NHS East Midlands NSR Perinatal Mental Health Strategy Dr Margaret - - PowerPoint PPT Presentation

The implementation programme for the East Midlands Next Stage Review

NHS East Midlands NSR Perinatal Mental Health Strategy

Dr Margaret Oates

The implementation programme for the East Midlands Next Stage Review

Definition

Perinatal Mental illness Complicate pregnancy and postpartum year Perinatal Psychiatric Services provide care for women and their infants Serious and/or complex illness both new onset and existing illness Needs infant before and after delivery central to speciality, care and services

The implementation programme for the East Midlands Next Stage Review

National Drivers

Mental Health NSF 2009 NICE Guidelines ANPNMH 2007 Children young people & Maternity NSF (11) 2004 (07) Confidential Enquiries into Maternal Deaths 2002, 04, 07 CNST 2000 (08) Scottish Maternity Framework 2002 Women’s Mental Health Strategy 2002 Royal College of Psychiatrists CR88 2000

All recommend that

The implementation programme for the East Midlands Next Stage Review

• Specialist MDT with Psychiatrist in Mental Health Trust
• All women requiring psychiatric admission following delivery should

be admitted to a specialist Mother & Baby Unit

• PH & FH serious mental illness should be elicited at booking
• Management plans in place for those at high risk
• Managed Care Networks

CR88 NSF Carter Report

The implementation programme for the East Midlands Next Stage Review

Childbirth and mental illness

• Increased risk
• Common
• Serious
• Some predictable / preventable
• Adverse outcomes mother and infant
• Different
• 2nd patient
• General services do not meet need

The implementation programme for the East Midlands Next Stage Review

• Puerperal Psychosis

2/1000

• Chronic SMI

2/1000

• Severe depressive illness

3%

• Mild/mod depressive illness 10%
• Adjustment disorders

15-30% Epidemiology Postnatal Illness

The implementation programme for the East Midlands Next Stage Review

Onset of major functional disorders in the puerperium

Number of admissions Weeks prior to delivery Weeks following delivery

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

Kendell et al 1987

Is childbirth associated with increased risk?

The implementation programme for the East Midlands Next Stage Review

5 10 15 20 25 30 35 40 45 50 Psychiatric Cardiac Embolism Haemorrhage Early pregnancy Sepsis Rate per million maternities Direct Indirect Suicide/open verdict Misadventure Drug/alcohol

Leading causes of maternal mortality CEMD 2000/02

The implementation programme for the East Midlands Next Stage Review

Based on known epidemiology of perinatal disorders None Mental Health Trusts sufficient psychiatric morbidity to justify inpatient unit “critical mass” EM - needs 14 beds but together they do JOINT COMMISSIONING

The implementation programme for the East Midlands Next Stage Review

all Mental Health Trusts sufficient serious morbidity to justify locality specialised perinatal community team + specialist perinatal psychiatrist “HUB AND SPOKE” MBU

The implementation programme for the East Midlands Next Stage Review

We have for the East Midlands:

• Shared vision equitable, quality comprehensive

specialised care for all

• Service Model:

– Hub (Mother and Baby Units) and Spokes (Specialised Perinatal Community Teams)

• Managed Clinical Network
• Standards
• Commissioning Framework

The implementation programme for the East Midlands Next Stage Review

NSR Perinatal Workstream supported by the SCG Commissioning Clinical Involvement Patient Involvement East Midlands Clinical Lead Perinatal Steering Group Lead Commissioners + Business Managers 5 MH Trusts Clinical Advisory Group – clinicians involved in the care pathway Managed Clinical Network Standards, Education, Patient Groups Links with Maternity & Health Visiting Services, Adult Mental Health

The implementation programme for the East Midlands Next Stage Review

Patient engagement

• Five Expert Patient Groups
• Five focus groups
• Four themes – access, specialism vs.

generalism, continuing specialised care, distant vs. local services

The implementation programme for the East Midlands Next Stage Review

Patient Themes

• Need improved training, information and advice

for non-specialists (and patients)

• Specialised skills and resources essential –

care/treatment, mother/baby interaction, patient/professional relationships

• Follow-up support – transition back home,

continuity of care, continuing care needs

• Willing to travel to MBU out of area but local

community services essential

The implementation programme for the East Midlands Next Stage Review

Treatment Primary Care Specialist MW/HV Psychological Therapies Improved skills HV & Primary Care Teams Basic education all staff Compassionate understanding All women Mild/Moderate 10% “PND” Adjustment disorders distress 15% - 30% Good Psychological care Promoting Maternal-child Mental health Referral & Management Guidelines Specialist Perinatal Community Teams Serious illness 30/1000 “admission vulnerable” Hub & Spoke integration Mother & Baby Unit Outreach Service Consultation & advice Acute Psychoses 2/1000 Severe/complex 2/1000 Chronic SMI 2/1000 “inpatient equivalents”

M C N

I C P

The implementation programme for the East Midlands Next Stage Review

Progress to Date

• Clinical and Patient Engagement
• Initial Impact Assessment drafted
• Capgemini working with PCTs on current

expenditure and modelling costs

• Service standards circulated for comment
• Specification for Inpatient and Community

Services being drafted

The implementation programme for the East Midlands Next Stage Review

Next Phase

• Point prevalence census
• Market Assessment
• Produce Options for Delivery
• Consider commissioning

arrangements