1. CRSI Conference Perinatal Mental Health Care Workshop Brigid Arkins b.arkins@ucc.ie

2. What is Perinatal Mental Health Mental health issues concerning women who are: Child bearing years Child bearing years Pregnant Pregnant In the postnatal year In the postnatal year Pre-existing mental illness Pre-existing mental illness High risk of developing mental illness High risk of developing mental illness (family history of mental illness)

3. Rates of Perinatal Conditions “Baby blues” 50-80% “Baby blues” 50-80% Postnatal depression10-15% Postnatal depression10-15% Puerperal psychosis0.1-0.2% Puerperal psychosis0.1-0.2% Antenatal depression10-15% Antenatal depression10-15% Pre-existing SMI/h/o bipolar1-2% Pre-existing SMI/h/o bipolar1-2%

4. Risks of Perinatal Mental Illness Relapse and emerging illness more common around birth Relapse and emerging illness more common around birth Medication may harm the developing baby but so may relapse Medication may harm the developing baby but so may relapse Mental illness at this time can be extreme Mental illness at this time can be extreme Illness may compromise adequate care and protection of a child Illness may compromise adequate care and protection of a child Illness may compromise the child’s development and attachment Illness may compromise the child’s development and attachment

5. Consequences for the baby postnatally Postnatal maternal mental ill health: Lack of appropriate stimulation Lack of appropriate stimulation Lack of dialogue with mother Lack of dialogue with mother Multiple care givers or none Multiple care givers or none Neglect Neglect Increases risk for the infant of: Poor attachment Poor attachment Failure to thrive Failure to thrive Slower development Slower development Injury Injury Infanticide Infanticide

6. Consequences on the child Poor attachment Poor attachment Child abuse/neglect/filicide Child abuse/neglect/filicide Poor language development Poor language development Conduct disorder Conduct disorder Lower IQ Lower IQ Behavioural problems in sons Behavioural problems in sons Emotional problems in teenage girls Emotional problems in teenage girls

7. Vision for Change One perinatal mental health resource should be provided in a national maternity hospital, with a national remit. Perinatal mental health services require both a specialist mental health service and obstetric services. Women with serious mental illness require coordinated care across disciplines: psychiatry (general and perinatal), obstetric, general practice and child and family social services.

8. Vision for Change Recommendation 15.5.4: One additional adult psychiatrist and senior nurse with perinatal expertise should be appointed to act as a resource nationally in the provision of care to women with severe perinatal mental health problems.

9. Some Perinatal Policy Guidance UK 1) Confidential Enquiry into Maternal Deaths “Why women die” (2000-2002) Psychiatric disorders are the leading indirect cause of maternal deaths in the UK 2) NICE guidelines for antenatal care All women should be screened for a previous history of severe mental disorders 3)NSF for children, young people and maternity services All professionals must be able to identify mental health problems in new mothers Each woman identified as at risk of relapse of serious mental illness must have a written plan All women that require a mother and baby in patient unit must be able to access one

10. 4) Women’s mental health – into the mainstream The perinatal period carries the greatest lifetime risk of severe mental illness for women. Protocols for management of postnatal depression should be developed. Local education and training programmes needed to develop knowledge Preventable death. See case history. 5) CEMACH “Saving Mothers’ Lives” 2003-2005 Fewer suicides. Substance abuse. Pre-conception counselling 6) NICE guideline for Antenatal and Postnatal Mental Health (2007) Planned care for at risk women. Managed networks. Specialist teams. Access to timely psychological therapies.

11. 7) New Horizons Vision for Mental Health (2009) Treating mental illness for parents as a priority under CPA 8) CEMACH “Saving Mothers’ Lives” 2006-2008 (2011) No reduction in suicides. Substance abuse. Priority care pathways for pregnant and postpartum women. Specialised CMHT