Perinatal Mental Health for Health Professionals By: North London Partners, Specialist Perinatal Mental Health Team Contact details: Karen Mettle, Cherise Thompson, 020 3317 7114 / 7805 / 6093

What is Perinatal Mental Health? The emotional wellbeing of women, their partner and their children from conception to one year following the child’s birth. Perinatal mental health problems range from mild to moderate to severe and complex, requiring different levels of intervention at different times.

Why is it important to identify women who are at risk? To inform preconception advice Help women make difficult decisions about medication Identify which women need close monitoring throughout pregnancy and postpartum Unrivalled opportunity for prevention

Types of Perinatal Mental Illness Adjustment Disorder Anxiety Disorders Perinatal Mood Disorders Postpartum Psychosis Other Mental Health Conditions Women can experience any kind of mental health problems during and after pregnancy, but there are some that are particularly common or are specifically linked to pregnancy and childbirth.

Fathers and Perinatal Mental Health Pregnancy is the most demanding period for the fathers’ psychological reorganisation of self Labour and birth the most emotional moments Postnatal period is the most challenging time (Genesoni and Tallandini 2009) The most common risk factors ( factual or perceptual): Maternal depression Poor social support Low emotional support (Boyce et al 2007, Castle et al 2008) Before discussing fathers mental health acknowledge and discuss the important role of fathers and maternal PMI: Mothers who are ill are more likely to turn to their partners for support Perceived support from baby’s father is strongly correlated with lower rates of depression ‘Well’ fathers can act as ‘buffers’ protecting the child from negative effects of mother’s depression Now discuss the growing evidence base around fathers own mental health in perinatal period using information on the slide.

Risk Factors for PP History of bipolar disorder Nearly 1 in 2 risk of any mood disorder postnatally (Di Florio, 2013) Family history of postpartum psychosis Relapse rates as high as 74% in women with bipolar and with a family history of post-partum psychosis… …compared with only 30% of bipolar women without any family history of postpartum psychosis (Jones & Craddock, 2001) But 50% or more women with postpartum psychosis have no history that would have placed them at high risk (Robertson Blackmore et al, 2013) Primiparity (If it is a first baby) (Robertson Blackmore et al, 2006) Discontinuation of mood stabiliser during pregnancy (Viguera et al, 2000) Obstetric complications (Robertson Blackmore et al, 2005) Previous episode of post partum psychosis, 57% of women went on to experience another episode of PP (Robertson et al, 2005)

Symptoms of Postpartum Psychosis Rapidly changing mood Bizarre behaviour Lack of inhibition Hallucinations – distortion of the 5 senses Delusions – thought disorder Confusion Agitation Flight of ideas Lack of insight Risk to mother and infant

Postpartum psychosis Psychiatric emergency requiring immediate treatment Typically occurs in the first few days following delivery 50% will have presented by day 7 90% will have presented by 3 months (Kendell et al, 1987) Sudden onset, rapid deterioration, rapidly changing presentation Often detected by midwives (Jones and Craddock 2001)

Suicide: Red Flags Recent significant change in mental state or emergence of new symptoms New thoughts or acts of violent self harm New or persistent expressions of incompetency as a mother or estrangement from the infant

Safeguarding Children – Referral Issues To include: Maternal history of severe mental illness Delusional thinking involving the infant or child Threats to harm the infant or child Self harming behaviour and suicide attempts Misuse of drugs/ alcohol/ medication Alters states of consciousness e.g. splitting/dissociation (Working together to safeguard children 2015) Clarify any issues that arise here, encourage discussion Discussion on preparing a referral and things to include and current threshold for SS input Ask delegates to refer to SBARD and discuss tool in resource pack: Situation Background Assessment Recommendations Decision ©Institute of Health Visiting

Essential referrals Diagnosis of severe mental illness (schizophrenia, bipolar disorder, schizoaffective disorder History of post-partum psychosis History of severe depression   History of contact with mental health services Family history of bipolar affective disorder or perinatal mental illness Suicidal thoughts/self-harming behaviour Threats to harm the infant or child Delusional thinking involving the child or infant Active eating disorder Advice on/review of psychotropic medication during pregnancy/breastfeeding Refer to : Working Together to Safeguard Children (2013)

Summary of perinatal mental illness Mild and short-lived mood disturbance is common Untreated perinatal depression can lead to poor outcomes for mother and baby The risk of developing a severe mental illness is markedly elevated following childbirth (but only affects a minority of women) and has serious implications for the mother, infant and family Suicide has previously been identified as the leading cause of maternal deaths Prescribing in pregnancy and breastfeeding is complex and individualised Effective communication, interfacing and sharing of information is vital