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

2. Maternal mental illness

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

5. 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

6. “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

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

8. Specialist mental health care matters

9. Costs of not treating

10. Meeting need in Scotland
UK MBUs
Scottish specialist community services

11. 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

12. SIGN
2012
NSPCC/MMHS
2015
MWC
2016

13. 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

14. 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.

15. 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

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

17. 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

18. 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

19. 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

20. 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

21. Thinking bigger…

27. Challenges
NO money!
Big task
Reliance on goodwill

28. Be careful what you wish for…