A survey of specialist perinatal mental health services in England

Self-harm in postpartum depression and referrals to a perinatal mental health team: an audit study

There is a paucity of research on self-harm during pregnancy and the postpartum period despite suicide being a leading cause of death and high rates of mental disorder during this time. This audit describes a cohort of women referred to a new perinatal mental health team (PMHT) based in a large maternity hospital in the UK over a 12-month period. The audit was conducted in two stages. Stage one describes the clinical and socio-demographic characteristics of 225 pregnant women referred to the team after screening positive for a significant mental health history. Stage two determines the veracity of data on a subgroup of 73 pregnant women referred for previous postpartum depression (PPD), 58 % of whom disclosed an episode of self-harm with the 'intent to kill themselves' to the maternity staff when they first booked in for antenatal care. Previous PPD accounted for the largest majority of referrals (32 %) to the PMHT followed by depression (27 %) and self-harm (10 %). The majority of women (85 %) referred to the PMHT were engaged. Eight percent were so unwell at the point of referral they required an admission to the hospital. Attempted suicide in the subgroup of 73 women with previous PPD ranged from 24-49 %. The findings from this audit suggest that self-harm in PPD warrants further investigation.

Using the repertory grid technique to examine nursing staff's construal of mothers with mental health problems

BACKGROUND

This study explored the attitudes of psychiatric nursing staff towards mothers with mental health difficulties. Working with mothers experiencing mental health problems can evoke negative reactions in staff that activate value-laden beliefs regarding the capacity of these women to care for their infants, which could diminish the provision of optimal care and treatment for patients.

METHOD

Ten psychiatric nursing staff working in a specialist mother and baby unit in the North of England were interviewed about their views of various types of client by using the repertory grid technique.

FINDINGS

A total of 86 constructs that clustered under 21 headings were elicited. All staff made critical judgements about some clients. Staff often described the context in which these perceptions were reached such as the behaviour of clients and the quality of the nurse-client relationship.

CONCLUSIONS

Clients with a personality disorder and those who were thought to be 'bad' mothers were construed as being furthest from the self and more negatively than clients with depression or psychosis. Further training is indicated for staff working with mothers displaying challenging interactional styles; however, training packages must consider the individuality of perception and experience present within staff groups.

Health-Led Interventions in the Early Years to Enhance Infant and Maternal Mental Health: A Review of Reviews

BACKGROUND

  Increasing recognition of the importance of maternal mental health and early parenting in optimising the later mental health of the child has given rise to new ways of working during the perinatal period.

AIMS

  The objective of this review is to identify effective health-led interventions to support parents, parenting and the parent-infant relationship during the perinatal period,¹ and beyond.

METHOD

  A systematic search of key electronic databases was undertaken to identify secondary and primary sources of data addressing the research question. Twenty-four reviews addressed the effectiveness of interventions delivered during the postnatal period in promoting closeness and sensitive parenting, infant sensory and perceptual capabilities, and positive parenting, and in addressing infant regulatory problems, maternal mental health problems, and parent-infant relationship problems.

CONCLUSIONS

  A number of methods of working are recommended as part of a model of progressive-universalism beginning ante-natally and continuing through the first two post-natal years, and beyond. The implications for universal, targeted and specialist healthcare services are explored, alongside the role and contribution of CAMHS practitioners.

The rise and fall of a psychiatric antenatal clinic: development of a perinatal psychiatric service linked directly to the provision of antenatal care

Usual referral pathways to psychiatric services can miss opportunities for timely intervention in maternal perinatal psychiatric ill health. Psychiatric illness leading to suicide is a significant factor in at least 10% of maternal deaths. Despite Royal College of Psychiatry and National Institute for Health and Clinical Excellence recommendations for specialist provision of perinatal mental health services, this remains sporadic and insufficient. We set out to develop a new integrated antenatal-psychiatric direct referral pathway and present a year of experience using this service model. The psychiatric service was delivered from within the antenatal clinic setting with a direct health-care professional (HCP) led referral pathway between 2003 and 2004. The service comprised one session per week of a senior psychiatric specialist registrar and provided three new patients and two follow-up appointments per week. During this period, a total of 75 referrals to the service were made with 57 individuals attending for an appointment. There was a range of diagnoses among the women who attended, with only 24% meeting eligibility criteria for referral to secondary psychiatric services. The majority diagnosis was depression. More severely ill women were not referred to this clinic by obstetric HCPs. In conclusion, this model for developing and delivering a specialist perinatal psychiatric service using direct links to antenatal medical care was not successful despite requiring minimal funding. Nevertheless, it has been used to inform development of a new perinatal service in keeping with the Royal College of Psychiatrists' recommendations and incorporating enhanced training of HCPs responsible for the referral pathway.

An audit of pregnant women with severe mental illness referred during the first 2 years of a new perinatal mental health service

The importance of identifying pregnant women at high risk of postpartum psychotic illness has been highlighted by recent enquiries and guidelines. It has been recommended that these women are referred to perinatal mental health services, and that individualised care plans are made prior to delivery. This audit describes a cohort of 45 women, referred to a new perinatal mental health service, with a history of psychotic illness or at risk of developing a postpartum psychotic episode. It describes the characteristics of this group, and the outcomes in terms of relapse and whether their children remained in their care. Thirty-nine women (87%) were seen for assessment. Sixty-seven per cent were under the care of a community mental health team. Twenty-one (53.8%) were well at the time of referral. Planned pregnancies were uncommon (15%). All women seen antenatally had care plans written to address the high risk of postpartum relapse. Ten (26%) women had psychiatric admissions during pregnancy. Fifteen (38%) relapsed or had admissions during the first postpartum year. At 1 year postpartum, 74% women had care of their children; 18% children had been adopted or were in foster care; and the outcome was unknown for 8%.

A survey of instruments used for the psychological assessment of patients admitted to mother and baby inpatient facilities

This survey examined which instruments were routinely used for the psychological assessment of patients admitted to Mother and Baby inpatient facilities in the United Kingdom (UK). Thirty eight percent replied and the findings highlight that only a few questionnaires were routinely utilised. The facilities surveyed varied in the measures used, which were mostly measures of depression, psychosis and mother-infant bonding. Staff identified a range of advantages and disadvantages in relation to their use.