Improving Perinatal Mental Health HIT review of 2014-15

Dr Jonathan Evans and Inge Shepherd, Directors of the Improving Perinatal Mental Health (IMPROVE) Health Integration Team, give an update on progress in 2014-15.

Pregnancy and the early postnatal period are particularly
important for the mental health and wellbeing of families. Detecting, treating
and preventing mental health problems in mothers and fathers at this time will
pass benefits on to the next generation.

Across Bristol there are around 12,000 women who give birth
every year and over 1,000 of these mothers will experience levels of depression
or anxiety sufficient for them to benefit from treatment. This may be through
psychological therapies or medicines. A further 120 women will have more severe
mental health problems, either pre-existing or, for about 20 of these women, a
new onset of psychosis.

In the first year of this HIT we have drawn together
professionals from midwifery, obstetrics, health visiting, psychiatry,
psychology, general practice, infant mental health and children’s centres,
along with commissioners and researchers, to work at improving the care of
mothers, father and infants at this time.

We have developed work streams focusing on the care pathway,
developing a business case for a perinatal mental health team, training and
education, and approaches to universal prevention. Another stream will develop
capacity for patient and public involvement across the HIT.

An early priority has been to make the case for
commissioning a perinatal mental health service to provide assessment and
treatment, contribute to training and to ensure high standards and governance
of the whole care pathway. This is being negotiated with Bristol CCG.

All women are screened for depression during pregnancy and
we have audited the data collected from 12,000 women. About 7 per cent are
identified as requesting help during pregnancy, which is lower than expected.
We have seen an increase in referral for psychological treatment since the
services available have been made clearer to midwives, partly as a result of
setting up this HIT. Our aim for the next year is to improve the recognition of
mental health problems in pregnancy and the postnatal period, and clarify the
pathway once these problems are recognised to ensure the correct advice and
treatment is given to women.

We are also developing research proposals including ways of
helping fathers to support partners with mental health problems, and
interventions that could improve the emotional preparations for becoming a
parent and their overall health.