Specialist Mother and Baby Mental Health service

What we offer:

• preconception advice, pregnancy and birth planning if you’ve previously experienced mental illness
• advice about prescribing medication for mental health reasons during pregnancy and during breastfeeding e.g. anti-depressants
• consultation to assess risk and treatment options
• assessment which reflects what’s important to you during your pregnancy
• shared development of a care plan that meets your personal needs
• planning for your postnatal period to promote wellness and prevent relapse
• information about other support services
• help to build a positive relationship with your baby
• psychological therapy
• occupational therapy

Therapies

Some women may find talking therapies or parent-infant therapy helpful. Other women may find that activities, doing different things, can help their mental well-being.

We offer a range of different therapies. For example, we offer therapies:

• to help you understand your experience and to work out different ways of thinking and feeling
• to help you recover from traumatic events that are distressing to you;
•  to help you bond with your baby;
•  to help you change behaviours, which in turn change how you are thinking and feeling;
•  to help relieve physical discomfort.

We will talk with you to work out together what therapy may be may most useful to you and we will explain what we will do together if you decide that you want to make use of a therapy.

We understand that mums need to be able to care for and enjoy their babies and so the therapies we offer focus on helping you to be able to do this. Because we can only work with you up to a year after the birth of your baby, we offer a limited number of sessions of therapy but we also help work out if you may benefit from other therapies in the future and where you can get these.

• •  Bradford and Craven Talking Therapies -offers a range of treatments for mental health issues such as stress, anxiety and depression.
  • First Response service – 24 hour mental health crisis support
  • Compassion for Parents and Babies Well-being scheme
  • Royal College of Psychiatrists  – rcpsych.ac.uk
  • Action on Postpartum Psychosis – app-network.org
  • Lisa Milne’s blog – born ready to relate

We provide advice and support for women and other birthing people who are at high risk during the perinatal period because they have a history of, or current, severe mental health problems. We also provide pre-conception advice about risks and treatments when considering a future pregnancy.  Women and other birthing people experiencing mental health problems during the perinatal period have specialist treatment needs. We focus on preventing problems and intervening early to promote early recovery.

Information for referrers

Referral form – adult mental health services
Referral criteria form

Prescribing in Perinatal Mental Health: Guidance for general practitioners (GPs) and Prescribers in primary care.

 Who is the service for?

We support women and other birthing people with a range of mental health problems who are considering having a baby, are pregnant or have a baby under the age of one and have a GP within the Bradford, Airedale, Wharfedale or Craven area. The range of mental health problems includes:

• bipolar disorder
• post-partum psychosis
• schizophrenia
• depression or anxiety (OCD, panic, phobia, birth trauma)
• if the woman/other birthing person has a first degree relative with bipolar disorder or postpartum psychosis, and/or the woman/other birthing person has a significant change in mental state in late pregnancy or early after birth
• eating disorders
• personality disorders
• severe fear of pregnancy and childbirth 

Referral process

Please discuss the referral before sending in a referral.

A referral form will need to be completed, available by downloading from our website. This will need to be sent/faxed to SPoA (single point of access).

Urgent referrals – for women/other birthing people experiencing a mental health crisis.

Please call the First Response team for an urgent assessment on telephone: 0800 9521181

Red Flags

The perinatal period can be a risky time. Be aware of the Red Flags for urgent referrals and Amber Flags relapse of existing mental health conditions.
Red flags may indicate high risk and their presence should prompt urgent specialist review/input:

• Recent significant change in mental state or emergence of new symptoms
• New thoughts or acts of violent self-harm

New or persistent expressions of incompetency as a mother or estrangement from the infant.

Amber flags indicating risk for recurrence of major perinatal mental illness, particularly in early postpartum:

•  Previous history of psychosis gives a 25% chance of recurrence in a subsequent pregnancy
• Women with a family history of bipolar disorder or postpartum psychosis who themselves have mood disorder or change in mental state
• Person and family patterns of occurrence and re-occurrence can inform risk management strategies.

Your GP, midwife or Health visitor can refer you to the right mental health service for support.

Clinicians should be aware that mental health difficulties can be exacerbated by pregnancy and/or childbirth, or present for the first time during the perinatal period.

Admission to a mother and baby unit should always be considered where a woman has any of the following:

• rapidly changing mental state,
• suicidal ideation (particularly of a violent nature),
• pervasive guilt or hopelessness,
• significant estrangement from the infant,
• new or persistent beliefs of inadequacy as a mother,
• evidence of psychosis

To discuss a referral

Please email perinatalsmabs@bdct.nhs.uk for general advice and liaise about potential referrals. Please leave your telephone number for a call back.

