The PRAMS (Perinatal Redesign for Accessing Mental Health Services) Study: a research protocol

Background Perinatal mental health (PMH) problems affect 10-20% of women during pregnancy and the postnatal year, costing the UK an estimated £8.1 billion annually. Underserved groups—including women from ethnic minorities, deprived areas, and those facing multiple disadvantages—experience the greatest inequalities in access and outcomes. Despite national investment, many fall between primary care (general practice, NHS Talking Therapies) and specialist PMH services, with limited guidance on bridging this gap.

Aim To co-design an experience-based intervention to address unmet PMH needs among underserved women, and to explore barriers to accessing care and gaps across PMH pathways.

Design & setting A mixed-methods study using the MRC framework and an adapted Accelerated Experience-Based Co-Design (AEBCD) approach.

Method Work Package 1 will survey and interview professionals nationally across diverse roles and organisational contexts. Work Package 2 will involve focus groups and interviews with underserved women in Sheffield and Doncaster (South Yorkshire, UK), supported by bilingual community link workers. Findings will be synthesised and used in co-design workshops (Work Package 3) to develop an accessible, evidence-informed intervention tailored to the needs of an underserved group.

Conclusion The PRAMS study will generate clinically relevant insights into improving access to and management of PMH care for underserved women and birthing people. By working collaboratively with practitioners, women with lived experience, and community partners, PRAMS will deliver a co-designed intervention with potential to reduce inequalities. Findings will inform local service delivery and contribute national learning on user-led redesign of PMH services across primary and secondary care.