1. SJOG Raphael Centres for Perinatal & Infant Mental Health
Leading Innovations in Mental Health Care
SJOG Raphael Centres for Perinatal & Infant Mental Health
A/Assoc. Prof. Caroline Zanetti
Catholic Health Australia Conference
Pan-Pacific Hotel, Perth, 2012

2. The Raphael Centre SJOG Subiaco Hospital
The only perinatal & infant mental health service in WA
Established 10 years ago
Supported by SJOG Social Outreach & Advocacy
5 other services: Ballarat (2010), Berwick (2006), Geelong (2003), Warnambool (2006) in Victoria & Blacktown (2010) in Sydney
Now joined by SJOG Murdoch Raphael Centre

3. What is ‘perinatal mental health’?
Perinatal: The period between conception and the first year postpartum
The period in which women are the highest risk for mental disorder (Kendell et al, 1976)
Antenatal mood disturbance often precedes postnatal mood disorder (Heron et al. 2004)
Postnatal mood disorders in the mother are a source of grief & distress for the whole family (Cox et al. 1982)
Antenatal stress and anxiety have adverse effects on foetal development (Glover & O’Connor, 2002)
Deleterious effects on infant development persist beyond maternal recovery (O’Conner et al, 2002; Murray & Cooper, 1996)
‘Postnatal depression’ is a very loose term

4. What is ‘Infant Mental Health’?
The capacity to grow and live well, to form and sustain meaningful and lasting relationships throughout life, and to contribute to the best of one’s ability.

5. Do infants have mental illness?
Relationships are an essential part of human experience, and for the infant, a crucial aspect

6. Behavioural Indicators of Infant Mental Health
Emotional regulation
Ability to communicate feelings to caregivers
Active exploration of the environment

7. Without a healthy supportive relationship…
Death (Spitz, 1945)
‘In the foundling homes, the children die of sadness.’
from the diary of a Spanish bishop, 1760
(quoted in Brockington, 1996)
Lasting physical, cognitive and social disability (Nelson et al., 2007; Bucharest Early Intervention Project Core Group, 2007)
Personality disorder ‘There is accumulating evidence that maltreatment impaires the child’s reflective capacities and sense of self’ (Fonagy et al, 2004, p.346)
Criminality (Bowlby, 1944; Richards et al, 2009)
Serious physical and mental health problems (Felitti, 2002)

8. How is infant mental health affected by maternal mental illness?
Winnicott (1967) the infant’s sense of self is built substantially upon having the mother mirror back his experience in a way that also gives him a sense of her experience of him
Stern (1985): mirroring occurs in terms of voice, affect and movement
Trevarthen (1979): one’s sense of self emerges from within an intersubjective experience

10. Perfect B

11. Attachment Theory
Human infants are born with the capacity to identify and attach psychologically and emotionally to those caregivers (usually the parents) who will keep them safe as they learn about the world, and develop the skills that enable successful negotiation of life’s challenges
Attaching to a particular person means that the infant will rely upon him or her to provide a safe haven when discomfort or danger arises, and a secure base for exploration at other times (Bowlby, 1969)

12. Attachment Theory
the tendency to seek and maintain the support of an attachment figure is fundamental to human infant behaviour
many things can promote, and interfere with, the caregiver’s capacity to provide adequate support for infants and small children

14. Raphael Centre Model of Care
Based on attachment theory – caregivers and the service offer a secure base for the parent and the family
Range of therapeutic modalities
Evidence-based, strong clinical governance
Early intervention and comprehensive approach to mental health care: bio-psycho-social issues that impact on well-being through to treating diagnosable mental illness

15. Raphael Centre Model of Care
Support the woman’s physical, mental, social, cultural & spiritual well-being, including the well-being of her foetus, infant and family
Collaboration between professionals and others providing care for the woman
Providing continuity of care
Carers and significant others encouraged to play an active role in planning, delivery and evaluation of services

16. Raphael Centre Model of Care
Caregivers are competent and supported
Services are affordable
Geographically accessible and welcoming to all cultures
Consumers engaged in development and delivery of services
Model of care endorsed by the SJOG SOA PIMH Advisory Committee, and links with other work undertaken by the Committee in evaluation, research and workforce development

17. Subiaco Raphael Centre Model of Care
Pregnancy
Individual
Growing Together
Enough for now
Pre-Conception
Grief work
Planning
Consultation-Liaison
Maternity
NICU
0 – 4 years
Psychiatry
MHN
Allied Health
Research
Training
RAPHAEL CENTRE TREATMENT PROGRAM
ASSESSMENT
1st Postnatal year
Individual
Coming Together
Little Movers
Pathways to Wellness
Baby Massage
Parent-Toddler/Preschooler
Relationship
Individual
COS-P DVD
Touching Base
COS-P-Plus
Other Service

18. Research at the Raphael Centre
Evaluation of clinical programs
Coming Together Project – in conjunction with WA Perinatal Mental Health Unit and Women’s & Children’s Health Service
Perinatal Experience Study – screening in the first week postpartum for risk of mental disorder or parent-infant relationship problems
NETAS Neonatal Exposure to Antidepressant Medication
NICU Neonatal Nurses Perception of their work

19. ADVOCACY
Social Outreach & Advocacy services are delivered specifically for people experiencing disadvantage which may be excluding them from living a full and rich life.
Guiding principles:
Building capacity
Early intervention
Working with clients at their own pace
Removing barriers to service
Providing opportunities for building individual and family resilience and confidence
Creating partnerships of trust with other agencies

20. ADVOCACY
Social Outreach & Advocacy services are aimed at families experiencing marginalisation and disadvantage
Some measures of disadvantage are easy to identify: e.g. poverty, social dislocation
Perinatal mental health problems do not vary in severity across socio-economic status, although the person’s presentation may vary in terms of complexity
Stigma and difficulties in engagement are common
There are very few specialised services for treating perinatal and infant mental health problems
Infants are particularly vulnerable in the presence of parental mental illness, whatever their families’ circumstances

21. ADVOCACY
Social Outreach & Advocacy services are aimed at families experiencing marginalisation and disadvantage
Special, very inclusive, considerations need to be made when setting criteria for reaching out to families with perinatal stress & mental illness, as this is a way of building real social capital