Specialist Perinatal Mental
Health Service
NHS Lanarkshire
Mental Health and Learning Disabilities
4th February 2015
Aim of Project
To establish a Lanarkshire-wide community
based service that enables multi-disciplinary
professionals to provide an excellent standard
of care for women of childbearing age with
mental health needs and their families, in
order that they experience positive
pregnancies with healthy children.
Prior to Improvement project
 NHSL Perinatal mental health (PMH) special interest
group
 Perinatal mental health ‘link’ nurses in some localities
 Mothers managed by generic community mental
health teams
 Good inter-agency working in some localities
Identified areas for development
 Lack of specialist community perinatal mental health
service in Lanarkshire
 Lack of specialist PMH liaison service for Maternity
inpatients
 Variation in clinical practice across Lanarkshire in
caring for mothers
 No formalised pathways for communication
between agencies
 Limited awareness and training of PMH
The need for improvement
 Childbearing is a critical time in the life of a mother,
her baby and her family.
 Undetected or untreated maternal mental illness
can lead to long term adverse outcomes for the
whole family, including the father.
 Some children have been shown to have long term
psychological, social and educational difficulties as
they age.
The benefits of early intervention
Perinatal and infant mental health services are aimed
at giving every child the best start in life by promoting
the wellbeing of parents and their babies across the
perinatal period, in addition to the early identification
and treatment of problems that complicate
pregnancy and the post-partum year.
Drivers for change
 Local and national guidelines/policies recommended
specialist PMH services
 SIGN guidelines (2012), NICE guidelines (2014),
Confidential Enquiries into maternal death
 Recognition of inequality of service provision across
Lanarkshire
 Demand from staff to increase awareness and training
in recognising and managing women with PMH
difficulties
 Learning from patient experience/feedback
The Project
A Lanarkshire-wide specialist perinatal mental health
service focusing on four key areas,
1.
2.
3.
4.
Maternity inpatient liaison service
Specialist maternity mental health liaison clinic
Training and education for colleagues
Promote and support good practice and review local
pathways of care
Details of project
 Establishment of a specialist PMH clinic and
maternity liaison service
 Delivering a package of training across Lanarkshire
for all agencies
 Produce educational resource guides and written
information for staff
 Review and update Integrated Care Pathway for
Antenatal and Postnatal mental health in
Lanarkshire
 Perinatal Mental Health Conference (12 March 2015)
Challenges of establishing a new
service
 Raising awareness
 Managing expectations
 Ensuring Service is accessible and beneficial for staff
and patients
 Internal processes, protocols and procedures
 Admin and IT systems
Key partners






Mental health services
Maternity services
Public Health
Primary Care
Social work
Service users
Data! Data! Data!
Initial findings
1. Baseline survey of CMHT team leaders and senior
midwives
2. Referral information so far
Survey
How confident are you at meeting
the mental health needs of patients ?
Midwifery Team Leader: Have you or any team members
undertaken any Antenatal/Postnatal Mental Health Post
registration Training
CMHT Team Leader: Have the following team
members had any additional perinatal mental health
training?
Referrals
0
21-Jan-15
19-Jan-15
17-Jan-15
15-Jan-15
13-Jan-15
11-Jan-15
9-Jan-15
7-Jan-15
5-Jan-15
3-Jan-15
1-Jan-15
30-Dec-…
28-Dec-…
26-Dec-…
24-Dec-…
22-Dec-…
20-Dec-…
18-Dec-…
16-Dec-…
14-Dec-…
12-Dec-…
10-Dec-…
8-Dec-14
6-Dec-14
4-Dec-14
Not officially accepting
referrals
2-Dec-14
30-Nov-…
28-Nov-…
26-Nov-…
24-Nov-…
22-Nov-…
20-Nov-…
18-Nov-…
16-Nov-…
14-Nov-…
12-Nov-…
10-Nov-…
8-Nov-14
6-Nov-14
4-Nov-14
2-Nov-14
10
31-Oct-14
Number of referrals
60
50
Total Referrals to date
40
30
20
Service Launched 17
November
Data! - Ongoing analysis
 Referrer satisfaction survey
 Patient satisfaction questionnaire
 Training impact analysis
 Admission details
Case Study
 Patient 28 wks gestation, 3rd pregnancy, 2 older children ages
5 and 2 years attended out of hours GP and A&E due to
worsening low mood and suicidal ideation. Referred onto
the PMHS by Duty Psychiatrist.
 Patient was contacted and assessed by Nursing and Medical
staff within 48 hrs – plan of care agreed and identified by
patient, family and PMHS.
Case Study
 Referred to PMHS by Maternity Staff. Assessment completed within 6 hours of
receipt of referral. Patient aged 38 yrs, 5 days post natal, history of Depressive
disorder previous suicide attempt - voicing concern that she is ‘not coping’
 Daughter born pre-term , low birth weight required additional feeding support.
 Plan of care identified and shared of midwifery staff.
 Ongoing support being offered in the community following discharge .
 Feedback from Staff and patient intervention by PMHS very positive.
Next Steps
 Complete pilot project and evaluate impact
 Discuss with key partners regarding implementation of
Service
 Establish system for ensuring evidence-based best
practice across Lanarkshire
“So What?”
Expected outcomes of Service
1.
Improved pre-pregnancy counselling and advice regarding risk of
mental illness and safety of prescribed medication
2.
Increased identification of significant risk factors of postnatal relapse,
thus enabling improved management during antenatal/postnatal
period. This will reduce psychological distress of mother and family and
reduce input required from multiple agencies and hospital admission
3.
Better maternal mental health which is likely to lead to better
parenting
4.
Healthier babies
5.
Improved mother-infant relationships and attachment
“So What?”
Expected outcomes of Service
6.
Improved communication and collaboration between multiple agencies and
professionals
7.
Reduced length of maternity admissions due to mental health concerns will be
achieved by rapid specialist assessment and facilitation of prompt input by
community mental health services.
8.
Better trained staff who are competent in identifying and managing mental health
difficulties
9.
Better informed mothers regarding mental health issues and availability of local
services
10. Appropriate treatment of maternal mental health difficulties is likely to reduce risk
of long term emotional, psychological, developmental, attachment and
educational problems in children.
What resources have been invested?
 Blood, sweat and tears
 Journey started over 10 years ago by dedicated nursing staff
 Staffing
 Nurses
 Psychiatrist
 Secretary
 Resources




IT
Publications
Expenses
Training
For More Information
Perinatal Mental Health Service



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Dr Aman Durrani
Helen Sloan
Liz Troy
Kathryn Thomson
Consultant Psychiatrist
Senior Charge Nurse
Charge Nurse
Secretary
 Email: [email protected]
 Airbles Road Resource Network, 49 Airbles Road, Motherwell ML1 2TP
 Tel: 01698 24 24 53