Perinatal Mental Health NZ Trust PMHNZ. GP CME Rotorua June 2014

Transcription

1 Perinatal Mental Health NZ Trust PMHNZ GP CME Rotorua June 2014

2 Postnatal Distress (PND) PND is an umbrella term to describe a number of psychiatric illnesses Antenatal depression and anxiety Postnatal depression Postnatal anxiety Adjustment disorder Postnatal psychosis Obsessive compulsive disorder (OCD) PTSD from birth trauma Grief reactions, perinatal loss and fertility difficulties It is NOT the baby blues.

3 Statistics PND can begin antenatally (10%) or postnatally (more than 20%) which includes immediately after the birth and up to a year later. 10% of men experience PND. PND is a clinical depression that can occur any time immediately after birth up to a year postpartum. The risk of it re-occurring with the next baby is 40%, with approximately 24% of all reoccurrences occurring within the first 2 weeks. (Wisner et al 2004)

4 Postnatal Psychosis Postnatal psychosis is a severe medical condition that is often misdiagnosed as postnatal depression. Psychosis occurs in 1 or 2 out of 1,000 postpartum women and if often associated with bipolar illness. The most common symptoms are severe agitation, delusional or bizarre thinking, hallucinations, insomnia, confusion, and a feeling of being out of touch with reality. Although this is a rare condition, it is always an emergency and requires immediate medical attention.

5 Symptoms She might: Have difficulty sleeping Cry over the slightest thing Feel exhausted most of the time No longer enjoy the things she used to enjoy Have a decrease in appetite Isolate herself from her friends and family Worry about little things that never used to bother her Wonder if she will ever have time to herself again Think her children would be better off without her Worry that her husband will get tired of her feeling this way Snap at her husband and children over everything Fear leaving the house or being alone Have anxiety attacks Have unexplained anger Have difficulty concentrating Think something else is wrong with her or her marriage Feel like she will always feel this way and never get better Think everyone else is a better mum than she is

6 Transition to Motherhood Women are far more at risk for depression and anxiety during their child bearing years than any other time. Myth exists that women enjoy optimal mental health as though encased in an emotional bubble. Reinforces silence. PND can strike without warning in women with no history of depression or women who have had it before. It can happen to women who are highly successful in their careers or women who stay home with their children. It can strike women in stable marriages and conflicted marriages, as well as single women, and adoptive mothers. It can happen to women who love their baby more than anything in the world. It can happen after the first baby, or after the fourth. It can happen to women who swore it would never happen to them.

7 Strong risk factors: Depression during pregnancy Anxiety during pregnancy Family history of depression Previous history of depression, including PND Stressful recent life events Lack of social support (perceived or real)

8 Moderate risk factors: Maternal personality (worrier, perfectionist, anxious, nervous ) Low self-esteem Relationship difficulties Previous birth trauma Low or changed socio-economic status Obstetric and pregnancy complications Current interpersonal difficulties Difficult experiences in early life e.g. sexual abuse or parental neglect Abortion and reproductive losses Temperament of the newborn. Having a sick baby (NICU, reflux etc.)

9 Postnatal Distress IS: A medical condition that can begin before the baby is born A neuropsychiatric illness that affects every cell in a woman s brain and body PND is typically an agitated depression, with symptoms of both depression and anxiety. Postnatal distress is the most common complication following childbirth PND Is NOT: A moral failure An ethical dilemma A symptom of weakness

10 Women feel robbed! Antenatal and postnatal distress robs a woman of what can be one of the most spectacular and truly unique experiences of her life (Kleiman, 2009)

11 PND Affects the Family PND dramatically affects the entire family PND chews up and spits out relationships Recovery will be smoother with the help of a supportive partnership Her partner needs information and support. He or she may be depressed too! They may sabotage treatment Or get in the way of it.

12 We must think about The quiet and terrible desperation with which some women lead their lives as young mothers

13 Becoming A Mother Much of what we do as postpartum specialists rests largely on what it means to be a mother. If it didn t, we would be able to apply any theory of depression and treat postpartum women as we would anyone else with depression, whether there were a baby in the picture or not. Kleiman (2009:297)

14 New Mums with PND Generally speaking Are not in the mood for therapy Do not want to take medication Don t want to go to yet another appointment Don t have time to go to appointments She feels that there is no time to take care of herself

15 She Feels Tired and sleep deprived Restless and overwhelmed Upset (tearful and crying and angry) more than usual Her nerves are shot Everything and anyone makes her feel angry, sad, and irritable Scared to death That something is wrong

16 She is Hormonally compromised Finding it very hard to concentrate Trying her best to be her own ideal image of a mother what she should look, sound, act and feel like

17 Messages a new mother learns from society The message women hear may be subliminal, but clear! Good mothers are supposed to be nurturing, devoted and self-sacrificing. They should put their children's needs before theirs at all times. But also, she must be able to continue to accomplish her own goals and maintain her own sense of identity. THE FEAR OF FAILING CAN MAKE HER VERY SICK!

18 Shame Shame tells us that our imperfections make us inadequate and our vulnerabilities are weaknesses. It sends two primary messages: Who do you think you are? and You ll never be good enough. Over time, we learn to hide our struggles and protect ourselves from shame, judgment, criticism, and blame by seeking safety in pretending and perfection.

