Maternal Mental Health : Perinatal Psychiatric Service in Hackney Tara Lawn - Community Consultant Olivia Protti- Inpatient Consultant

Cost - Morbidity/mortality Rates of perinatal psychiatric disorder : Postpartum psychosis 2/1000 (12) Chronic serious mental illness 2/1000 (12) Severe depressive illness 30/1000 (180) Mild-moderate depressive illness and anxiety states 100-150/1000 (900) Post traumatic stress disorder 30/1000 (180) Adjustment disorders/distress 150-300/1000 (1800) Suicide remains leading cause of maternal death (MBRRACE)

Cost – Financial London School of Economics report 2014 Perinatal mental health problems carry economic & social long term cost of £8.1billion £1.2 billion of cost falls on NHS & SS 72% due to adverse impact on the child Cost £280million/year to bring services up to national guidance ~ £400 per birth NCT Survey 2014 3% of CCGs have a strategy for commissioning perinatal mental health services. 60% have no plans to develop a strategy

Our Community team Part-time consultant (0.7wte) Clinical nurse specialists (2 wte) Psychologist (0.4 wte) SpR (0.2wte) No SW, Nursery nurse or Parent infant psychotherapy PQN member, peer reviewed

What we provide Preconception advice Assessment & treatment of women with moderate to severe illness (conception till one year) Prophylactic care for well, high risk women

What we provide A detailed plan for late pregnancy and early postpartum psychiatric management Intensive CNS care post delivery alongside PHMW Support for mothers in order to help meet the physical and emotional needs of their baby Work closely with CYPS, maternity, primary care and CMHT (eGroups)

What we provide Advice about possible effects of medication on pregnancy to professionals Training to other professionals about perinatal mental health Happy to discuss cases where the need for referral is uncertain/woman refuses.

Prediction of high risk women In the first 6 weeks postpartum 33% of women with BPI , 9% of women with BPII and 0.3% of women with MDD will become psychotic 69% of these women will have an episode in pregnancy and postpartum that requires management Schizoaffective or affective psychotic illness

Referral Criteria Moderate/severe symptoms Refer all: Moderate/severe symptoms History of BPAD or a psychotic illness Previous puerperal psychosis Complex psychotropic medication regimens Previous psychiatric admission (screening) Anyone on an antipsychotic or mood stabiliser. New anxiety/depression of moderate severity in T3 or early postpartum Consider referring: Current illness of mild or moderate severity where there is a first degree relative with BPAD or PP. No current illness but strong FH Advise liaison with GP, and possibly CYPS, for women who decline referral to perinatal services.

Getting hold of us Referrals from any professional Written/email/fax Emergencies to CHAMRAS/HTT/A&E eGroups Tara.Lawn@eastlondon.nhs.uk Olivia.Protti@eastlondon.nhs.uk 0208 5108151

Margaret Oates Mother and Baby Unit Funded by specialist commissioning from NHSE All women requiring admission in late pregnancy/postnatal period in UK Prophylactic admissions PQN accredited as Excellent Margaret Oates Mother and Baby Unit

New guidelines out 18th December 2015

Summary Epidemiology well established Intervention easier than at other points Stepped care model Evidence base for the benefits of intervention Intervention is effective and cost effective Maternal mental health is a RCGP & DOH priority