Developing services and pathways for parent & infant mental health

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Rhoda Strickland
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1 Developing services and pathways for parent & infant mental health Sally Hogg Mums and Babies in Mind

2 A coalition of over 80 national professional and patient organisations committed to improving the lives of mothers and their infants through better perinatal mental health

4 Mums and babies in mind Working with local leaders to improve services for mums with perinatal mental health problems and their babies. Maternal Mental Health Alliance project, hosted by the Mental Health Foundation and funded by the Big Lottery Fund. Lasts for three years until Sept Focused work in 4 areas: Gloucestershire, Haringey, Blackpool and Southend. But creating tools and resources that are useful anywhere.

5 Three levels of support 1. Expert advice and support to each area depending on their needs and priorities. 2. A leader s programme to bring together leaders from the four areas to learn together, share ideas and support each other. 3. Communications activity to share our activity, tools and learning to support others.

7 My talk today. Perinatal mental health what it is and why it matters Tackling perinatal mental illness The state of services What you can do

8 What are perinatal mental health problems & why do they matter?

9 What is perinatal mental health? Perinatal mental health refers to the mental health of mothers during pregnancy and the year after birth. There are a range of mental health problems that can affect women during this time, including anxiety disorders, depression and postnatal psychotic disorders.

10 Symptoms to look out for Sadness and tearfulness Hopelessness Tiredness A lows of interest and enjoyment in activities Feeling like you can t cope Feeling irritable and hostile with other people. Feeling isolated Anxiety and feeling tense or uptight Fear or distress Uncontrollable worries or panic Flashbacks or nightmares Obsessive thoughts Feeling unreal, strange and detached Problems persist and can stop mums functioning in their daily lives.

11 In mums own words

12 Why do women suffer from mental health problems at this time? A time of intense social, psychological and physical changes. Some women experience a mental illness for the first time during this period. Other women may have a pre-existing illness that persists, deteriorates or recurs during this period (perhaps due to stress, changes in medication or events during birth).

13 Who is most at risk? Early emotional trauma/childhood abuse History of mental illness Family history of mental illness Lone parent or poor couple relationship Low levels of social support Recent adverse or stressful life experience Socioeconomic disadvantage Teenage pregnancy Unwanted pregnancy

14 How prevalent are perinatal mental health problems? More prevalent than people think: More than 1 in 10 new mothers experiences some form of perinatal mental illness. Postpartum psychosis affects 1 in 500 new mothers it is twice as common as Downs Syndrome.

15 Depression is the most common major complication in pregnancy. 14% 12% 10% 8% 6% 4% 2% 0%

17 Admissions This isn t just the baby blues Women are more likely to be hospitalised with a mental illness in the two weeks following birth than at any other point in their lives Weeks before Weeks after Birth Kendell, 1987

18 Mental illness is one of the leading causes of maternal death in the UK today.

19 If not treated effectively, perinatal mental illness can impact on children Mental health problems can have direct and indirect impacts on fetal development. After birth, perinatal mental health problems can effect how a mother cares for her baby.

20 But problems aren t inevitable Clips from our Breakdown or Breakthrough films

21 Tackling perinatal mental illness

22 We can prevent the harms caused by perinatal mental illness Proper management of an existing mental illness can prevent it from escalating during the perinatal period. Early detection and action to tackle problems in pregnancy or postnatally can prevent them continuing and escalating. Early action to treat mothers with serious mental illness can prevent serious harms to them and their baby. Supporting mothers to provide sensitive, responsive care to their babies can prevent any adverse outcomes for babies.

23 A spectrum of services are needed Health Visitors Children s Centres FNP Specialist Obstetricians Peer support services/ groups Specialist PMH community services Midwives GPs Talking therapies Parent & baby groups/activities Mother and Baby Units

24 Universal services Midwives, health visitors and GPs are well placed to identify risks and issues and help women to get the support they need. Continuity of care Good quality training Information for all parents Use of evidence based tools and clinical judgement to assess risks Clear care and communication pathways Active management of cases Specialist champions

25 A focus on families Services that involve and support fathers As fathers of babies As supporters of mums As parents potentially in need of help themselves Services that support parent-infant relationships research has shown that interventions can improve the symptoms of women with depression without improving the quality of motherinfant relationships or infant outcomes

26 This should all be underpinned by: Clear pathways across services A skilled workforce Clear roles and responsibilities Audits, monitoring and quality improvement Understanding of local needs Clinical leadership Structures and processes to support multiagency working

27 The State Of Services

28 There are many gaps across services

29 Specialist perinatal mental health services

30 Mother and Baby Units

31 Treatment of postnatal depression 100% 80% 60% 40% 20% 0% Prevalent PND Cases 40% Recognized Clinically 24% Any Treatment 10% Adequate Treatment 3% Achieved Remission (Gavin et al)

32 Inadequate services cost lives "That chain of failures contributed to Charlotte's death. Zaani's death was contributed to by a chain of failures in her mother's care."

33 There are economic costs of inaction Cost if we don t act 8.1bn 337m Cost of taking action

35 Successes Seats around the table with Government, NHS England and Health Education England. Pledge to have specialist mental health midwives in every maternity unit. Pledge to turn the map green supported by 360m investment in specialist services and Mother and Baby Units. Funding for a range of projects including training GPs, Midwives and health visitors.

36 Specialist Perinatal Community Services professional 2 professionals full team

37 What can you do?

38 Whatever your role, if you are working with expectant/new parents you could: Talk about mental health and emotional wellbeing the good and the bad Help address stigma and myths Be warm and sensitive in your interactions Build trusting relationships Maintain relationships and check in with women Ask questions and listen to the answers Give women and their partners time to talk Encourage women to seek help Report your concerns

40 Any #mabim

Developing services and pathways for parent & infant mental health

Developing services and pathways for parent & infant mental health Sally Hogg Mums and Babies in Mind #MABIM @salhogg My sessions today. Session 1: A recap what are perinatal mental health problems and