In 2014, our team members Dr. Cerith Waters and Claire Traylor, were working in a Specialist Perinatal Mental Health Service in Cardiff and Vale UHB located within Wales, United Kingdom. Recognising the need for timely interventions which met the needs of those who used the service, they piloted an 8-week face-to-face Acceptance and Commitment Therapy (ACT) group intervention. The pilot was a successful, and in 2016, Cerith secured funding through Health Care Research Wales to ‘fine tune’ the intervention and evaluate it’s feasibility, safety, acceptability and effectiveness.

In 2020, two things happened! Cerith, Claire and others within the Perinatal Mental Health Service published their findings which showed that over an 18 month period of evaluation, the ACT group was feasible, safe, acceptable and effective (Waters et al., 2020).

However, the other thing which happened was the COVID-19 pandemic which in NHS Wales, haulted most face-to-face care. Cerith, Claire (and then joined by Jen) took the brave steps to pilot a remote-delivered ACT intervention (later known as ACT-for-PNMH). At the time, there was little guidance around delivering interventions remotely, so through literature reviews and following guidance provided by the British Psychological Society (BPS) on remote-delivered interventions, the 8 week course was moved to an online platform for delivery.

As with the face-to-face intervention, there was a need to evaluate the feasibility, safety, acceptability and effectiveness of the intervention. The pilot was completed, and a lot of learning came out on what was helpful and unhelpful for both attendees and facilitators. At the same time, Improvement Cymru provided funding for an evaluation of what facilitators or creates a barrier to engaging in remote-delivered interventions, which further informed changes.

Listening to the feedback of this pilot, adaptations were made to the intervention. The Improvement Cymru results also supported the changes made, and in 2021, in collaboration with Cardiff University, Innovation for All funding was awarded to Jen, Cerith and Claire to support dissemination of the group. This funded supported adaptations made, allowed translation of materials in to Welsh, supported the creation of graphics and animations to support learning, and funded the development of a ‘train the trainer’ programme. 2021-2022 was spent developing and piloting the ‘train the trainer’ programme with Swansea Bay UHB Specialist Perinatal Mental Health Service, led by Dr. Matt Lewis (Clinical Psychologist), and with our partners in Hospital Universiti Malaysia Sabah (HUMS), led by Dr. Nicholas Pang, Dr. Farah and Dr. Corine.

The results of the Innovation for all funded pilot then supported further funding applications through collaboration with Cardiff University, leading to funding through Medical Research Council (MRC) and Official Development Assistance (ODA). This means that since 2021, we now have partnerships in NHS Wales, NHS England, Malaysia, United States of America (USA) and Pakistan. These partnerships have led to all of Wales being trained in delivering ACT-for-PNMH, with four out of seven healthboards routinely delivering the intervention. Our colleagues in Malaysia have adapted the intervention for Malay-speaking mothers, and found promising results! The USA are currently delivering within two contexts, and adapting for the use with Latin-American speaking mothers. Our colleagues in Pakistan have published a feasibilility study on the use of a culturally-adapted ACT-for-PNMH, delivered in Urdu, and through ODA, we have received further funding to complete a feasibility Randomised Control Trial within Islamabad, Pakistan, of an adapted ACT-for-PNMH between November 2025 – March 2026.

Alongside all of the developments with this project, many stakeholders have been involved, and vitally, this has included an expert reference group (ERG) of mothers who have experienced difficulties with their mental health during the perinatal period. Their feedback has been vital in the developments of the both the original pilot of ACT, and also cultural adaptations across the world.

Our ongoing vision for ACT-for-Perinatal Mental Health is to continue adapting the model to fit different services and contexts, and create a not-for-profit model which allows teams to be trained in delivering group and individual ACT interventions related to the perinatal period.