Maternal Mental Health and attachment care pathway Rebecca Balakrishna Consultant Nurse CAMHS WAHT

INTRODUCTION: History of the pathway development Closer working relationship of HVs with CAMHS-consultation, supervision and training(Solihull). Changes in working practice for HVs, national and local. Increasing concern re:maternal mental health and infant attachment for priamry care workers Multi-agency approach to Perinatal care- health visitors, midwives, adult mental health, CAMHS, social services, primary care. Development of the care pathway Finding the right tools and support

Criteria for Placement on the Care Pathways PQ9 GAD7 This is divided into two aspects depression and anxiety. Depression A score of 7 or lower is low concern A score of 8-9 is moderate concern A score of 10 or more is high concern Anxiety

Detection tools continued Mothers Object Relations Scales (MORS) Warmth and Invasion scores Warmth scale A score of 11 and lower is high concern A score of 15 - 10 is moderate concern A score of 16 and above is low concern Invasion scale A score of 17 and above is of high concern A score of 12 -16 is of moderate concern A score of 11 and below is of low concern

Patient-Infant Relationship Global Assessment Scale (PIR-GAS)- DC;0-3R score 70 ( out of 100) and above then place low concern care pathway score 50-69 then place moderate concern care pathway score 49 or below then place high concern care pathway. using a visual analogue scale

continued Combining the outcomes of the scores They are place on the care pathway Either: high concern moderate concern low concern,

Guidelines for the Detection and Treatment of Mental Health Concerns and Attachment Disorder in Mothers and their Infants Service available to all new mothers and infants (Appropriate consent must be gained.) All actions following assessment will be applied with the knowledge and consent of the mother. Antenatal concern - refer to midwife The care pathway

Menu of Complementary Care Packages: Moderate concern Home start- family support Baby massage course Sure Start activities and other support Parenting groups Baby Peep – toddler peep High concern Counseling. Adult drop in service (blue to new) Social Services-family support workers 0-17 Referral to CAMHS Watch Wait Wonder Breaking free group for parents Housing review

Future developments Improved Antenatal screening. Pilot complete Better access to specialist perinatal Services Increased hours for adult primary mental health specialist Ensured standard practice and services across North Somerset On going training and supervision for staff Care pathway linked to Social Care

Contact details Rebecca.balakrishna@nhs.net 01934 881262 John Oates Robin Balbernie Thank you on behalf of the perinatal steering group