1. The role of Intensive Home Treatment for Maternal Mental Illness
Dr Colin Crawford Consultant Psychiatrist & Fiona Smith Senior Charge Nurse
Both work for Perinatal service and IHTT

2. Karen age 34 First pregnancy planned twin pregnancy
Difficult pregnancy
Swine flu at 30 weeks
Babies born at 33weeks by Caesarian Section
Onset of Postpartum Psychosis at day 3
Suicidal ideation tried to jump of second floor window of maternity unit
Admitted to Mother and Baby unit for prolonged period
On discharge followed by CMHT

3. Most recent pregnancy Unplanned Pregnancy single pregnancy
Discontinued Imipramine 50mgs
Referred to the perinatal service
Seen early in pregnancy and reviewed regularly
Well but some anxiety about becoming unwell following childbirth
Perinatal Management Plan developed and Pre birth planning meeting held
Olanzapine 5mgs provided to her to bring to labour ward

4. Baby boy born on due date
3rd degree tear
Breast feeding
Seen daily by the perinatal team in post natal ward
Day 2 not well with predominant “racing thoughts” and anxiety
Started Olanzapine 5mgs
Day 3 keen to get home with husband did not want hospital admission husband happy to support going home
Risks assessed taken on by IHTT with review where possible with IHTT perinatal team members
Initially Twice daily visits

5. Progress Seen by IHTT for a total of 10 weeks
Initially daily and gradually less frequently
Medication changed and at time of discharge was on Olanzapine 10mgs and Imipramine 150mgs
Had used Diazepam 2mgs p.r.n.
Continued to breast feed and baby thrived
Liaison with CPN,HV,GP

6. What Made It Possible? Good home support
Patient keen for a different experience
Patient had better understanding of symptoms
Regular risk assessment at every visit
24 hour phone contact
Regular medical review and adjustment of medication
Good pre-birth planning
Knowing that Mother and Baby unit an option

7. Perinatal Mental Health Team
Advanced Nurse Practitioner
&
Clinical Nurse
Specialist
W.T.E
2 CPN
Consultant Psychiatrist
2 sessions
Acute
Nursing
Staff
OT x 1
Trainee
Doctors
The team and how it all works when we came into operation

8. Intensive Home Treatment Team
Same day emergency psychiatric assessments
Offer a direct alternative to inpatient care
Support early discharge from acute wards
Multidisciplinary team
3 nurses , 1 OT and Consultant Psychiatrist with dedicated time, enhanced knowledge, expertise and skills in perinatal mental health

9. Perinatal / IHTT Referrals
Year/ Perinatal period
2013
2014
2015
2016
2017- March 31st
Antenatal IHTT 2 3
Postnatal
IHTT 11 8 10 15 4
Total 13 18

10. Susan age 37
Traumatic first birth with tear and some bowel problems ,son now 5
Second son born inFVRH
Re- admitted with 2nd baby high BP, breast feeding
Noted to be very anxious
Referred to perinatal team 7 days post natal
No past history of note
Arranged review at clinic

11. Cont
Seen at perinatal clinic still anxious about physical health prescribed Paroxetine 20 mgs.
Referred IHTT at 8 weeks anxious about health but also delusions of reference and auditory hallucinations
Husband very anxious and not coping making home treatment unsustainable
Admitted to Mother and baby unit

12. Referred back to IHTT One month admission to M and B
Prescribed Olanzapine 5mgs b.d. and continued Paroxetine
Much improved but husband in particular still very anxious
One month input by IHTT
Followed up by Perinatal service till baby just over a year old and had been able to come off all medication

13. What Made it Not Possible
Home Treatment not possible for all the treatment.
Carer strain when symptoms became clearly psychotic
Symptom escalation prior to admission to M and B unit
No risks of self harm or harm to baby
No past psychiatric symptoms or significant personal history

14. Summary Need good reliable home support
Need integration of IHTT and Perinatal service
Regular risk assessment essential
24hour back up support helpful
Good for step down from Mother and Baby unit
Working with experienced Perinatal clinicians helps build confidence

15. Any questions?