Professor Louise M Howard Section of Womens Mental Health Health Service and Population Research Department IoP, KCL & Womens Health Academic Centre, KCL

Psychotic disorders ass with increased risk of stillbirth, obstetric complications (Howard et al 2003) ; antenatal depression associated with SIDS (Howard et al 2007) WHY? Stressors? Domestic violence in pregnancy ass with antenatal & postnatal depression, obstetric complications, child behavioural problems (Flach et al 2011) Smoking? Pregnant women with mental disorders more likely to smoke but less likely to be recorded/addressed by services (Howard 2003; Shah & Howard 2007; Howard et al 2007) Nutrition? MRC PhD studentship on obesity and mental health in pregnancy (Emma Molyneaux) Medication? PhD on decision making re: pregnancy in women with bipolar disorder (Clare Dolman) SRs for national guidelines (BAP depression 2008) CRIS data on risks/benefits of antipsychotics in 900 pregnant women Womens Mental Health – perinatal mental health research Page 2

Use of CAN-M - outcome measure for pregnant women/mothers with psychoses (Howard et al 2008 ) found frequent unmet needs around violence and abuse (Howard & Hunt 2008) UK APMS – men & women experiencing DV at 3x risk of mental disorders (higher for PTSD, eating disorders and psychosis) (Jonas et al In Prep ) Mental health professionals only detect 10-30% of cases of DV (Howard et al 2010) Barriers to disclosure - fear of consequences, actions of perpetrator, shame; Barriers to enquiry - role boundaries, competency, confidence (Rose et al 2011) Systematic Reviews - prevalence of DV victimisation & perpetration in men & women with mental disorders (Kylee Trevillion, PhD student) Mental disorders and perpetration of DV homicides (Confidential Enquiry data) WHO Guidelines 2012; HO/DH VAWG strategy 2010;2011; NICE guidelines Womens Mental Health – recent domestic violence (DV) research Page 3

Pilot domestic violence advocacy intervention integrated within mental health services increased number of referrals to Multi-Agency Risk Assessment Conferences, decreased abuse & improved QoL (Trevillion et al) Multi-centre RCT found antidepressants more effective than watchful waiting for PND in primary care (Sharp et al 2010) Pilot patient preference RCT found Womens Crisis Houses to be as effective and cost-effective as admissions to general wards (Howard et al 2010) National evaluation of psychiatric Mother and Baby Units for acute postpartum illnesses (Elkin et al 2009) Smoking cessation services for pregnant women with mental disorders (RCP/RCPsych Report Smoking and Mental Health 2012) FUNDERS : Cancer Research UK; Guys and St Thomass Charitable Foundation; MRC; NIHR; FSID; Sir Halley Stewart Trust; South London and Maudsley Trustees; Tommys the Baby Charity Interventions – development and evaluation Page 4 Linking Abuse and Recovery through Advocacy