Maternal mental illness
Impact on women’s health
The Confidential Enquiries into Maternal Deaths
Latest findings from CEMD
Saving Lives, Improving Mothers’ Care 2012-2014
Maternal suicide reclassified by WHO
as a direct cause of maternal death
No change in maternal suicide rate
since 2003
Suicide now the leading direct cause of
maternal death in year after childbirth
“The children left behind”
“Any child whose mother
dies must face a far poorer
start to family life. The fact
that so many of the children
were already living in
complex circumstances with
vulnerable families, or were
in care, continues to
underscore the important
public health dimension of
this Enquiry.”
Gwyneth Lewis OBE
Impact on children growing up
• Impairment not inevitable
but…
– Severe/chronic maternal
disorder
– Social adversity
Specialist mental health care
matters
Costs of not treating
Meeting need in Scotland
UK MBUs
Scottish specialist community
services
What should Scotland have?
All women across Scotland should have
equitable access to:
Specialist community perinatal mental health
services
Inpatient mother and baby unit beds
Interventions which promote good infant mental
health
SIGN
2012
NSPCC/MMHS
2015
MWC
2016
Mental Health Strategy 2017-2027
2017
• Fund the introduction
of a Managed Clinical
Network to improve the
recognition and
treatment of perinatal
mental health problems
The Best Start
2017
•
The Scottish Government should ensure
–
–
•
NHS Boards should
–
–
–
•
Perinatal Mental Health key focus in
Mental Health Strategy
Connections are made with new models of
care described in that strategy
Review current access to perinatal mental
health services to ensure early and
equitable access is available to high
quality services
Clear referral pathways
Adequate provision of staff training to
allow staff to deliver services to the
appropriate level.
Primary midwives, in partnership with
primary care colleagues, should
–
Play a proactive and systematic role in the
identification and management of
perinatal mental health care.
What is a managed clinical
network?
•
•
•
•
•
‘linked group of health professionals and organisations
primary, secondary, and tertiary care
working in a coordinated way
not constrained by existing organisational or professional boundaries
ensure equitable provision of high quality, clinically effective care’.
(Scottish Executive, 1999)
At national level?
•
•
•
Formally designated by SGHSC on the advice of the National Services Advisory
Group and Board Chief Executives’ Group.
Commissioned and performance managed by NSD of NHS National Services
Scotland (NSS) on behalf of the SGHSC and NHS Boards.
Subject to regular review.
For perinatal mental health?
 Approved Jan 2017; Established April 2017; £173,000/yr for 3 years
RCPsych Campaign Roundtable
2017
PRIORITIES FOR A NATIONAL
MCN
MAPPING AND GAPPING
COMMUNICATION
EQUITY OF PROVISION
SKILLED WORKFORCE
EVALUATION
Develop a communications strategy
that effectively informs and educates
the public, professionals and service
commissioners about the importance
of maternal and infant mental health
Communication
Stakeholder
empowerment
Public health
Website
Develop care pathways to
ensure all women and their
infants have access to the level
of assessment and treatment
appropriate to their needs
Equity of
provision
National care
pathway
Local/regional
networks
National bed
management
Skilled workforce
Professional
competencies
Specialist team
composition
Ensure that there are
adequately staffed and trained
multi-professional teams who
can deliver effective care
Training
resources
Proposed organisational structure
NMCN Manager |
NMCN Clinical Lead
Maternity Lead | Nursing Lead | Infant Mental Health Lead
Information management | Administrative support
Service
provision
Communication
Regional networks
Education
& training
Thematic subgroups
Thinking bigger…
Challenges
• NO money!
• Big task
• Reliance on goodwill
Be careful what you wish for…