Thinking big: a national managed clinical network for Scotland Roch Cantwell

Maternal mental illness

Impact on women’s health The Confidential Enquiries into Maternal Deaths

Latest findings from CEMD Saving Lives, Improving Mothers’ Care 2012-2014 Maternal suicide reclassified by WHO as a direct cause of maternal death No change in maternal suicide rate since 2003 Suicide now the leading direct cause of maternal death in year after childbirth

“The children left behind” “Any child whose mother dies must face a far poorer start to family life. The fact that so many of the children were already living in complex circumstances with vulnerable families, or were in care, continues to underscore the important public health dimension of this Enquiry.” Gwyneth Lewis OBE

Impact on children growing up Impairment not inevitable but… Severe/chronic maternal disorder Social adversity

Specialist mental health care matters

Costs of not treating

Meeting need in Scotland UK MBUs Scottish specialist community services

What should Scotland have? All women across Scotland should have equitable access to: Specialist community perinatal mental health services Inpatient mother and baby unit beds Interventions which promote good infant mental health

SIGN 2012 NSPCC/MMHS 2015 MWC 2016

Mental Health Strategy 2017-2027 2017 Fund the introduction of a Managed Clinical Network to improve the recognition and treatment of perinatal mental health problems

The Best Start 2017 The Scottish Government should ensure Perinatal Mental Health key focus in Mental Health Strategy Connections are made with new models of care described in that strategy NHS Boards should Review current access to perinatal mental health services to ensure early and equitable access is available to high quality services Clear referral pathways Adequate provision of staff training to allow staff to deliver services to the appropriate level. Primary midwives, in partnership with primary care colleagues, should Play a proactive and systematic role in the identification and management of perinatal mental health care.

What is a managed clinical network? ‘linked group of health professionals and organisations primary, secondary, and tertiary care working in a coordinated way not constrained by existing organisational or professional boundaries ensure equitable provision of high quality, clinically effective care’. (Scottish Executive, 1999) At national level? Formally designated by SGHSC on the advice of the National Services Advisory Group and Board Chief Executives’ Group. Commissioned and performance managed by NSD of NHS National Services Scotland (NSS) on behalf of the SGHSC and NHS Boards. Subject to regular review. For perinatal mental health?  Approved Jan 2017; Established April 2017; £173,000/yr for 3 years

RCPsych Campaign Roundtable 2017 Priorities for a national mcn Mapping and gapping Communication Equity of provision Skilled workforce Evaluation

Stakeholder empowerment Communication Develop a communications strategy that effectively informs and educates the public, professionals and service commissioners about the importance of maternal and infant mental health Stakeholder empowerment Website Public health

National bed management Local/regional networks Equity of provision Develop care pathways to ensure all women and their infants have access to the level of assessment and treatment appropriate to their needs National care pathway National bed management Local/regional networks

Professional competencies Specialist team composition Skilled workforce Ensure that there are adequately staffed and trained multi-professional teams who can deliver effective care Professional competencies Training resources Specialist team composition

Proposed organisational structure NMCN Manager | NMCN Clinical Lead Maternity Lead | Nursing Lead | Infant Mental Health Lead Information management | Administrative support Service provision N W E Communi-cation Education & training Regional networks Thematic subgroups

Thinking bigger…

Challenges NO money! Big task Reliance on goodwill

Be careful what you wish for…