Detection and initial assessment of mental disorder: the midwife's role

Abstract

Two studies were undertaken to evaluate a programme to encourage midwives to detect and refer women with mental health problems. In the first study, 187 midwives completed questionnaires before and one month after a study day. There was a significant improvement in answers to knowledge questions and in self-reported confidence and attitudes. In the second study, the handheld maternity notes carried by pregnant patients were examined after discharge. Significantly more records showed mental health problems entered and more had explanatory information added beside the diagnosis.

A mixed methods review to develop and confirm a framework for assessing midwifery practice in perinatal mental health

“…Better knowledge, and more accurate illness perceptions, can improve attitudes towards women with PMH problems by counteracting negative stereotypes and stigma and reducing fear. This is supported by several studies included in this review which suggest that training, and therefore increased knowledge, helps to reduce stigma and increases understanding (Elliott et al., ; Higgins et al., ; Higgins, Carroll, et al., ; McLachlan et al., ; Reed et al., ).…”

“…Lack of confidence can lead to increases in referrals to other services (Rothera & Oates, ). Training increased levels of confidence (Elliott et al., ; Higgins et al., ; Lau et al., ; McLachlan et al., ; Reed et al., ; Williams et al., ), as did previous experience (Hauck et al., ), although Jomeen et al. () suggest that taught, rather than accrued, conceptualizations of PMH problems are more likely to be effective in increasing confidence.…”

“…As one of the studies (McCann & Clark, ) showed, students who have just started a midwifery course are likely to use lay conceptualizations of mental disorders, highlighting the need for comprehensive PMH training in the curriculum. Several studies included in this review found that training improved confidence, knowledge and skills and reduced stigma among midwives (Elliott et al., ; Higgins et al., ; Higgins, Carroll, et al., ; Jardri et al., ; Lau et al., ; McLachlan et al., ; Reed et al., ; Williams et al., ). This needs to be treated with some caution as in many studies knowledge and skills were self‐rated and any increase in knowledge and training was assessed soon after training and may not necessarily be sustained over a longer time period.…”

“…There was considerable variation in midwives' levels of PMH knowledge. Overall, knowledge was good for most conditions, particularly PND, but there were notable gaps, particularly for more severe conditions and for risk factors and consequences of PMH problems (Elliott et al, 2007;Hauck et al, 2015;Higgins, Carroll, et al, 2016;Jarrett, 2015;Jomeen et al, 2009;Jones et al, 2011;Phillips, 2015). Many studies examined self-rated knowledge, which tended to be more positive than assessed knowledge but is likely to be less reliable.…”

“…Many studies examined self-rated knowledge, which tended to be more positive than assessed knowledge but is likely to be less reliable. Training increased levels of knowledge (Elliott et al, 2007;Higgins et al, 2012;Lau et al, 2015;McLachlan et al, 2011). Midwives used a range of assessment approaches (Gibb & Hundley, 2007;Yelland et al, 2007), including informal and adapted techniques (Jarrett, 2014;Rollans et al, 2013a;Salomonsson et al, 2011;Williams et al, 2016).…”