Working together to improve the lives of mothers and their infants in Wessex

Dr Alain GrégoireConsultant/Hon. Senior Lecturer in Perinatal Psychiatry, Southampton

Chair, UK Maternal Mental Health Alliance

I can announce today a £290 million investment by 2020, which will mean that at

least 30,000 more women each year will have access to

evidence-based, specialist mental health care during or

after pregnancy.

Why perinatal MH?Clear evidence of individual needsClear evidence of economic and social needClear evidence of investment for NHS,

public purse and societyClear and consistent NICE and scientific

evidence baseSuccessful models for delivery of careQuality standards & assurance systemActive and consistent support from all

stakeholders

0%

2%

4%

6%

8%

10%

12%

14%

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Depressive illness: the most common major complication of maternity

Global Burden of Disease: DALYs (life years lost through death or illness) for women aged 15–44

WHO, 2008

Highest ever risk of psychosis

Ad

mis

sio

ns

Weeks before Weeks after

20

18

16

14

12

10

8

6

4

36 34 32 30 28 26 24 22 20 18 16 14 12 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

The combined effects of raised anxiety (or depression) both antenatally (32 weeks) and postnatally (33months) on child outcome up to 13 years

O’Donnell et al 2014

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

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Never In utero 1st year Earlychildhood

Middlechildhood

Adolescence

When mother first depressed

Depressedadolescents

Welladolescents

Pawlby et al 2009

Perinatal period: the most efficient time for detecting depression in women

(Sharpe et al 2006)

More than 1 in 10 women develop a mental illness during pregnancy or the first year after having a baby

7 in 10 women hide or underplay the severity of their illness

Delivery episodes with identified MH problem

Source: Hospital Episode Statistics, Health and Social Care Information Centre

Postnatal depression care(Gavin et al in press)

40%

24%

10%3%

0%

20%

40%

60%

80%

100%

Prevalent PNDCases

RecognizedClinically

AnyTreatment AdequateTreatment

AchievedRemission

Simplified Perinatal MH Pathway

Support from GP, HV and MW, plan continued close monitoring in the

early postnatal period. Obtain specialist advice as necessary.

Other agenciesTalking

therapies

GP assessment for medication and talking therapies & continued

support from GP, HV and MW

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Specialised perinatal

care pathways:Bipolar disorderSchizophrenia

Complex PTSDDepression

AnxietyOCD

Support from GP, HV and MW

History of mental illness and current mental health assessed at first contact

and booking

Coping with daily living problems

Pe

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riage

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History of possible severe mental illness or current severe illness,

identified by any service

If persists or worsens

Current severe illness

Current moderate illness

Current mild illness

If persists or worsens

Routine antenatal care Mental health care

Perinatal specialist inpatient

care (mother

and baby unit)

Any positive responses to questions (communicate for

information)Communicate for information

Routine postnatal care

Q

Maternity services

GP, primary care, IAPT

General adult MH services

Perinatal MH services

3rd sector

NB! At every stage assess and

enhance mother-infant relationship

What women who need specialist perinatal mental health care can access from our NHS

Economic costs if we continue as we are(LSE & Centre for Mental Health, 2014)

Cost if we don’t act

£8.1bn£337m

Cost of taking action

7 Guiding Principles of the NHS(NHS Constitution 2011)

and perinatal mental illness in most of the UK

1. NOT comprehensive

2. NOT based on clinical need

3. NOT providing highest standards

4. NOT listening to patients

5. NOT working across boundaries

6. NOT providing best value

7. NOT accountable

Specialist Perinatal Community Services: 2004-15

0

5

10

15

20

25

30

35

40

45

2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

1 professional

2 professionals

full team

Parity with specialist physical health care in maternity

• UK maternity care = £2800/woman• Specialist perinatal mental health across the UK

= £67/woman

• Total NHS maternity budget £2.6bn• Cost of 60 more MBU beds = £6m (0.23% of

maternity costs)

(Costs if we stay as we are = £8.1bn)

5YFV, Future in Mind, Better Births

• Clear pathway across all services, within waiting time standards

• Specialist community perinatal mental health teams meeting national quality standards/accreditation

• Access to therapy, including parent-infant therapy and C-PTSD/PD within waiting time standards

• Mental health in maternity and health visiting • Specialist Mental Health Midwives and

Health Visitors

What are they doing about it?• Ministerial commitment• Funding• HEE Mandate: training & workforce• Future in Mind, 5YFV, Better Births• NHSE Transformation Board• National Clinical Directors• MMHA: Professional Bodies; 3rd Sector;

Everyone’s Business; Lottery Toolkit development; scrutiny; quality improvement

• Wessex PMH Network

That means

YOU

Wessex Perinatal MH Network: the road to parity, equity, quality

5YFV, Future in Mind, Better Births: Wessex Commissioners (CCGs/LAs)2016/17 (NOW): •Contracts for maternity, health visiting, general adult MH, liaison, IAPT to specify national/regional quality and waiting time standards for perinatal careBY 2018:•Specialist community perinatal mental health teams meeting national quality standards/accreditation•Access to therapy, including parent-infant therapy and C-PTSD/PD within waiting times

5YFV, Future in Mind, Better Births: Wessex providers (acute/MH/LAs)

2016/17 (NOW): •Maternity: appoint specialist perinatal MH midwives Health visiting: as above•General adult MH, liaison: prioritise therapy access to perinatal; valproate prescribing.•IAPT: Prioritise perinatal; training; tailored access and interventions•CAMHS: include parent-infant services in modernisation plans •All: agree pathways for identification, prevention and care; training and workforce

That means

YOUWessex mums:

first in

UK to get

best care!