Perinatal mental health: introduction to

the issues Dr Giles Berrisford, FRCPsych – Consultant/Hon. Senior Lecturer in Perinatal Psychiatry, Birmingham; Chair of Action on Postpartum Psychosis Emily Slater – Everyone’s Business Campaign Manager, Maternal Mental Health Alliance

Becki Hemming – MH Access & Waiting Times Programme Lead, NHS England

Perinatal Mental Health: essential care for

mothers and their infants Dr Giles Berrisford

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Depression: the most common

major complication of maternity

Maternity: the highest ever risk of

psychosis

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Puerperal psychosis:

more rapid onset, more

severe, and higher risk

than at any other time

(Oates, 1996; Appleby et al 1998)

Kendell, 1987

Suicide: always in the top three causes of

maternal deaths up to 12 months

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Children depressed at 16 all had mothers who

were depressed, mainly during pregnancy

No maternal depression No children

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Perinatal depression care

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RecognizedClinically

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Gavin, Meltzer-Brody, Glover, and Gaynes in press

Organisation of services Managers and senior healthcare professionals responsible for perinatal mental health services (incl maternity and primary care services) should ensure that:

• there are clearly specified care pathways so that all primary and secondary healthcare professionals know how to access assessment and treatment

• staff have supervision and training, covering mental health problems, assessment methods and referral routes, to allow them to follow the care pathways

Clinical networks should be established for perinatal mental health services, managed by a coordinating board of healthcare professionals, commissioners, managers, and service users and carers. These networks should provide:

• a specialist multidisciplinary perinatal service in each locality, which provides direct services, consultation and advice

• access to specialist expert advice on psychotropic medication • clear referral and management protocols for all relevant services • pathways of care for service users • defined roles and competencies for all professional groups involved

Inpatient

Mother and

Baby Units

Specialist

Perinatal

Community Care

Perinatal Mental Health: essential care for

mothers and their infants Emily Slater emily.slater@everyonesbusiness.org.uk

www.everyonesbusiness.org.uk

Maternal Mental Health Alliance national campaign

Reflection on the costs – human & economic

Handing over to NHS England

www.everyonesbusiness.org.uk

October 2013 – October 2016

Accountability at national level (including for inpatient

mother & baby unit provision)

Community specialist perinatal mental health service in

every area in line with national guidance

Training for all health & social care professionals working

with women of reproductive age

October 2013 – October 2016

Reflection on costs

1. How many women will develop a mental illness

during pregnancy or within the first year following

childbirth?

2. How many women will hid or underplay their

symptoms?

3. What is a leading cause of maternal mental

death?

Economic costs (LSE & Centre for Mental Health, 2014)

Cost if we don’t act

£8.1bn

Economic costs (LSE & Centre for Mental Health, 2014)

Cost if we don’t act

£8.1bn£337m

Cost of taking action

Perinatal mental health and the

NHS England Access and Waiting

Times Programme Becki Hemming

becki.hemming@nhs.net

Access and waiting times – part of a wider

commitment to parity of esteem for mental health…

Equivalent standards as for physical health:

• Tackle long waits for treatment: ensure that access to service is timely

• Reduce the treatment gap: increase the number of people accessing treatment

• Embed NICE-concordant care in all areas: ensure that services accessed are evidence-based, clinically effective, safe and recovery focussed

… and align closely with the clinical strategy

of our National Clinical Directors Bio-psycho-social approach, with whole-person care encompassing :

• Psychological therapies and safe medication

• Physical health

• Crisis prevention and management

• Wider determinants: relationships/parenting, housing, employment

Focus across the entire life-course

• Being born well, and best early years development

• Living, working and growing older well

• Dying well

Supporting effective action through Clinical Networks

• Provide leadership on Business Plan priorities: CAMHS, ED, Perinatal, EIP

• Embed mental health within all areas of work: (eg) stillbirth/neonatal death,

reducing child mortality, transition from paediatric to adult services for LTCs

Demonstrating value

• Focussing on outcomes (and savings to the public purse) of effective care

• Robust evaluation and timely data to drive continuous improvement

• Using public and political awareness to show tangible benefits

Dr Geraldine Strathdee

Mental Health

Dr Jackie Cornish

Children, Young People, Transition

Mental health AWTs building on waiting time

standards existing in other areas of the NHS

• Build on “Big 5” standards operating

elsewhere in the NHS, currently covering:

- A&E (4 hour to admission, discharge or

referral)

- Cancer (2 weeks to specialist

appointment, 2 months to treatment)

- Elective care (18 weeks referral-to-

treatment)

- Diagnostics (6 weeks)

- Ambulance (8 or 19 minutes)

• Set out in the NHS Constitution and

Government’s Mandate to NHS England

• Data published weekly/monthly/quarterly

• Could include:

- A given number of people

- Equitable access across

patient groups

Patient level

How many people access treatment

Service level

What service people will access

• Could cover:

- Availability of service in all areas

- Workforce training and staffing levels

- Delivery of NICE-approved interventions

- Routine outcome measurement

- Method of access (eg single point)

- Patient choice (where appropriate)

Waiting-time standards Maximum time people should wait

Access Standards What services, and who should access them

Initial standards – first stage of five year plan

Early Intervention in Psychosis

• 50% of people experiencing a first episode of psychosis treated with a NICE-approved package of care within two weeks of referral - £40m recurrent funding

Improving Access to Psychological Therapies

• 75% treated within 6 weeks, and 95% within 18 weeks - £10m non-recurrent funding

Liaison Mental Health

• Support effective models of liaison psychiatry in a greater number of acute hospitals - £30m non-recurrent funding

Better Access by 2020 October 2014

Autumn Statement December 2014

Budget March 2015

Eating Disorders

• Improve CYP access to specialist evidence-based community services - £30m recurrent funding

CAMHS

• Local Transformation Plans across NHS, Local Government and schools - £235m recurrent

Perinatal

• Process underway to inform allocation and implementation - £75m over five years

1 2a

2b

Work led by process of expert engagement

Broad definition of expertise required:

• Clinical (all appropriate specialties)

• Non-clinical professionals

• Experts by experience

• Commissioners

• Service managers

Remit to advise NHSE on:

• How best to commission NICE-concordant care

• Possibility for access/waiting-time standards

• Use of additional funds

• Wider enablers and success factors (workforce, datasets,

payment/levers, etc)

Work to produce:

• Model pathways

• Commissioning guidance

Expert advice and input

Convened by National Collaborating Centre for

Mental Health

Expert Reference Group

Two meetings held: June, July. Further meeting:

September

• Facilitator: Prof Steve Pilling (UCL, NCCMH)

• Chair: Dr Lise Hertel (Newham CCG)

• Cross-disciplinary expertise:

- By experience

- Mental Health: Commissioning, Psychology,

Psychiatry

- Others: Health Visiting, Midwifery, Obstetrics,

Pharmacy

Technical Team

Meets fortnightly

• Cross-disciplinary expertise: Commissioner,

Psychiatrist, Service Advisers

• Supported by: Editor, Facilitator,

Health Economist, NHS England

programme staff, Project

Manager, Research

Assistant

Questions & discussion