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What does excellence in Perinatal Mental Health look like?

Professor Howard gave an extended interactive session focusing on the key elements of effective perinatal mental health services and meeting the recommendations of the Dec 2014 NICE Guideline on postnatal mental health at today's Perinatal Mental Health conference.

In her presentation Professor Howard stated:

'If we manage to identify a mental health problem, the outcome can be very good - we need to intervene as quickly as possible'


'40% of women with babies in ICU are affected by depression'


'Its not just about making the referrals - its about making sure the outcomes are achieved'


'There is a lot we don’t know in this area, and I think it's very important that we point out areas of which we are uncertain'


'Considerations for women who experience traumatic birth, stillbirth or miscarriage - we should not be saying everyone needs a structured debriefing, with high intensity psychological intervention' It has not been proven that this is helpful'


In her presentation Professor Howard disussed:

The Mother-Baby relationship

Recognise that some women with a mental health problem may experience on-going difficulties with the mother–baby relationship. Assess verbal interaction, emotional sensitivity and physical care 3 primary mechanisms through which depression disrupts early parenting:
1.Emotional disturbance associated with lack of maternal warmth, difficulties in regulating an infant’s distress and intrusiveness during stressful situations.
2.Depressive rumination interferes with vital cognitive processes such as maternal attention and responsiveness to infant cues.
3.Depressed mothers show reduced motivation and withdrawal from parenting tasks. Infants/children experience higher rates of emotional and behavioural difficulties, compromised social functioning, insecure attachment, and cognitive and language delays – compounded by social adversity Discuss any concerns that the woman has about her relationship with her baby and provide information and treatment for the mental health problem.

Principles of care for women with mental health problems in pregnancy and the postnatal period

•Acknowledge the woman's role in caring for her baby and support her to do this in a non-judgmental and compassionate way.
•Involve the woman and, if she agrees, her partner, family or carer, in all decisions about her care and the care of her baby.
•Assess and address the needs of partners, families and carers
•Instil hope
•Mental health taken into account as part of all care plans
Provide culturally relevant information
•Be aware of the recommendations in the guideline on pregnancy and complex social factors (CG110)
•When working with girls and young women with a mental health problem in pregnancy or the postnatal period be familiar with local and national guidelines on confidentiality and the rights of the child
•Ensure continuity of care for the mental health problem if care is transferred from adolescent to adult services

Assessment and diagnosis of a suspected mental health problem should include:

-A history or family history of any mental health problem -Physical wellbeing and history of any physical health problem -Alcohol and drug misuse -The woman’s attitude to and experience of the pregnancy -The mother-baby relationship -Any current or past treatment for a mental health problem and response to any treatment -Social networks, living conditions, and social isolation -Domestic violence and abuse, sexual abuse, trauma, or childhood maltreatment -Housing, employment, economic and immigration status -Responsibilities as a carer for other children and young people or other adults Take account of learning disabilities or acquired cognitive impairments; consult Risk assessment e.g. self-neglect, self-harm, risks to others (incl baby), domestic abuse Follow local safeguarding protocols where safeguarding concerns

Future conferences of interest:

Improving Mental Health Support for Asylum Seekers and Refugees
Wednesday 8 June 2016
ICO Conference Centre
Investigation of Deaths in Mental Health & Learning Disabilities Services
Wednesday 22 June 2016
Hallam Conference Centre
Improving Mental Health Crisis Care: Maintaining Momentum
Wednesday 22 June 2016
ICO Conference Centre
Mental Health, Ill Health & Personality Disorder
Thursday 23 June 2016
ICO Conference Centre



Download: louise-howard_1383.pdf

4 May 2016


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