1. Maternal Mental Illness What can we do? Dr Andrew Mayers amayers@bournemouth.ac.uk

2. 2 Perinatal Mental Illness  Focus on improving attachment  Looking for signs  Signposting - systems and support  NHS  Charities  Support groups  Social media  Campaigns  Training

3. 3 Perinatal Mental Illness  What does perinatal mean?  Covers pregnancy and (typically) 1 st year after birth  Antenatal depression relatively under-researched  Mums AND dads  Dads can get ‘perinatal mental illness’ too  Less well-researched  A few support groups (e.g. Fathers Reaching Out – see later)  Coping with partner/spouse mental illness  Dads can develop symptoms independently  Causes for dads often relate to ‘changes’  Income, relationship, responsibility, emotions, dynamics…  Managing expectations

4. 4 Importance of maternal bond  We saw this slide earlier – but worth revisiting…  Early mother–infant bond may have sig. impact on developing infant (e.g. Bowlby, 1953; Ainsworth, 1993)  Infant’s internal working model (IWM) is very important  Expectations about themselves in relation to others  Model of self and of other  If infant’s carer attends positively and responds to needs   Infant has positive IWM:  High self-worth, availability of others, resolution of crises  Infant’s carer inconsistent response and attention   Infant’s has negative IWM:  Low or ambivalent self-worth, unavailable others, crises not resolved

5. 5 Attachment – what can we do?  How well is mum bonding?  Does she maintain eye contact?  Is she comfortable with baby?  Does mum appear distressed about feeding and bonding?  Does baby appear distressed?  Be positive  Take care not criticise  Empathise and encourage  Praise and reinforce  Make mum feel good about herself  Don’t give too much advice

6. 6 Looking for signs and risk factors  Vulnerability factors  Genetic vulnerability  Life stresses  Moving house, developmental or behavioural difficulties in other children, relationship breakdown…  Social support  Experience of childhood  Protective factors  Self-compassion  Mindfulness  Reflection and insight

7. 7 Signposting to services  GP surgeries  Specialist midwife team  Mother-and-baby unit (MBU: if your area has one!)  Charities and support groups  PANDAS  Fathers Reaching Out  Action on Postpartum Psychosis (APP)  Maternal OCD  Local/specialist charities and groups

8. 8 PANDAS  http://www.pandasfoundation.org.uk/ http://www.pandasfoundation.org.uk/  Twitter: @Pandas_uk@Pandas_uk  Facebook: https://www.facebook.com/PANDASFoundation?fref=ts

9. 9 PANDAS  National charity supporting all perinatal mental health  Mums, dads, and families  Especially antenatal and postnatal depression  Support groups across UK  Telephone support line  E-mail support group  Campaigns  Information  Sign-posting

10. 10 Action on Postpartum Psychosis (APP)  http://www.app-network.org/ http://www.app-network.org/  Twitter: @ActionOnPP@ActionOnPP  Facebook: https://www.facebook.com/ActionOnPP?fref=ts

11. 11 APP  National charity offering specialist support  Postpartum psychosis & bipolar disorders  Information and education  For women, their families & health professionals  National events & workshops  Signposting to resources or support  Secure and confidential online peer-support  For women and partners  Specialist advice (via panel of experts)  Free referral to specialist second opinion psychiatry service  Research

12. 12 Maternal OCD  http://www.maternalocd.org/ http://www.maternalocd.org/  Twitter: @maternalocd@maternalocd

13. 13 Maternal OCD  National charity offering specialist support  Specifically focuses on Maternal OCD  Talks and presentations – education and advice  Service users  Professionals  Support for 'drop ins'  Interactive training workshops  Research  Currently working with C4 to make documentary  See recruitment clip: https://www.youtube.com/watch?v=VcghErjT5GQ https://www.youtube.com/watch?v=VcghErjT5GQ

14. 14 Social media  Great way to get message out  Support for service users and families  Promote information  Campaign  Tackle discrimination  Encourage talk  Examples  #PNDHour  Wednesday 8-9pm  #Bumpsandmumsocdhr  Monday 7-8pm  #APPchat – restarting very soon  Follow me @DrAndyMayers to see more about how we support

15. 15 Raising awareness - campaigns  Do you know where the local MBUs are?  How many areas of UK have specialist community teams?  Those that are ‘accredited’ to RCPsych standards  How much does perinatal mental illness cost the UK?  How much does UK Government need to spend to put it right?

16. 16 Campaigns  Maternal Mental Health Alliance http://maternalmentalhealthalliance.org.uk / http://maternalmentalhealthalliance.org.uk /  Coalition of 60 national charities, groups and Royal Colleges  Everyone’s Business campaign http://everyonesbusiness.org.uk/ http://everyonesbusiness.org.uk/  Every mother has access to proper MH services across UK  Major milestones  Mapping of perinatal mental health services – July 2014  Less than 1/6 th of UK has sufficient services  See - http://everyonesbusiness.org.uk/?page_id=349http://everyonesbusiness.org.uk/?page_id=349  Economic impact of perinatal mental health – Oct 2014  Long-term costs £8.1b per one-year cohort births  Perinatal depression, anxiety, psychosis  £335m investment (only) to deliver services needed to address this  See – http://everyonesbusiness.org.uk/?p=742http://everyonesbusiness.org.uk/?p=742

17. 17 Campaigns  Everyone’s Business – who needs to know this?  National Government – Department of Health  We launched economic report in Parliament Oct 21  Need long-term financial commitment  Local government, MPs and Clinical Commissioners  I have been in touch with all Dorset MPs  These are vital issues for constituents  I am leading plans with local councils (esp. Dorset CC)  Contacting all Clinical Commissioning Groups  They spend the NHS money allocated by Government

18. 18 MMHA goes to Parliament

19. 19 Campaigns  Perinatal Mental Health Partnership  Collaboration of local groups, service users and experts  Local charity leaders, GPs, midwives, health visitors, campaigners, people with lived experience  Working ‘bottom-up’ to influence change  Develop materials for ‘birthing packs’  Training health professionals  Informing local and national media  Campaigning and raising awareness  We have just had first steering meeting  Watch this space!

20. 20 Training  Maternal Mental Health Alliance campaigning for ALL health professionals to get training  Midwives, health visitors, antenatal/birthing nurses, obstetricians, occupational therapists…  Some prof bodies (Royal Colleges, etc.) running some courses  Other centres running additional training  Pre- and post-registration  I am doing some right now!  Content  Diagnosis, symptom recognition, warning signs, risk factors, medication safety, treatment and therapy options, support groups, service user and family education  Mental Health First Aid

21. 21 What next  More campaign work through national groups  Maternal Mental Health Alliance  Perinatal Mental Health Partnership  Research  Working my BU team – academics and students  Links to charities and those they support  Bournemouth perinatal mother and baby unit  Training  Health professionals  Existing health visitor courses  Start new courses at BU  HVs, midwives, GPs, obstetricians…  PGDip Health Visitors – training post-qualification students

22. 22 What have we learned  Focus on improving attachment  Looking for signs  Signposting - systems and support  NHS  Charities  Support groups  Social media  Campaigns  Training