An audit of pregnant women with severe mental illness referred during the first 2 years of a new perinatal mental health service

Abstract

The importance of identifying pregnant women at high risk of postpartum psychotic illness has been highlighted by recent enquiries and guidelines. It has been recommended that these women are referred to perinatal mental health services, and that individualised care plans are made prior to delivery. This audit describes a cohort of 45 women, referred to a new perinatal mental health service, with a history of psychotic illness or at risk of developing a postpartum psychotic episode. It describes the characteristics of this group, and the outcomes in terms of relapse and whether their children remained in their care. Thirty-nine women (87%) were seen for assessment. Sixty-seven per cent were under the care of a community mental health team. Twenty-one (53.8%) were well at the time of referral. Planned pregnancies were uncommon (15%). All women seen antenatally had care plans written to address the high risk of postpartum relapse. Ten (26%) women had psychiatric admissions during pregnancy. Fifteen (38%) relapsed or had admissions during the first postpartum year. At 1 year postpartum, 74% women had care of their children; 18% children had been adopted or were in foster care; and the outcome was unknown for 8%.

Self-harm in postpartum depression and referrals to a perinatal mental health team: an audit study

“…Again, the GP and if involved secondary mental health services were informed of the pregnancy, and the PMHT copied into all future correspondence up to the point of delivery. Similar to the findings of Green et al (2008), those with psychotic disorders including schizophrenia, bipolar disorder and schizoaffective disorder accounted for only 9 % of the total number of referrals, despite referrals being accepted from family doctors, psychiatrists and secondary mental health services. Referrals for these disorders have gradually increased since the audit took place, but the reason for the low numbers is unknown.…”

“…A minimum requirement for management should be regular monitoring and support for at least 3 months following delivery (Oates and Cantwell 2011). There is however a lack of perinatal mental health service provision in the UK with less than a quarter of NHS trusts having both inpatient and outpatient community services (Oluwatayo and Friedman 2005; Rowan and Bick 2008; Green et al 2008). Consequently, there have only been a handful of studies describing the clinical and socio-demographic characteristics of pregnant women attending perinatal services in the UK and abroad, particularly women who self-harm (Green et al 2008; Rowen et al 2010; Wilson et al 2004).…”

Engaging women at risk for poor perinatal mental health outcomes: A mixed‐methods study

“…Pregnancy is a time when many women will engage with services (Green et al . ), and this can provide a strong motivation for change (Hall & van Teijlingen ; Sword et al . ).…”

Collaboration and integrated services for perinatal mental health: an integrative review

“…The definitional problems are often resolved in the literature by the presentation of various models. Some examples of service models that may represent collaborative or integrated services include: a designated link worker (Allison et al., 2007), having a common manager across services (Allison et al., 2007), multidisciplinary managed and coordinated networks/steering committees (Sullivan, Raynor, & Oates, 2003; Waterhouse, 2009), perinatal multidisciplinary teams (Green et al., 2008; Miller et al., 2009), structured multidisciplinary peer supervision (Thomasgard, Warfield, & Williams, 2004), co‐location of services (Callaly, von Treuer, Dodd, & Berk, 2010; Smith, Howell, Wang, Poschman, & Yonkers, 2009) and the inclusion of the non‐government and voluntary sectors (Miller & Ahmed, 2000).…”