1. Maternal Mental Health : Perinatal Psychiatric Service in Hackney
Tara Lawn - Community Consultant
Olivia Protti- Inpatient Consultant

3. Cost - Morbidity/mortality
Rates of perinatal psychiatric disorder :
Postpartum psychosis 2/1000 (12)
Chronic serious mental illness 2/1000 (12)
Severe depressive illness 30/1000 (180)
Mild-moderate depressive illness and anxiety states /1000 (900)
Post traumatic stress disorder 30/1000 (180)
Adjustment disorders/distress /1000 (1800)
Suicide remains leading cause of maternal death (MBRRACE)

4. Cost – Financial London School of Economics report 2014
Perinatal mental health problems carry economic & social long term cost of £8.1billion
£1.2 billion of cost falls on NHS & SS
72% due to adverse impact on the child
Cost £280million/year to bring services up to national guidance ~ £400 per birth
NCT Survey 2014
3% of CCGs have a strategy for commissioning perinatal mental health services.
60% have no plans to develop a strategy

6. Our Community team
Part-time consultant (0.7wte) Clinical nurse specialists (2 wte) Psychologist (0.4 wte) SpR (0.2wte) No SW, Nursery nurse or Parent infant psychotherapy PQN member, peer reviewed

7. What we provide Preconception advice
Assessment & treatment of women with moderate to severe illness (conception till one year)
Prophylactic care for well, high risk women

8. What we provide
A detailed plan for late pregnancy and early postpartum psychiatric management
Intensive CNS care post delivery alongside PHMW
Support for mothers in order to help meet the physical and emotional needs of their baby
Work closely with CYPS, maternity, primary care and CMHT (eGroups)

9. What we provide
Advice about possible effects of medication on pregnancy to professionals
Training to other professionals about perinatal mental health
Happy to discuss cases where the need for referral is uncertain/woman refuses.

10. Prediction of high risk women
In the first 6 weeks postpartum 33% of women with BPI , 9% of women with BPII and 0.3% of women with MDD will become psychotic
69% of these women will have an episode in pregnancy and postpartum that requires management
Schizoaffective or affective psychotic illness

11. Referral Criteria Moderate/severe symptoms
Refer all:
Moderate/severe symptoms
History of BPAD or a psychotic illness
Previous puerperal psychosis
Complex psychotropic medication regimens
Previous psychiatric admission (screening)
Anyone on an antipsychotic or mood stabiliser.
New anxiety/depression of moderate severity in T3 or early postpartum
Consider referring:
Current illness of mild or moderate severity where there is a first degree relative with BPAD or PP.
No current illness but strong FH
Advise liaison with GP, and possibly CYPS, for women who decline referral to perinatal services.

12. Getting hold of us Referrals from any professional Written/email/fax
Emergencies to CHAMRAS/HTT/A&E
eGroups

13. Margaret Oates Mother and Baby Unit
Funded by specialist commissioning from NHSE
All women requiring admission in late pregnancy/postnatal period in UK
Prophylactic admissions
PQN accredited as Excellent
Margaret Oates Mother and Baby Unit

14. New guidelines out 18th December 2015

15. Summary Epidemiology well established
Intervention easier than at other points
Stepped care model
Evidence base for the benefits of intervention
Intervention is effective and cost effective
Maternal mental health is a RCGP & DOH priority