This study provides evidence of the benefits of a specialist multiagency home support service over standard home care, in the opinion of service users, carers and careworkers, and defines the operational model that achieves this. Findings confirm best practice recommendations, based on models of dementia care which emphasise respect for 'personhood'.

an appropriately resourced and constructed specialist service using an adaptive rehabilitation approach aimed at maintaining personhood can deliver good individualised care to people with dementia, but specific and appropriate commissioning for these services is needed to nurture them.

Perinatal psychiatric illnesses are a leading cause of maternal morbidity and mortality but difficulties still exist with the correct identification and management of these disorders. This study surveyed health professionals involved in the care of women with maternal mental health disorders and identified where improvements are required. Midwives, obstetricians and health visitors were asked for their views on the identification, treatment and management of a range of perinatal mental health disorders. The results showed that participants lacked the required knowledge/skills to identify and manage these disorders effectively and most had not received any specific pre-qualification or postgraduate training in perinatal mental health. Most requested additional support, including specialist advice, training and guidelines and agreed that all women with perinatal mental health disorders should have the support of specialized perinatal psychiatric services. Systems are needed to develop and maintain practitioners’ knowledge and skills and to ensure improved access to specialist advice and support when required.

Ethnicity recording in general practice is feasible and acceptable. Nevertheless, the role of ethnic data in assessing health need in primary care, an adequate recording system, and evidence that recording offers benefits greater than the costs need to be established.

Aims and MethodTo identify problems with the management of perinatal mental health disorders and areas where improvements are thought-required. The study used qualitative methods comprising focus groups with recovered patients and interviews with health professionals.ResultsIssues we identified included a lack of knowledge, skills, integrated working, poor access to resources and ill-defined professional roles and responsibilities. Improving care and service provision requires the development of training and education programmes, care pathways and protocols, and referral guidelines and liaison services.Clinical ImplicationsDifficulties over managing perinatal mental illnesses occur at all levels of healthcare provision. Our findings confirm best practice recommendations which emphasise improved joint working and the provision of specialist services in all localities.