perinatal mental health, pop up uni, 9am, 3 september 2015
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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
Becki Hemming – MH Access & Waiting Times Programme Lead, NHS England
Perinatal Mental Health: essential care for
mothers and their infants Dr Giles Berrisford
0%
2%
4%
6%
8%
10%
12%
14%
majo
r depre
ssion
hypertensio
nPPH
prete
rm
diabete
s
precla
mpsia
IUG
R
placenta
l abru
ption
Depression: the most common
major complication of maternity
Maternity: the highest ever risk of
psychosis
16
16 12
Ad
mis
sio
ns
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
Suicide: always in the top three causes of
maternal deaths up to 12 months
0
5
10
15
20
25
Cardia
cVTE
Suicid
e
CNS Haem
orrhage
Sepsis
Preecla
mpsia
AFE
Haemorrh
age
Infe
ctions
Ma
tern
al D
ea
th:
rate
s p
er
mil
lio
n m
ate
rnit
ies
, UK
2
00
3-0
5
Maternal anxiety at 32 weeks and child
mental health problems
0.0
2.5
5.0
7.5
10.0
12.5
15.0Low prenatal anxiety (n=6,731)
High prenatal anxiety (n=1,213)
4 7 9 11.5 13
Age (yrs)
Po
pu
lati
on
pre
vale
nce
%
(O’Donnell et al
in press)
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
% o
f ad
ole
scen
t off
spri
ng
Never In utero 1st year Early
childhood
Middle
childhood
Adolescence
When mother first depressed
Depressed
adolescents
Well
adolescents
Pawlby et al 2009
Perinatal depression care
24%10%
3%0%
20%
40%
60%
80%
100%
PrevalentPNDCases
RecognizedClinically
AnyTreatment
AdequateTreatment
AchievedRemission
40%
Gavin, Meltzer-Brody, Glover, and Gaynes in press
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
Inpatient
Mother and
Baby Units
Specialist
Perinatal
Community Care
Perinatal Mental Health: essential care for
mothers and their infants Emily Slater emily.slater@everyonesbusiness.org.uk
www.everyonesbusiness.org.uk
Maternal Mental Health Alliance national campaign
Reflection on the costs – human & economic
Handing over to NHS England
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
October 2013 – October 2016
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?
Economic costs (LSE & Centre for Mental Health, 2014)
Cost if we don’t act
£8.1bn
Economic costs (LSE & Centre for Mental Health, 2014)
Cost if we don’t act
£8.1bn£337m
Cost of taking action
Perinatal mental health and the
NHS England Access and Waiting
Times Programme Becki Hemming
becki.hemming@nhs.net
Access and waiting times – part of a wider
commitment to parity of esteem for mental health…
Equivalent standards as for physical health:
• Tackle long waits for treatment: ensure that access to service is timely
• Reduce the treatment gap: increase the number of people accessing treatment
• Embed NICE-concordant care in all areas: ensure that services accessed are evidence-based, clinically effective, safe and recovery focussed
… 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 show tangible benefits
Dr Geraldine Strathdee
Mental Health
Dr Jackie Cornish
Children, Young People, Transition
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 time people should wait
Access Standards What services, and who should access them
Initial standards – first stage of five year plan
Early Intervention in Psychosis
• 50% of people experiencing a first episode of psychosis treated with a NICE-approved package of care within two weeks of referral - £40m recurrent funding
Improving Access to Psychological Therapies
• 75% treated within 6 weeks, and 95% within 18 weeks - £10m non-recurrent funding
Liaison Mental Health
• Support effective models of liaison psychiatry in a greater number of acute hospitals - £30m non-recurrent funding
Better Access by 2020 October 2014
Autumn Statement December 2014
Budget March 2015
Eating Disorders
• Improve CYP access to specialist evidence-based community services - £30m recurrent funding
CAMHS
• Local Transformation Plans across NHS, Local Government and schools - £235m recurrent
Perinatal
• Process underway to inform allocation and implementation - £75m over five years
1 2a
2b
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
Questions & discussion
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