This document provides an overview of perinatal mental health issues and services. It discusses: - Depression is the most common major complication of maternity. Postpartum psychosis has a more rapid and severe onset during pregnancy and the postpartum period compared to other times. - Suicide is always among the top three causes of maternal death up to 12 months postpartum. Maternal anxiety during pregnancy is linked to increased risk of child mental health problems. - Only a minority of women with perinatal depression are recognized and receive adequate treatment. Specialist perinatal community services and inpatient mother and baby units are needed. - National campaigns call for accountability, community perinatal

1. 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
BeckiHemming – MH Access & Waiting Times Programme Lead, NHS
England

2. 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

4. Maternity: the highest ever risk of
psychosis
16
16 12
Admissions
Weeks before Weeks after
20
18
14
12
10
8
6
4
36 34 32 30 28 26 24 22 20 18 14 10 8 6 4 2
2
1 2 3 4 5 6 7 8 9 10
Birth
Puerperal psychosis:
more rapid onset, more
severe, and higher risk
than at any other time
(Oates, 1996; Appleby et al 1998)
Kendell, 1987

5. Suicide: always in the top three causes of
maternal deaths up to 12 months
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20
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MaternalDeath:
ratespermillionmaternities,UK
2003-05

6. Maternal anxiety at 32 weeks and child
mental health problems
0.0
2.5
5.0
7.5
10.0
12.5
15.0
Low prenatal anxiety (n=6,731)
High prenatal anxiety (n=1,213)
4 7 9 11.5 13
Age (yrs)
Populationprevalence%
(O’Donnell et al
in press)

7. Children depressed at 16 all had mothers who
were depressed, mainly during pregnancy
No maternal depression  No children
depressed at 16
0
10
20
30
40
50
60
70
%ofadolescentoffspring
Never In utero 1st year Early
childhood
Middle
childhood
Adolescence
When mother first depressed
Depressed
adolescents
Well
adolescents
Pawlby et al 2009

8. Perinatal depression care
24%
10%
3%
0%
20%
40%
60%
80%
100%
Prevalent
PND Cases
Recognized
Clinically
Any
Treatment
Adequate
Treatment
Achieved
Remission
40%
Gavin, Meltzer-Brody, Glover, and Gaynes in press

9. 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

10. Inpatient
Mother and
Baby Units

11. Specialist
Perinatal
Community Care

12. Perinatal Mental Health: essential care for
mothers and their infants
Emily Slater
emily.slater@everyonesbusiness.org.uk
www.everyonesbusiness.org.uk

13. Maternal Mental Health Alliance national campaign
Reflection on the costs – human & economic
Handing over to NHS England

15. www.everyonesbusiness.org.uk
October 2013 – October 2016

16. 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

17. 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?

18. Economic costs
(LSE & Centre for Mental Health, 2014)
Cost if we don’t act
£8.1bn

19. Economic costs
(LSE & Centre for Mental Health, 2014)
Cost if we don’t act
£8.1bn£337m

20. Perinatal mental health and the
NHS England Access and Waiting
Times Programme
Becki Hemming
becki.hemming@nhs.net

21. Access and waiting times – part of a wider
commitment to parity of esteem for mental health…
Equivalent standards as forphysicalhealth:
• Tackle longwaits fortreatment: ensure that
access to service is timely
• Reduce the treatment gap: increase the
number of people accessingtreatment
• Embed NICE-concordant care inall areas:
ensure that services accessedare evidence-
based, clinically effective,safe andrecovery
focussed

22. … 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 showtangible benefits
Dr Geraldine Strathdee
Mental Health
Dr Jackie Cornish
Children, Young People, Transition

23. 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 timepeople should wait
Access Standards
What services, and who should access them

24. Initial standards – first stage of five
year plan
Early Interventionin Psychosis
• 50% of people experiencinga first episode of
psychosis treatedwitha NICE-approvedpackage
of care withintwo weeks of referral - £40m
recurrent funding
ImprovingAccess to PsychologicalTherapies
• 75% treatedwithin 6 weeks,and 95% within 18
weeks - £10mnon-recurrent funding
Liaison MentalHealth
• Support effective models ofliaisonpsychiatry ina
greaternumber of acute hospitals - £30mnon-
recurrent funding
BetterAccess by 2020
October 2014
Autumn Statement
December 2014
Budget
March 2015
Eating Disorders
• Improve CYPaccessto specialist evidence-based
community services - £30mrecurrent funding
CAMHS
• Local TransformationPlans across NHS,Local
Government andschools- £235mrecurrent
Perinatal
• Process underwayto informallocation
and implementation- £75m over
five years
1 2a
2b

25. 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

26. Questions & discussion