to third sector organisations with focus on the field: Carers Trust and Rethink. Audience: frontline charity workers and users of the organisations. Target dates: Between June 2027 and Oct 2028

​• Presentation of report of findings results in at All Parliamentary Group on Young Carers and Young Adult Carers. Audience. Audience: MPs, those involved in policy making. Target dates: Between June 2027 and Oct 2028

​• Lay presentation of results which will be shared via social media (e.g., LinkedIn). Audience: those with interest in mental health research. Target dates: July 2027 and July 2028​

​​The outputs will not contain NHS England Data and will only contain aggregated information with small numbers suppressed as appropriate in line with the relevant disclosure rules for the dataset(s) from which the information was derived. ​

The outputs will be communicated to relevant recipients through the following dissemination channels:

​• NHS and professional groups: Results will be reported to NHS England’s Mental Health Data Quality and relevant practice and professional groups and shared with relevant professional and voluntary organisations (e.g. Mind, Rethink, Royal College of Psychiatrists).

​• Public communication: Lay summaries and infographics will be shared via NIHR, ARC KSS, and institutional websites to communicate findings to the public and third-sector partners.

​• Policy engagement: The CI will leverage the results in ongoing policy engagement work (for example recent involvement in concession to Mental Health Bill to mandate parental identification).

​• Data quality improvement: A summary of data-quality findings will be fed back directly to NHS Digital to support enhancements to the MHSDS parental-responsibility variable.

​• Academic transparency: Academic dissemination will include open-access publication and conference presentation to support transparency and widest accessibility.

​• Social media

​• Press release, using the University of Sussex’s press office. This is expected to be published in national press.

​• Potentially webinars​

This work package is expected to generate national-level evidence on clinical outcomes for mothers admitted to psychiatric inpatient services in England. This foundational evidence is only possible through the linkage and analysis of the Hospital Episode Statistics (HES), Mental Health Services Data Set (MHSDS) and Index of Multiple Deprivation (IMD) data.

​The study aims to quantify the prevalence, characteristics, and outcomes of hospitalised mothers and explicitly identify inequalities by ethnicity, and socioeconomic group. This focus on health equity is crucial given known disparities in access and outcomes in mental health services. Evidence relating to admission duration and clinical outcomes for mothers is expected to contribute to the delivery of the NHS Mental Health Implementation Plan (2019) aim to improve inpatient experience and outcomes and shorten stays. It is expected to have direct public benefit by informing NHS England, Integrated Care Systems (ICSs), and Trust-level planning and resource allocation. This aligns with:

​• DHSC Areas of Research Interest (ARI) 2 “Interventions that can reduce hospital stays” and ARI 3 “Shaping and supporting the health and social care workforce of the future.”

​• The Children Act (1989) and NICE NG26, which emphasise recognition of dependent children when a parent is hospitalised.

​Although the analysis uses pseudonymised administrative data and involves no direct participant contact, it is expected to deliver substantial indirect benefit to patients, carers, and families by providing the national evidence base required to improve care for hospitalised parents. Specifically, through the following mechanisms:

​ ​- Identification: Identify how many adult inpatients are mothers and how their outcomes (e.g. length of stay, readmission, A&E attendance) differ from non-mothers.

​ ​- Targeting of resources: Highlight service inequities or regional differences, enabling NHS planning and commissioning to better target support and resources to address health inequalities thereby enhancing future patient care and safeguarding practice.

​These insights will help to ensure that parents’ family roles are recognised in clinical settings, ultimately improving recovery and family wellbeing.

​In addition, the findings of this study are expected to contribute to the development of a co-produced ward-level intervention protocol designed to enhance provision for parents who are hospitalised. Evidence such as service usage, readmission rates and clinical and demographic profile of parents will inform the design and delivery of this programme of work, which is being developed as subsequent work packages of the CI’s NIHR Award.

​In summary, this work package is expected to generate actionable national intelligence to improve the identification and support of hospitalised parents and support the evidence-base for the later intervention development.​

Yielded Benefits is not a requirement for new applications.