19 Definition of shame It is best defined as the intensely painful feeling or experience of believing we are flawed and therefore unworthy of acceptance and belonging. (B Brown: 2004)

20 Shame: A Web Women often experience shame as a web of layered conflicting and competing social-community expectations: Who we should be What we should be How we should be Once in the web, women feel flooded with feelings of fear, blame and disconnection.

21 Perfectionism Perfectionism is a self destructive and addictive belief system that fuels this primary thought: If I look perfect, live perfectly, and do everything perfectly, I can avoid or minimize the painful feelings of shame, judgment and blame. (From B Brown blog)

22 Resistances to Therapeutic Treatment PND is a weakness Feelings of shame Treatment costs too much money Having PND means I'm crazy It means I'm not a good mother It means I'm not perfect and in control I don t have time to be unwell It is so hard to differentiate the symptoms of the illness from how she feels as a mother.

23 What every new mother with PND does want, despite the resistances is SYMPTOM RELIEF! She wants: To sleep To think clearly To feel less anxious To stop crying all day To feel like herself To enjoy and love her baby

24 Karen Kleiman Postpartum depression can create a conglomeration of conflicting emotions; it can cause a woman to challenge everything she has ever thought about herself and about her own childhood experience, as well as her identification with her own mother. It robs her peace of mind and it makes her feel as if she s lost touch with her very core IT FRACTURES HER SOUL

25 Several barriers for healthcare providers in identifying PND: Failing to assess for PND Minimizing symptoms of PND, which can leave Mums feeling Embarrassed/Ashamed Disappointed Frustrated Alone Limited training in detecting and managing PND Not knowing how to effectively help, so reluctant to raise issues Not being culturally sensitive Language barriers

26 Widespread Implications Studies suggest that chronic effects are three-fold: Long term effects on women s mental health, including stigma and further risk of depression The mother infant relationship and it s influence on child development The marital relationship consider how many women on the DPB might have had PND?

27 Long term consequences for the child Consequences include: Ongoing cognitive and social difficulties Difficulties in infant attachment and development Parental attachment to the baby is compromised Parental attachment to other children is compromised Emotional neglect Child abuse only in the most severe cases As an adult the baby may have: Difficulties parenting their own children Attachment issues in relationships Educational and social difficulties

28 Early detection is vital! PND robs woman of a unique experience of mothering Can we all be doing more? YES! Sick mothers deserve empathy, psycho-education, and access to timely and effective treatment. Depression hurts both mothers and their children and their partners. Once depression is detected treatment will help and can prevent the long term inter-generational consequences identified.

29 Untreated Depression We all must become aware that the long term risks of untreated depression in women potentially pose difficulties to their child s social, intellectual, and cognitive development, as well as to the quality of attachment and the later relationship between mother and child.

30 Early treatment helps! When antenatal and postnatal depression can be identified early and treated, women have the opportunity to be supported in their journey through motherhood. Support groups Psychological treatment: Psychotherapy or Counselling Medication via GP or MMH

31 Reaching Out Regardless of who we are, how we were raised, or what we believe, all of us fight hidden, silent battles against not being good enough, not having enough, and not belonging enough. When we find the courage to share our experiences and the compassion to hear others tell their stories, we force shame out of hiding and end the silence. (B Brown, 2007: 127)

32 PMHNZ Trust National Perspective New National Group Formed Feb 2011 Hub/umbrella organisation to signpost and support those working in, and those connected with perinatal mental health National Board - members from around NZ

33 PMHNZ Trust Mission To improve outcomes for families and whanau affected by mental illness related to pregnancy, childbirth and early parenthood

34 PMHNZ Trust The PMHNZ Trust Networks and supports: professionals, agencies, researchers, educators, support groups, community supporters, government agencies & policy makers, and employers AND Mums & Dads and whanau

35 PMHNZ Trust Aims & Objectives National NZ Voice for Perinatal Distress - PND Improving Awareness of Perinatal Distress (PND) Encouraging De-stigmatisation of PND Helping to Navigate PND services Promoting NZ Research Providing Evidence Based study days Disseminating Information National and Regional Networking Actively working to improve service provision

36 PMHNZ Trust Achievements Run several seminar/training days around NZ 2014 Seminar Series 6 regions all different day National PMHNZ Conference Auckland with International speakers Established Annual Perinatal Mental Health Awareness Week in November 3 years - Buggy Walks & Picnics around NZ Regular Newsletter Website Developing national team of advisors, speakers and trainers Developing National Database of Perinatal Distress services and personnel Established Wellington Perinatal Mental Health Network and developing other regions

37 Treatment Support Recovery You are welcome to call or me anytime Susan Goldstiver The Postnatal Distress Centre

38 Perinatal Mental Health Trust - PMHNZ Contacts : Rosie Smith Chairperson pmhnztrust@gmail.com PO Box Mana Porirua Treena Cooper Administrator pmhnzoffice@gmail.com PO Box 58122, Whitby, Porirua 5245, NZ Ph: (+64) Find us on Facebook: Perinatal Mental Health Trust