1. Maternal Mental Health and attachment care pathway
Rebecca Balakrishna
Consultant Nurse CAMHS
WAHT

2. INTRODUCTION: History of the pathway development
Closer working relationship of HVs with CAMHS-consultation, supervision and training(Solihull).
Changes in working practice for HVs, national and local.
Increasing concern re:maternal mental health and infant attachment for priamry care workers
Multi-agency approach to Perinatal care- health visitors, midwives, adult mental health, CAMHS, social services, primary care.
Development of the care pathway
Finding the right tools and support

3. Criteria for Placement on the Care Pathways
PQ9 GAD7
This is divided into two aspects depression and anxiety.
Depression
A score of 7 or lower is low concern
A score of 8-9 is moderate concern
A score of 10 or more is high concern
Anxiety

4. Detection tools continued
Mothers Object Relations Scales (MORS)
Warmth and Invasion scores
Warmth scale
A score of 11 and lower is high concern
A score of is moderate concern
A score of 16 and above is low concern
Invasion scale
A score of 17 and above is of high concern
A score of is of moderate concern
A score of 11 and below is of low concern

5. Patient-Infant Relationship Global Assessment Scale (PIR-GAS)- DC;0-3R
score 70 ( out of 100) and above then place low concern care pathway
score then place moderate concern care pathway
score 49 or below then place high concern care pathway.
using a visual analogue scale

6. continued Combining the outcomes of the scores
They are place on the care pathway
Either:
high concern
moderate concern
low concern,

7. Guidelines for the Detection and Treatment of Mental Health Concerns and Attachment Disorder in Mothers and their Infants
Service available to all new mothers and infants (Appropriate consent must be gained.)
All actions following assessment will be applied with the knowledge and consent of the mother.
Antenatal concern - refer to midwife
The care pathway

8. Menu of Complementary Care Packages:
Moderate concern
Home start- family support
Baby massage course
Sure Start activities and other support
Parenting groups
Baby Peep – toddler peep
High concern
Counseling. Adult drop in service (blue to new)
Social Services-family support workers
0-17
Referral to CAMHS Watch Wait Wonder
Breaking free group for parents
Housing review

9. Future developments Improved Antenatal screening. Pilot complete
Better access to specialist perinatal Services
Increased hours for adult primary mental health specialist
Ensured standard practice and services across North Somerset
On going training and supervision for staff
Care pathway linked to Social Care

10. Contact details Rebecca.balakrishna@nhs.net 01934 881262 John Oates
Robin Balbernie
Thank you on behalf of the perinatal steering group