Perinatal Mental Health in communities Dr Andrew Mayers Bournemouth University Dorset HealthCare University NHS Foundation Trust DorPIP Twitter: @DrAndyMayers

Who am I? First worked in Hampshire perinatal MH unit in 2003 Now associated with Dorset MBU in Bournemouth Member of Maternal Mental Health Alliance Member of Perinatal Mental Health Partnership Member of Parliament APPG, “1001 Critical Days” Governor, Dorset HealthCare University NHS Foundation Trust Patron, Dorset Mind Chair, DorPIP For more information: http://www.andrewmayers.info/perinatal-mental-health.html Follow me on Twitter @DrAndyMayers

Perinatal Mental Health in communities Perinatal MH support Historical shortage in MBU & community support Need for MH training for health professionals Recent advances What we still need to do Why ‘perinatal’? Why help needed in community?

Where is Maternal MH support?

Campaigns Maternal Mental Health Alliance http://maternalmentalhealthalliance.org.uk/ Coalition of 85 national charities, groups and Royal Colleges Everyone’s Business campaign http://everyonesbusiness.org.uk/ Every mother needs access to proper MH services across UK Major milestones Mapping of perinatal mental health services – July 2014 Less than 1/6th of UK has sufficient services See - http://everyonesbusiness.org.uk/?page_id=349 Economic impact of perinatal mental health – Oct 2014 Long-term costs £8.1b per one-year cohort births Perinatal depression, anxiety, psychosis £335m investment (only) to deliver services needed to address this See – http://everyonesbusiness.org.uk/?p=742

Campaigns All Party Parliamentary Group (APPG) “1001 Critical Days” Cross-party initiative Aims to ensure all children have very best start in life 1001 days = pregnancy to child's second birthday Perinatal mental health central to these aims ‘Building Great Britons’ report launched at Parliament Feb 2015 Relaunched and reinforced in December MPs urged to consider how important this is Government allocated £300million to PMH services over 4 years http://www.1001criticaldays.co.uk/

Campaigns Perinatal Mental Health Partnership Collaboration of local groups, service users and experts Local charity leaders, GPs, midwives, health visitors, campaigners, people with lived experience Working ‘bottom-up’ to influence change Campaigning and raising awareness Training health professionals Mapping ‘Quality’ peer support groups Informing local and national media Working with TV – e.g. EastEnders postpartum psychosis story http://www.bbc.co.uk/news/health-35349999

Training Maternal Mental Health Alliance campaigning for ALL health professionals to get training Midwives, health visitors, antenatal/birthing nurses, obstetricians, occupational therapists… Some prof bodies (Royal Colleges, etc.) running some courses Other centres running additional training Pre- and post-registration Content Diagnosis, symptom recognition, warning signs, risk factors, medication safety, treatment and therapy options, support groups, service user and family education Mental Health First Aid

So has it made a difference?

So has it made a difference? Dots shows areas in receipt of dedicated funding Specialist community perinatal mental health services Direct result of MMHA EB & 1001 Critical Days campaign BUT - map also shows areas of the country currently lacking So what else needs to be done? Clearly, clinical services still need attention But what about those in community not so unwell they need MBU or specialist secondary care services?

What needs to be done in community Why ‘perinatal’? Pre- and postnatal Evidence that prenatal anxiety bigger risk factor for… Postnatal mental illness Poorer child outcomes Fathers as well as mothers Dads need information/advice on supporting wife/partner Dads can independently develop ‘PND’ etc. More work needed on fathers’ experience of witnessing birth trauma Information, support, PTSD

What needs to be done in community Why focus on the community? Some mums may not be so unwell they need MBU/secondary care But still need support, advice, toolkits, etc. Help prevent escalation Support for mums discharged from MBU/secondary care Help prevent relapse Coping skills Ideally opportunity for peer support Benefits for those supporting and those being supported So long as safe and appropriate Often key focus is improving bond between parents and infant

DorPIP We are starting new PMH support programme PIP UK (http://www.pipuk.org.uk/) aims to support in 3 ways Therapy focused on attachment ‘Patient’ is the relationship between mother and infant Education (parents, health professionals) Improve prevention Raising awareness (to get more support) PIP UK model is to have local programmes (run independently) Groups in Northamptonshire (NorPIP), Oxfordshire (OxPIP), Brighton (BrightPIP), Liverpool LivPIP)… etc. We will be starting Dorset version soon! (DorPIP) Follow progress on Twitter @dor_pip

Summary Need for perinatal MH support Campaigns have focused largely on more MBU/secondary care And need for better perinatal MH training for HCPs Success of those campaigns welcome But we need more community support Mums who do not meet criteria for MBU/secondary care Still need support And more support for dads Charities and third sector may be able to help DorPIP