1. PERINATAL MENTAL HEALTH CARE Where is Scotland now?
MATERNAL MENTAL HEALTH SCOTLAND CONFERENCE
8th May 2017
Dr Juliet Brock
Medical Officer, Mental Welfare Commission

2. Overview About the Commission Perinatal care in Scotland Background
Where are we now?
MWC perinatal themed visit
Key findings & themes
Key recommendations
Ongoing work
Ms OP report – Alison Thomson, Executive Director (Nursing)

3. Mental Welfare Commission
“ We protect and promote the human rights of people with mental health problems, learning disabilities, dementia and related conditions”
We do this by:
Visiting people
Monitoring use of the Acts
Investigations
Providing information, advice and guidance
Influencing and challenging

4. Perinatal mental health care in Scotland
The past

5. From “Unsoundness of Mind” by TS Clouston (1911)
Conditions “connected with child-bearing”
Severe
“one of the most violent storms that the physician has to treat”
Treatable
“amongst the most curable varieties of mental disease”
Recovery
“…a joyous mother, in her right mind, clasping her child”
Patients can “resume their place in the family and society… and be as if they had never been ill.” :

6. Timeline in Scotland
2002
2003
2004
2009
2012
SIGN 60 Postnatal depression and puerperal psychosis
MBU Glasgow
MBU Livingston (2006)
SIGN 127
Management of perinatal mood disorders
*recommended national MCN
Mental Health (Care and Treatment) (Scotland) Act 2003
Scottish Perinatal Mental Health Forum
(now MMHS)

7. 2015 NSPCC / MMHS report * RCPsych campaign 2016 MWC reports *
* repeated SIGN recommendation for a MCN

8. Perinatal mental health care in Scotland
The present

9. Perinatal themed visit

10. Main focus – inpatient care
SIGN 127
Monitoring: 2003 Act
Changes to the 2015 Act:
Provision extended: post-natal depression or mental disorder (other than PND)
If HB “satisfied that doing so would be beneficial to the wellbeing of the child”

11. What we did Inpatient survey Visits and interviews
Health Board questionnaire
Online consultant survey

12. What we found Key themes
STIGMA
INEQUITY
Community care
Inpatient care
TRAINING

13. STIGMA
INEQUITY
Community care
Inpatient care
TRAINING

14. Results of 3 month survey Post-partum inpatient mental health care women received inpatient care across Scotland: (57%) MBU care (36%) GA / IPCU care (7%) Both MBU & GA/IPCU care

15. Why were women not being admitted to MBUs?
Distance & family commitments
Patient preference
Staff awareness and knowledge of MBUs
Woman not main carer for baby

16. Inequity in inpatient care:
What women told us:
Contrasting experiences: MBU vs GA care*
Contact with baby
Staff: specialist knowledge & installation of hope
Role of peer support
Family participation / inclusion
*exception GA wards with ‘perinatal’ focus

17. Patient A Patient B Admitted to MBU with psychosis.
When asked about care: “It has been a very positive experience... When I first arrived here the nurses asked if I would like them to take over (baby’s) care until I felt able to…For first forty-eight hours I slept.”
“I was so stressed and experiencing psychosis. They built up my confidence. This is day thirteen and for the last three nights I have taken over complete care of my baby.”
Admitted to GA ward with PND
Previous PND with first child: No perinatal service - CMHT care. Unwell >1yr
When asked about care: “Its a good ward, its just a busy ward”.
Seen baby twice in 2 weeks. Not seen older child. “Probably won't see him until I get home”.
Would like to see them more, misses them. “Things will be ok once I'm home”.

18. What we found:
Differences MBU vs GA care
Focus on mother-infant relationship
Specialist MDT care (n.nurses, psychology, SW)
Risk management
Carer participation & family-friendly visiting
Large regional variations in MBU use (data )

19. Carer views Importance of: Information Carer support Involvement
Experienced and knowledgeable staff
Community support + perinatal expertise

20. STIGMA
INEQUITY
Community care
Inpatient care
TRAINING

21. All 14 HBs returned questionnaire
5 HB have community perinatal MH service
5 HB have perinatal care pathways
4 HB have perinatal prescribing guidelines
Importance of national managed clinical network

22. STIGMA
INEQUITY
Community care
Inpatient care
TRAINING

23. Experiences of community care - seeking help
Stigma and fears about seeking help:
“I didn’t tell anyone. I felt too ashamed”
“I was very worried (my baby) would be taken off me”
Feeling supported in seeking help:
“As soon as I realised I was unwell, I went to my GP because I wanted to continue to look after my baby”

24. STIGMA
INEQUITY
Community care
Inpatient care
TRAINING

25. Experiences of community care - receiving help
Primary care:
Most women received timely support from GP or HV
Mixed experiences
Community mental health care:
- Some concerns re: lack of perinatal expertise and management of risk
Need for better education & training

26. KEY RECOMMENDATIONS For Scottish Government to establish a MCN
Health boards
Duties re MBU admission
Link-workers
Specialist community provision
Training

27. Ongoing work Follow-up on recommendations Sharing information with MCN
11 of 14 HB responses
Ongoing reviewing of progress
Sharing information with MCN

28. Ms OP report September 2016 Alison Thomson, Executive Director (Nursing)

29. Thank you
Contacts: MWC: