National and local strategies (best practices)
- The London School of Economics have drawn on Longitudinal Studies which suggests that maternal depression and anxiety in the perinatal period are at least as common during pregnancy as they are in the year after childbirth. The fact that most cases of perinatal depression and anxiety are present during pregnancy sends a clear signal that the main focus of efforts to detect and treat conditions should be in the antenatal period.
- Nationally, an additional NHS expenditure of around £280 million a year would bring perinatal mental health to a standard level of care in England. This is equivalent to around £1.3 million a year in an average CCG. This compares against an average spend of £500 million a year for a typical CCG.
- NICE recommends clinical networks should be established for perinatal mental health services with a coordinated approach.
- Ensure there are clear pathways for primary and secondary healthcare professionals involved during pregnancy and postnatal period and that they know how to assess and treat.
- Clear referral and management protocols across a stepped care framework.
- Involve woman and family in agreement in all decisions about her care and care of baby with a coordinated, integrated care plan.
- Take into account and if appropriate assess and address the needs of partners, families and carers including welfare of the baby.
- Access to perinatal mental health teams preferably a specialist perinatal mental health service.
- Women to be asked at first contact and during postnatal period the two whooley questions to identify depression and consider using GAD2 questions to identify anxiety.
- At all contacts after the first contact, should consider asking two whooley questions and the GAD2 questions as part of general discussion. Use of PHQ9 or EPDS as part of monitoring and to gage level of severity. Repeat questions at suggested time intervals.
- Midwives and GP to agree to share information
The Joint Commissioning Panel for Mental Health has 10 key messages on commissioning perinatal services:
- Ensure a regional perinatal mental health strategy is present
- Ensure there is a perinatal mental health integrated care pathway
- Mother and baby units should be accredited by Royal College of Psychiatrists and have formal links with specialised community perinatal mental health teams locally
- Specialised perinatal community mental health teams should be members of the Royal College of Psychiatrists.
- Parent-infant services provided by CAMHS and maternal mental health teams provided in primary care and by non health organisations are an addition to, not a substitute for, services provided for women with serious mental illness.
- When commissioning adult mental health services consider perinatal mental health
- Ensure that adult mental health services consider perinatal mental health
- When commissioning maternity services the needs of pregnant and postpartum patients are met.
- Ensure that IAPT services meet the needs of pregnant and postpartum patients
- Ensure that Primary Care services meet the needs of pregnant and postpartum patients.
Last updated Tuesday, 17th January 2017