We read with interest the paper by Drs Oluwatayo & Friedman on the provision of specialist perinatal mental health services in England (Psychiatric Bulletin, May 2005, 29, 177–179). It is particularly worrying that, despite two confidential enquiry reports into maternal deaths identifying psychiatric disorder as the most common cause of death during pregnancy or within the first postnatal year (Confidential Enquiry into Maternal and Child Health, 2004), the number of specialist facilities has actually declined, and trusts in England do not regard such provision as a priority. We agree wholeheartedly with Oluwatayo & Friedman that there is need for a national approach and guidance on minimum standards.

The Mental Health (Care and Treatment) (Scotland) Act 2003 enshrines in law a requirement for National Health Service (NHS) boards in Scotland to make appropriate provision for admitting mothers with their babies for treatment of mental illness in the postnatal period. The Act also encourages NHS boards to collaborate in delivering services. Recent guidance (Scottish Executive Health Department, 2004) emphasises the need to develop community, maternity liaison and specific primary care services in tandem with in-patient provision, and sets minimum standards for care for both mother and baby. A formal Scottish Executive Health Department review of progress towards implementation of the Act in October 2005 is ongoing. Inevitably this has led to an approach that is national in aspiration.

Scottish provision remains patchy, with one six-bed unit serving the west, but plans are rapidly developing in other areas through regional planning structures, with close communication between those involved in running existing services and those commissioning new provision. What has become clear from our experience is that specialist provision must involve collaboration across wide geographical/population areas to ensure viability of services and development of appropriate knowledge and expertise.