From 1994 to 1996 the Enquiries had a psychiatric assessor, Prof. Channi Kumar, followed by Dr Margaret Oates. Regional assessors followed in 2006-8. The importance of psychiatric illness was recognised by WHO in 2012 when suicide was categorised as Direct death. Suicide and substance abuse are the main causes. Most deaths are Late (> 42 days after birth) and under-reporting is a problem. All social classes are at risk of suicide but social deprivation increases the risk of death from substance misuse. Screening for mental health disorder is now standard practice at booking. Good communication between primary care and maternity services is essential. Red flag indicators of risk should lead to review by a senior clinician and possible referral to a mother and baby unit. Risk factors include failure to restart medication after pregnancy. Each area should have a clinician responsible for the perinatal mental health service. The 2009-13 Report recommended regional networks to coordinate care. Rapid referral may be needed and the 2017-19 Report identified a lack of clear pathways into care. Management of substance misuse needs integrated multidisciplinary specialist services.