CHANGES AND CHALLENGES

Transcription

1 CHANGES AND CHALLENGES Creating a perinatal Mental Health Network in Flanders from the point of view of a Mother Baby Unit (MBU) Klaas Bauters

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3 MBUs in Flanders Population: 6,381,859 inhabitants (Brussels not included) 2 units: 1,177,210 fertile women Zoersel: 8 & 4 Gent: 6 2 8

4 MBUs abroad Germany: 57 (Berlin 2) France: 20 (Paris 2) United Kingdom: 17 (London 3) The Nederlands: 1 A lot of specialized mobile teams Barely MBUs in less developed countries

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6 inclusion / exclusion inclusion criteria: depression psychosis anxiety disorders adjustment disorders personality disorders OCD exclusion criteria: primary addiction judicial motivation problematical social behaviour without any psychiatric indication mental disorder

7 Treatment modules Residential module Day treatment module Ambulant module Intensive home treatment (mobile) Ambulant treatment in a centre East and West Flanders

8 Social and cultural factors Vulnerability factors: present before pregnancy Provoking factors: occur around the moment of birth Psychological problems and mental disorders in the postpartum period Factors which nurture the symptoms BIO-PSYCHOSOCIAL MODEL (Jeanette Milgrom)

9 Contact and fine-tuning as a basis for safe bonding IMH-theory Contact and fine-tuning safety and security stimulation and start for world exploration healthy development The inverse cycle prohibits development in different fields.

10 Mother treatment (CURATIVE) Working on the interaction between mother and baby through mother, baby and context (PREVENTIVE) Dyadic approach There is no such thing as a baby, only a mother-baby unit (Dr Donald W. Winnicott, 1949)

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12 Prevalence of PP Disorders Worldwide about 10% of pregnant women and 13% of women who have just given birth experience a mental disorder or primarily depression. In developing countries this is even higher, i.e. 15.6% during pregnancy and 19.8% after childbirth. Source: WHO 28/08/2016

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17 Becoming a parent is one of the greatest challenges in life, If you don t crash at that moment, you re on the right track

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19 40% psychological problems 10-15% mental disorder major mental disorder: 4,7% minor mental disorder: 13% (Marcé Society) 40% of untreated PPDs lead to chronic problems (S. Casalin ea, KUL, 2014) It s important to detect and treat as early as possible!

20 Loaded subject Only few mothers ask for help Mental healthcare taboo especially in that stage of life Diffidence, shame, guilt, fear of not being understood, feeling of failure as a mother Social imaging about pregnancy and childbirth Poor knowledge and sensitivity, even with professional workers

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22 Good is good enough

23 Growing awareness Exponential growth of research and publications about perinatal mental healthcare issues (e.g. Marcé Society, WAIMH, WMMHA ) More media coverage

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27 Conclusion > prevalence Still taboo despite growing awareness Lots of cries for help remain unnoticed The consequences of non-treatment are substantial for both moeder and baby Knowledge and sensitivity with both society and professional workers are too limited Highly specialized MBUs

28 Launch the Global Maternal Mental Health Alliance Prof Dr Alain Gregoire

29 It is possible to avoid extra costs and sorrow

30 Resolution about the early detection and treatment of a postnatal depression -Freya Saeys, Katrien Schrijvers a.o.-

31 Synopsis Big prevalence Huge consequences Taboo Insufficient detection Sensibilisation Screening and detection Referral list for professional help Perinatal expertise centre for mental healthcare Federal knowledge centre for healthcare states a medical policy, incorporating the expertise of the MBUs.

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34 Current developments and opportunities Pilot projects Short stay care after childbirth minister De Block Network Mental Healthcare Children and Youngsters East Flanders Media campaign Flemish Authorities (prevention of PPD) Conference The Future is young Universal proportionalism Perinatal Mental Healthcare Pathway test project in corporation with UZG CMB and various local partners (Flemish Gouvernment)

35 Ghent Collaborative Perinatal Mental Health Care Project

36 Aim Better detection of psychiatric disorders during the perinatal period Psychiatric disorder screening through a scaled screening tool Sensibilisation of professional workers - Development of a regional perinatal mental healthcare care path Starting before pregnancy and ending one year after childbirth Advice, diagnosis, treatment Ambulant, day care, residential, home treatment First, second and third line

37 Who Centrum voor Consultatieve en Liaisonpsychiatrie, Universitaire Dienst Psychiatrie, UZ Gent Afdeling Kinder- en Jeugdpsychiatrie, Universitaire Dienst Psychiatrie, UZ Gent Moeder-Baby eenheid, PZ Sint Camillus, St Denijs-Westrem Dienst Pediatrie, UZ Gent Dienst Neonatologie, UZ Gent Dienst Verloskunde Gynaecologie, UZ Gent Sociale Dienst, UZ Dienst Psychologie, UZ Gent WGC Nieuw Gent & Botermarkt Kind en Gezin.

38 Screening for PPD

39 EPDS

40 Flowchart

41 From micro to macro 1. Developing, underpinning and executing a care path with the current partners in the network 2. Spreading this method in other hospitals in the region 3. Interlacing the care path in a wider regional perinatal network 4. Thus creating a model for Flemish use

42 The importance of a perinatal expertise centre for mental healthcare Awareness Destigmatization Prevention Multidisciplinary consultation and advice Professional refferal Specialized treatment Research

43 Film tips L Etranger en moi ( Das Fremde in Mir ) Film van D Emily Atef (Fr/D) Postpartum een film van Delphine Noels (B/Fr/Lux)

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45 PZ Sint-Camillus Sint-Denijs-Westrem