Transcript Slide 1

CRSI Conference
Perinatal Mental Health Care Workshop
Brigid Arkins
[email protected]
What is Perinatal Mental Health
Mental health issues concerning women who are:
 Child bearing years
 Pregnant
 In the postnatal year
 Pre-existing mental illness
 High risk of developing mental illness
(family history of mental illness)
Rates of Perinatal Conditions
“Baby blues”
 Postnatal depression
 Puerperal psychosis
 Antenatal depression
 Pre-existing SMI/h/o bipolar
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50-80%
10-15%
0.1-0.2%
10-15%
1-2%
Risks of Perinatal Mental
Illness
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Relapse and emerging illness
more common around birth
Medication may harm the
developing baby but so may
relapse
Mental illness at this time can
be extreme
Illness may compromise
adequate care and protection
of a child
Illness may compromise the
child’s development and
attachment
Consequences for the baby
postnatally
Postnatal maternal mental ill health:
 Lack of appropriate stimulation
 Lack of dialogue with mother
 Multiple care givers or none
 Neglect
Increases risk for the infant of:
 Poor attachment
 Failure to thrive
 Slower development
 Injury
 Infanticide
Consequences on the child
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Poor attachment
Child abuse/neglect/filicide
Poor language development
Conduct disorder
Lower IQ
Behavioural problems in sons
Emotional problems in
teenage girls
Vision for Change
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One perinatal mental health resource should be
provided in a national maternity hospital, with a
national remit.
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Perinatal mental health services require both a
specialist mental health service and obstetric
services.
Women with serious mental illness require
coordinated care across disciplines: psychiatry
(general and perinatal), obstetric, general practice
and child and family social services.
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Vision for Change
 Recommendation
15.5.4:
 One additional adult psychiatrist and
senior nurse with perinatal expertise
should be appointed to act as a
resource nationally in the provision of
care to women with severe perinatal
mental health problems.
Some Perinatal Policy Guidance
UK
1) Confidential Enquiry into Maternal Deaths “Why women die”
(2000-2002)
Psychiatric disorders are the leading indirect cause of maternal deaths in the UK
2) NICE guidelines for antenatal care
All women should be screened for a previous history of severe mental disorders
3)NSF for children, young people and maternity services
All professionals must be able to identify mental health problems in new mothers
Each woman identified as at risk of relapse of serious mental illness must have a
written plan
All women that require a mother and baby in patient unit must be able to access
one
4) Women’s mental health – into the mainstream
The perinatal period carries the greatest lifetime risk of
severe mental illness for women. Protocols for
management of postnatal depression should be
developed. Local education and training programmes
needed to develop knowledge
Preventable death. See case history.
5) CEMACH “Saving Mothers’ Lives” 2003-2005
Fewer suicides. Substance abuse. Pre-conception
counselling
6) NICE guideline for Antenatal and Postnatal Mental
Health (2007)
Planned care for at risk women. Managed networks.
Specialist teams. Access to timely psychological therapies.
7) New Horizons Vision for Mental Health (2009)
Treating mental illness for parents as a priority under CPA
8) CEMACH “Saving Mothers’ Lives” 2006-2008 (2011)
No reduction in suicides. Substance abuse. Priority care pathways
for pregnant and postpartum women. Specialised CMHT