1. Specialist Perinatal Mental Health Service NHS Lanarkshire Mental Health and Learning Disabilities 4 th February 2015

2. Aim of Project To establish a Lanarkshire-wide community based service that enables multi-disciplinary professionals to provide an excellent standard of care for women of childbearing age with mental health needs and their families, in order that they experience positive pregnancies with healthy children.

3. Prior to Improvement project  NHSL Perinatal mental health (PMH) special interest group  Perinatal mental health ‘link’ nurses in some localities  Mothers managed by generic community mental health teams  Good inter-agency working in some localities

4. Identified areas for development  Lack of specialist community perinatal mental health service in Lanarkshire  Lack of specialist PMH liaison service for Maternity inpatients  Variation in clinical practice across Lanarkshire in caring for mothers  No formalised pathways for communication between agencies  Limited awareness and training of PMH

5. The need for improvement  Childbearing is a critical time in the life of a mother, her baby and her family.  Undetected or untreated maternal mental illness can lead to long term adverse outcomes for the whole family, including the father.  Some children have been shown to have long term psychological, social and educational difficulties as they age.

6. Perinatal and infant mental health services are aimed at giving every child the best start in life by promoting the wellbeing of parents and their babies across the perinatal period, in addition to the early identification and treatment of problems that complicate pregnancy and the post-partum year. The benefits of early intervention

7. Drivers for change  Local and national guidelines/policies recommended specialist PMH services  SIGN guidelines (2012), NICE guidelines (2014), Confidential Enquiries into maternal death  Recognition of inequality of service provision across Lanarkshire  Demand from staff to increase awareness and training in recognising and managing women with PMH difficulties  Learning from patient experience/feedback

8. The Project A Lanarkshire-wide specialist perinatal mental health service focusing on four key areas, 1.Maternity inpatient liaison service 2.Specialist maternity mental health liaison clinic 3.Training and education for colleagues 4.Promote and support good practice and review local pathways of care

9. Details of project  Establishment of a specialist PMH clinic and maternity liaison service  Delivering a package of training across Lanarkshire for all agencies  Produce educational resource guides and written information for staff  Review and update Integrated Care Pathway for Antenatal and Postnatal mental health in Lanarkshire  Perinatal Mental Health Conference (12 March 2015)

10. Challenges of establishing a new service  Raising awareness  Managing expectations  Ensuring Service is accessible and beneficial for staff and patients  Internal processes, protocols and procedures  Admin and IT systems

11. Key partners  Mental health services  Maternity services  Public Health  Primary Care  Social work  Service users

12. Data! Data! Data! Initial findings 1.Baseline survey of CMHT team leaders and senior midwives 2.Referral information so far

13. Survey

14. How confident are you at meeting the mental health needs of patients ?

15. Midwifery Team Leader: Have you or any team members undertaken any Antenatal/Postnatal Mental Health Post registration Training

16. CMHT Team Leader: Have the following team members had any additional perinatal mental health training?

17. Referrals

18. Number of referrals

19. Data! - Ongoing analysis  Referrer satisfaction survey  Patient satisfaction questionnaire  Training impact analysis  Admission details

20. Case Study  Patient 28 wks gestation, 3 rd pregnancy, 2 older children ages 5 and 2 years attended out of hours GP and A&E due to worsening low mood and suicidal ideation. Referred onto the PMHS by Duty Psychiatrist.  Patient was contacted and assessed by Nursing and Medical staff within 48 hrs – plan of care agreed and identified by patient, family and PMHS.

21. Case Study  Referred to PMHS by Maternity Staff. Assessment completed within 6 hours of receipt of referral. Patient aged 38 yrs, 5 days post natal, history of Depressive disorder previous suicide attempt - voicing concern that she is ‘not coping’  Daughter born pre-term, low birth weight required additional feeding support.  Plan of care identified and shared of midwifery staff.  Ongoing support being offered in the community following discharge.  Feedback from Staff and patient intervention by PMHS very positive.

22. Next Steps  Complete pilot project and evaluate impact  Discuss with key partners regarding implementation of Service  Establish system for ensuring evidence-based best practice across Lanarkshire

23. “So What?” Expected outcomes of Service 1.Improved pre-pregnancy counselling and advice regarding risk of mental illness and safety of prescribed medication 2.Increased identification of significant risk factors of postnatal relapse, thus enabling improved management during antenatal/postnatal period. This will reduce psychological distress of mother and family and reduce input required from multiple agencies and hospital admission 3.Better maternal mental health which is likely to lead to better parenting 4.Healthier babies 5.Improved mother-infant relationships and attachment

24. 6.Improved communication and collaboration between multiple agencies and professionals 7.Reduced length of maternity admissions due to mental health concerns will be achieved by rapid specialist assessment and facilitation of prompt input by community mental health services. 8.Better trained staff who are competent in identifying and managing mental health difficulties 9.Better informed mothers regarding mental health issues and availability of local services 10.Appropriate treatment of maternal mental health difficulties is likely to reduce risk of long term emotional, psychological, developmental, attachment and educational problems in children. “So What?” Expected outcomes of Service

25. What resources have been invested?  Blood, sweat and tears  Journey started over 10 years ago by dedicated nursing staff  Staffing  Nurses  Psychiatrist  Secretary  Resources  IT  Publications  Expenses  Training

26. For More Information Perinatal Mental Health Service  Dr Aman DurraniConsultant Psychiatrist  Helen SloanSenior Charge Nurse  Liz TroyCharge Nurse  Kathryn ThomsonSecretary  Email: PerinatalMHS@lanarkshire.scot.nhs.ukPerinatalMHS@lanarkshire.scot.nhs.uk  Airbles Road Resource Network, 49 Airbles Road, Motherwell ML1 2TP  Tel: 01698 24 24 53