Access and discharge

Women/other birthing people who meet our criteria will be offered an assessment and where appropriate a personalised package of care. We also provide joint work with women/other birthing people who need care coordination by other mental health services.

The service cannot work with mothers after their child’s first birthday.  If the woman/other birthing person still need help and support they will be referred on to the most appropriate services available.

• joint work for women/other birthing people currently within secondary mental health services
• specialist assessment and risk assessment
• care coordination
• perinatal outpatient care
• specialist psychological and occupational therapies
• parent-infant assessment, interventions and therapy
• signposting and referral to appropriate interventions and services including Leeds Mother and Baby Unit where appropriate

Referral criteria for pre-conception counselling for women/other birthing people of child-bearing age

• Who have a personal history of serious mental illness including bipolar affective disorder, schizophrenia, schizoaffective disorder and severe depressive illness, particularly if associated with psychotic features.
• Who have had a previous episode of severe perinatal mental illness including post-partum psychosis, severe depressive illness, particularly if associated with suicidality or psychotic features.
• With a family history of post-partum psychosis, bipolar disorder, or other serious mental illness, particularly if requiring in-patient treatment.
• On Sodium Valproate, Lithium or other anti-epileptic drugs prescribed as a mood stabiliser in bipolar or schizo-affective disorder. 

Pre-conception information for women/other birthing people of child-bearing age and referrers

Pre-conception advice is provided for those who are at risk of developing significant mental health difficulties during pregnancy or postnatally and are considering a pregnancy.

Women and other birthing people of child-bearing age can be advised on their individual risk of becoming unwell and management options if they are planning a pregnancy.

The consultation will be with a senior psychiatrist from the perinatal service. In most cases a single 90 minute appointment is sufficient however follow-up appointments can be arranged if required.

The pre-conception counselling clinic provides consultation, information and advice, not ongoing care. Referral to the service for advice on further management in the light of a future pregnancy may be one of the recommendations arising out of the consultation.

Partners and/or other significant family members are encouraged to attend the appointment to involve them in understanding risks and management decisions.

The following areas may be covered during the consultation:

• Individual risk of becoming unwell.
• Treatment options may be beneficial during pregnancy.
• Risks and benefits of different medications during pregnancy and breastfeeding; this may include meeting with a pharmacist and discussing the most recent information on medication.
• Relapse prevention strategies.
• Support and monitoring during pregnancy and post-delivery.
• Early warning signs of illness.
• Care planning should the woman become unwell in the perinatal period.

Following the consultation a letter will be sent to the woman/other birthing person, the referrer, GP, and other relevant professionals involved in their care so that they are aware of the recommendations regarding risks and treatment decisions.

Responsibility for affecting any advice provided in the consultation will reside with the referrer and other professionals involved in the woman’s/other birthing person’s ongoing care. 

Referral Process for pre-conception counselling

Referrals would usually need to come from the Community Mental Health team or Consultant Psychiatrist. Discussions are welcome and advice to Psychiatrist may in some cases be sufficient.

For women/other birthing people in secondary mental health services a letter from the referring consultant psychiatrist outlining the current situation and reasons for request for pre-conception counselling. Referrals for pre-conception counselling must provide detailed information regarding previous mental health history including in-patient treatment, and a comprehensive drug history to enable a meaningful discussion to take place.

Some women/other birthing people who have been well for a number of years may not be under the care of secondary mental health services currently in which case the GP may make a referral any letters of previous psychiatric involvement, risks and inpatient admissions should be attached – particularly for those that are from out of area.

We aim to see referrals for pre-conception counselling within 28 days.

We can only accept referrals where the patient has been advised of the purpose of the referral and consents to referral. It should be clarified with the patient by the referrer that this is for information and advice and not for ongoing care and treatment.

We are happy to discuss potential referrals through advice line or email the Perinatal Specialist Team perinatalsmabs@bdct.nhs.uk and Dr Chua or one of the team will respond.

We welcome your views, feedback and suggestions about how we can improve our service. The Patient Advice and Liaison service (PALS) office is open, Monday to Friday from 9.00am – 5.00pm. Telephone 01274 251440 or email: advice.complaints@bdct.nhs.uk

Having a baby is life changing. You can experience feelings of love, joy and fulfilment but being a parent can also create demands and responsibilities that feel relentless, difficult and scary.

Our team has put together some top tips and advice to help you take care of yourself when you’re taking care of your infant.

• Top tip on spending time at home with a baby
• Ideas for soothing
• New baby new feelings
• Mum and Me
• Booklet one – information on baby blues and postnatal depression
• Booklet two – thinking about motherhood and babies