HNY Policy and Pathway Repository - Humber

The purpose is to support professionals working with women who are showing symptoms of perinatal mental health problems during the pre-conceptual, pregnancy period and/or up to one year after the birth of a baby. The team works with women and families with moderate to severe and complex mental health problems. 

• Women with a history of schizophrenia, bi-polar disorder, severe depression, other psychotic disorders or previous inpatient/crisis care should be referred to the perinatal team, this group is at increased risk of severe postpartum episodes.
• Women with a history of postpartum psychosis or with a mother and/or sister with a history of postpartum psychosis should be referred even if presenting with no symptoms of mental disorder.
• Women who have experienced recent significant changes in mental state or are presenting with uncharacteristic symptoms and marked changes to normal functioning. This can include symptoms of confusion and general perplexity.
• New thoughts or acts of violent self-harm
• New and persistent expressions of incompetency as a mother or estrangement from the infant
• Antenatal presentation can be a predictor for postnatal episodes of mental ill health

• High risk period is 1-10 days postnatal, but the threshold should be lower for women up to 10 weeks postnatally
• Partner, family or friends report significant change in presentation or acting out of character
• Older professional women with depression who appear to be functioning at a high level
• Women who present with anxiety/panic attacks or unusual or over valued ideas (ideas that seem out of context or extreme)

DO NOT REFER

• Women with a substance misuse problem should not be referred to specialised perinatal community mental health teams unless they are also suffering from, or there is, a suspected/potential serious/complex mental illness.

• Women who have mild to moderate mental health needs – these women should be signposted to primary care mental health services.

• If at the point of referral, it is identified that the baby is going to local authority care, the referral will be redirected to community mental health teams. If the decision is made for the baby to go into the care of the local authority after the referral has been accepted, consideration needs to take place as to where the woman’s care needs to reside – this will be discussed through the MDT on a case by case basis.

• If the baby is nearing their 1st birthday, please discuss appropriateness of the referral with the team.

• Women who experience trauma following a miscarriage, stillbirth (baby born after 24 weeks gestation), or neonatal loss should be treated via psychology. If the woman has a pre-existing mental health problem or develops a mental health problem, the treatment should be coordinated by the community mental health team.

• If a woman has been under the care of the perinatal mental health team and experiences a miscarriage, stillborn or neonatal loss, the team would support the woman and family; referring them onto other services.

Consider the woman’s existing support networks, for example midwifery and health visiting services in the first instance.

• A mild mental health problem is when a small number of symptoms that have limited effect on daily
• A moderate mental health problem is when a person has more symptoms that can make their daily life much more difficult than usual
• A severe/complex mental health problem is when a person has many symptoms that can make their daily life extremely difficult

A person may experience different levels at different times (NICE)

The specialist perinatal mental health service accepts referrals for women of any age who have a moderate to severe and/or complex perinatal mental health problems.

Please complete in its entirety the eRS referral form.

Referrals

Referrals will be accepted via the eRS referral form. Referrals will be reviewed four times a day by the team and appropriate action will follow. If the referral is accepted, the service aims to offer an assessment within two weeks.

Referral form on ARDENS

Contact details for the service:

Hnf-tr.perinatalmentalhealthteam@nhs.net

GPs are welcome to ring the Perinatal Mental Health Team to on 01482 336837 to discuss potential referrals or seek advice, which may mean a referral is no longer needed, or help guide the best course of action (including advice around prescribing for pregnant and breast- feeding women). This service operates Monday to Friday 9am – 5pm. 

NICE 2011, Generalised anxiety disorder and panic disorder in adults CG113

https://www.nice.org.uk/guidance/cg192

NICE pathways for antenatal and postnatal care

NICE 2015 identification and assessment of common mental health disorders

PHQ 9: http://www.cqaimh.org/pdf/tool_phq9.pd

EPNDS https://psychology-tools.com/epds/

GAD7 - https://patient.info/doctor/generalised-anxiety-disorder-assessment-gad-7

Other Information

Every Mum Matters Website – www.everymummatters.com

The every mum matters website has been developed locally to raise the profile of perinatal mental health and reduce the stigma, and encourage women to

All relevant information requested via the eRS referral form should be completed in its entirety prior to consideration