PERINATAL MENTAL HEALTH CARE Where is Scotland now? MATERNAL MENTAL HEALTH SCOTLAND CONFERENCE 8th May 2017 Dr Juliet Brock Medical Officer, Mental Welfare Commission

Overview About the Commission Perinatal care in Scotland Background Where are we now? MWC perinatal themed visit Key findings & themes Key recommendations Ongoing work Ms OP report – Alison Thomson, Executive Director (Nursing)

Mental Welfare Commission “ We protect and promote the human rights of people with mental health problems, learning disabilities, dementia and related conditions” We do this by: Visiting people Monitoring use of the Acts Investigations Providing information, advice and guidance Influencing and challenging

Perinatal mental health care in Scotland The past

From “Unsoundness of Mind” by TS Clouston (1911) Conditions “connected with child-bearing” Severe “one of the most violent storms that the physician has to treat” Treatable “amongst the most curable varieties of mental disease” Recovery “…a joyous mother, in her right mind, clasping her child” Patients can “resume their place in the family and society… and be as if they had never been ill.” :

Timeline in Scotland 2002 2003 2004 2009 2012 SIGN 60 Postnatal depression and puerperal psychosis MBU Glasgow MBU Livingston (2006) SIGN 127 Management of perinatal mood disorders *recommended national MCN Mental Health (Care and Treatment) (Scotland) Act 2003 Scottish Perinatal Mental Health Forum (now MMHS)

2015 NSPCC / MMHS report * RCPsych campaign 2016 MWC reports * * repeated SIGN recommendation for a MCN

Perinatal mental health care in Scotland The present

Perinatal themed visit

Main focus – inpatient care SIGN 127 Monitoring: 2003 Act Changes to the 2015 Act: Provision extended: post-natal depression or mental disorder (other than PND) If HB “satisfied that doing so would be beneficial to the wellbeing of the child”

What we did Inpatient survey Visits and interviews Health Board questionnaire Online consultant survey

What we found Key themes STIGMA INEQUITY Community care Inpatient care TRAINING

STIGMA INEQUITY Community care Inpatient care TRAINING

Results of 3 month survey Post-partum inpatient mental health care 44 women received inpatient care across Scotland: 25 (57%) MBU care 16 (36%) GA / IPCU care 3 (7%) Both MBU & GA/IPCU care

Why were women not being admitted to MBUs? Distance & family commitments Patient preference Staff awareness and knowledge of MBUs Woman not main carer for baby

Inequity in inpatient care: What women told us: Contrasting experiences: MBU vs GA care* Contact with baby Staff: specialist knowledge & installation of hope Role of peer support Family participation / inclusion *exception GA wards with ‘perinatal’ focus

Patient A Patient B Admitted to MBU with psychosis. When asked about care: “It has been a very positive experience... When I first arrived here the nurses asked if I would like them to take over (baby’s) care until I felt able to…For first forty-eight hours I slept.” “I was so stressed and experiencing psychosis. They built up my confidence. This is day thirteen and for the last three nights I have taken over complete care of my baby.” Admitted to GA ward with PND Previous PND with first child: - No perinatal service - CMHT care. Unwell >1yr When asked about care: “Its a good ward, its just a busy ward”. Seen baby twice in 2 weeks. Not seen older child. “Probably won't see him until I get home”. Would like to see them more, misses them. “Things will be ok once I'm home”.

What we found: Differences MBU vs GA care Focus on mother-infant relationship Specialist MDT care (n.nurses, psychology, SW) Risk management Carer participation & family-friendly visiting Large regional variations in MBU use (data 2012-15)

Carer views Importance of: Information Carer support Involvement Experienced and knowledgeable staff Community support + perinatal expertise

STIGMA INEQUITY Community care Inpatient care TRAINING

All 14 HBs returned questionnaire 5 HB have community perinatal MH service 5 HB have perinatal care pathways 4 HB have perinatal prescribing guidelines Importance of national managed clinical network

STIGMA INEQUITY Community care Inpatient care TRAINING

Experiences of community care - seeking help Stigma and fears about seeking help: “I didn’t tell anyone. I felt too ashamed” “I was very worried (my baby) would be taken off me” Feeling supported in seeking help: “As soon as I realised I was unwell, I went to my GP because I wanted to continue to look after my baby”

STIGMA INEQUITY Community care Inpatient care TRAINING

Experiences of community care - receiving help Primary care: Most women received timely support from GP or HV Mixed experiences Community mental health care: - Some concerns re: lack of perinatal expertise and management of risk Need for better education & training

KEY RECOMMENDATIONS For Scottish Government to establish a MCN Health boards Duties re MBU admission Link-workers Specialist community provision Training

Ongoing work Follow-up on recommendations Sharing information with MCN 11 of 14 HB responses Ongoing reviewing of progress Sharing information with MCN

Ms OP report September 2016 Alison Thomson, Executive Director (Nursing)

Thank you Contacts: juliet.brock@mwcscot.org.uk alison.thomson@mwcscot.org.uk MWC: 0131 313 8777