CRSI ConferenceCRSI ConferencePerinatal Mental Health Care Perinatal Mental Health Care

WorkshopWorkshopBrigid ArkinsBrigid Arkins

b.arkins@ucc.ieb.arkins@ucc.ie

What is Perinatal Mental What is Perinatal Mental HealthHealth

Mental health issues concerning women who Mental health issues concerning women who are:are:

Child bearing yearsChild bearing years PregnantPregnant In the postnatal yearIn the postnatal year Pre-existing mental illnessPre-existing mental illness High risk of developing mental illness High risk of developing mental illness

(family history of mental illness)(family history of mental illness)

Rates of Perinatal Rates of Perinatal ConditionsConditions

““Baby blues” Baby blues” 50-80%50-80% Postnatal depressionPostnatal depression 10-15%10-15% Puerperal psychosisPuerperal psychosis 0.1-0.2%0.1-0.2% Antenatal depressionAntenatal depression 10-15%10-15% Pre-existing SMI/h/o bipolarPre-existing SMI/h/o bipolar 1-2%1-2%

Risks of Perinatal Risks of Perinatal Mental IllnessMental Illness

Relapse and emerging Relapse and emerging illness more common illness more common around birth around birth

Medication may harm Medication may harm the developing baby but the developing baby but so may relapse so may relapse

Mental illness at this Mental illness at this time can be extremetime can be extreme

Illness may compromise Illness may compromise adequate care and adequate care and protection of a childprotection of a child

Illness may compromise Illness may compromise the child’s development the child’s development and attachmentand attachment

Consequences for the baby Consequences for the baby postnatallypostnatally

Postnatal maternal mental ill health:Postnatal maternal mental ill health: Lack of appropriate stimulationLack of appropriate stimulation Lack of dialogue with motherLack of dialogue with mother Multiple care givers or noneMultiple care givers or none NeglectNeglect

Increases risk for the infant of:Increases risk for the infant of: Poor attachmentPoor attachment Failure to thriveFailure to thrive Slower developmentSlower development Injury Injury InfanticideInfanticide

Consequences on the Consequences on the childchild

Poor attachmentPoor attachment Child Child

abuse/neglect/filicideabuse/neglect/filicide Poor language Poor language

developmentdevelopment Conduct disorderConduct disorder Lower IQ Lower IQ BehaviouralBehavioural problems in problems in

sonssons Emotional problems in Emotional problems in

teenage girlsteenage girls

Vision for ChangeVision for Change

One perinatal mental health resource should be provided in a national maternity hospital, with a national remit.

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.

Vision for Change 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 Some Perinatal Policy Guidance UK Guidance UK

1) 1) Confidential Enquiry into Maternal Deaths Confidential Enquiry into Maternal Deaths “Why women die” (2000-2002) “Why women die” (2000-2002) Psychiatric disorders are the leading indirect cause of Psychiatric disorders are the leading indirect cause of maternal deaths in the UKmaternal deaths in the UK

2) 2) NICE guidelines for antenatal careNICE guidelines for antenatal careAll women should be screened for a previous history of severe All women should be screened for a previous history of severe mental disordersmental disorders

3)3)NSF for children, young people and maternity NSF for children, young people and maternity servicesservicesAll professionals must be able to identify mental health All professionals must be able to identify mental health problems in new mothersproblems in new mothersEach woman identified as at risk of relapse of serious mental Each woman identified as at risk of relapse of serious mental illness must have a written planillness must have a written planAll women that require a mother and baby in patient unit must All women that require a mother and baby in patient unit must be able to access onebe able to access one

4) 4) Women’s mental health – into the Women’s mental health – into the mainstreammainstreamThe perinatal period carries the greatest lifetime The perinatal period carries the greatest lifetime risk of severe mental illness for women. Protocols risk of severe mental illness for women. Protocols for management of postnatal depression should for management of postnatal depression should be developed. Local education and training be developed. Local education and training programmes needed to develop knowledgeprogrammes needed to develop knowledgePreventable death. See case history.Preventable death. See case history.

5) 5) CEMACH “Saving Mothers’ Lives” 2003-2005CEMACH “Saving Mothers’ Lives” 2003-2005Fewer suicides. Substance abuse. Pre-conception Fewer suicides. Substance abuse. Pre-conception counsellingcounselling

6) 6) NICE guideline for Antenatal and Postnatal NICE guideline for Antenatal and Postnatal Mental Health (2007)Mental Health (2007)Planned care for at risk women. Managed Planned care for at risk women. Managed networks.networks.Specialist teams. Access to timely psychological Specialist teams. Access to timely psychological therapies. therapies.

7) 7) New Horizons Vision for Mental Health New Horizons Vision for Mental Health (2009)(2009) Treating mental illness for parents as a priority under CPA

8)8) CEMACH “Saving Mothers’ Lives” 2006-CEMACH “Saving Mothers’ Lives” 2006-2008 (2011)2008 (2011)

No reduction in suicides. Substance abuse. No reduction in suicides. Substance abuse. Priority care pathways for pregnant and Priority care pathways for pregnant and postpartum women. Specialised CMHTpostpartum women. Specialised CMHT