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

2. 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.

3. 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

4. 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.

5. 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.

6. 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)

7. 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

8. 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)

9. 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

10. 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

11. 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)

12. 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