1. Interprofessional Learning: Maternal Mental Health Elisa Perco Midwifery Lecturer e.perco@mdx.ac.uk Laura Foley Senior Lecturer in Mental Health nursing l.foley@mdx.ac.uk

2. Perinatal –For the purpose of this session this term refers to the antenatal (pregnancy), intrapartum (childbirth) and postnatal (early motherhood) periods

3. Objectives Define the early warning signs of perinatal mental health issues. Identify the core principles of and pathways to effective treatment and management of perinatal mental health issues. Appreciate the merits, challenges and opportunities in providing collaborative care to people experiencing perinatal mental health issues.

4. Quiz

5. Why should we care? Impact on child development Maternal suicide is the leading indirect cause of maternal death (CEMACH, 2015; Hogg, 2013) 10/32 borough in London have Specialist Perinatal Mental Health Services Up to 20% of women develop a mental health problem in pregnancy or within a year of giving birth

6. Trigger Questions Should expectant / new mom’s always ‘be happy’?

7. Results from online survey of 1,500 women in the UK, in 2013 (Boots Family Trust Alliance, 2013)

8. Should expectant / new mom’s always ‘be happy’? Women are reluctant to discuss, 30 % never disclosed symptoms (Boots Family Trust Alliance, 2013)

9. Should expectant / new mom’s always ‘be happy’? Adjustment disorders and distress150-300/1000 Mild to moderate depressive symptoms and anxiety 100- 150/ 1000 Post traumatic stress disorder30/1000 Severe depression30/1000 Chronic serious illness2/1000 Postpartum psychosis2/1000 (Hogg, 2013)

10. Should expectant / new mom’s always ‘be happy’? How do we distinguish from what is normal to what is not normal? Look for risk factors Make use of screening tools Person-centre approach (Hogg, 2013) Risk Factors History or family history of MH Lone parent or poor couple relationship Poor social support Stressful life events Unwanted pregnancy

11. Postpartum Depression Highest susceptibility is- 3 months after delivery Three types of postpartum disturbances: 1.Postpartum blues (“baby blues”) 2.Postpartum depression 3.Postpartum psychosis Postpartum depression should be distinguished from postpartum adjustment

12. Post natal depression Symptoms (Emotional and Physical Symptoms ) Exhaustion, fatigue Sluggishness Sleeping problems (not related to screaming baby) Appetite changes Headaches Chest pain Heart Palpitations Hyperventilation Increased Crying Irritability Hopelessness Loneliness Sadness Uncontrollable mood swings Feeling overwhelmed Guilt Fear of hurting self or baby

13. Postpartum Psychosis

14. Trigger Questions Should “mentally ill” people have children?

15. Should ‘mentally ill’ people have children?

16. Severe mental illness Schizophrenia Bipolar disorder Depression Mild, moderate or severe

17. Should ‘mentally ill’ people have children? 1 in 4 people in England will experience a mental health problem in any given year. (McManus et al., 2009)

18. Trigger Questions Can fathers be depressed?

19. Study into postnatal depression showed that 21% of fathers had a depressive episode, and the highest risk being in the child's first year. (Davé, Petersen, Sherr, and Nazareth, 2010)

20. Can fathers be depressed?

21. Irritable, aggressive and occasionally hostile Poor concentration Anxiety or excessive worrying Decrease or increase in appetite Lack of sleep or tiredness Unable to enjoy activities

22. Culture matters Family Traditions Support

23. Plan of Actions Assessment- Whooley Questions (Edinburgh PD Scale (EPDS); Hospital Anxiety & Depression (HADS); Becks depression & Anxiety) Referral to specialist perinatal MH team, safeguarding midwives, health visitors, etc.

24. Plan of Actions Treatment Medication Review Psychological (CBT; DBT; psychological & psychotherapy; mindfulness, etc.) Referral to mother and baby unit Hospital Admission Joint plan of care ( social support, liaison with MDT )

25. Useful resources http://everyonesbusiness.org.uk www.pandasfoundation.org.uk http://www.mind.org.uk http://www.pni.org.uk/

26. Guidelines Quick reference guide – a summary www.nice.org.uk/CG045quickrefguide NICE guideline – all of the recommendations www.nice.org.uk/CG045niceguideline Full guideline – all of the evidence and rationale www.nice.org.uk/CG045fullguideline ‘Understanding NICE guidance’ – a plain English version www.nice.org.uk/CG045publicinfo

27. The End Thank you for listening

28. References Boots Family Trust Perinatal Mental Health Report, 2013 CEMACH (2015) Why mothers die : confidential enquiry into maternal death. London: CEMACH. Davé S, Petersen I, Sherr L, Nazareth I. Incidence of Maternal and Paternal Depression in Primary Care. Archives of Pediatric and Adolescent Medicine. September 6 2010 (published online)Incidence of Maternal and Paternal Depression in Primary Care Hogg, S., 2013. Prevention in mind. All babies count: Spotlight on perinatal mental health. London: NSPCC.) McManus, S., Meltzer, H., Brugha, T.S., Bebbington, P.E. and Jenkins, R., 2009. Adult psychiatric morbidity in England, 2007: results of a household survey.