Description

A mother and professional talkingIf you are currently experiencing severe mental health problems or have experienced these in the past the Specialist Mother and Baby Mental Health service offers specialist short-term treatment to support your recovery during pregnancy and after birth.

Pregnancy, birth and mental health

Having a baby is a time of change.  You may experience a mixture of emotions and have greater mental health needs during this time.  If you’ve previously experienced severe mental illness this may increase your risk during and after pregnancy. Sudden changes in mental state in late pregnancy, or after birth, should be taken seriously and advice sought from a health care professional.

Who is the service for?

This service is for you if you have a history of or current severe mental health problems, and you’re considering having a baby, are pregnant or have a baby under the age of one. You will also need to be registered with a GP in the Bradford, Airedale, Wharfedale or Craven area.

We work with you, your family and other agencies to support your recovery.

Available Monday to Friday 9.00am to 5.00pm.

Please get in touch with a supporting health professional, i.e. your GP, midwife, health visitor, if for example you have:

  • bipolar disorder
  • post-partum psychosis
  • schizophrenia, schizoaffective disorder
  • depression or anxiety
  • obsessive compulsive disorder
  • panic disorders
  • birth related post-traumatic stress disorder
  • eating disorders
  • personality disorders
  • severe fear of pregnancy and childbirth

Do talk to them about how you’re feeling; they can refer you to mental health services and from there it may be identified that you will benefit from the specialist support and advice that this team offers.

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

Who’s in the team?

We have a range of professionals working in the team including Perinatal mental health nurses, nursery nurses, a perinatal consultant psychiatrist, an occupational therapist, a psychological therapist and a parent infant therapist. We also work closely with all healthcare professionals involved in your care.

How long will I have to wait for an appointment?

We aim to contact you within two weeks of referral. We  may contact you by telephone and we provide  face-to face appointments in a variety of settings close to where you live, including home visits. You can bring someone with you to your appointment.

If you need urgent help, due to a mental health crisis, please contact First Response, Bradford’s crisis response service.

Partners and family members

Partners and family members can find it worrying and stressful when loved ones have mental health needs/concerns. We’ll do our best to support the whole family by assessing their needs and providing advice.

How can you access this service?  

You can ask to be referred by your GP, midwife, health visitor, mental health practitioner, First Response or another healthcare professional.  They’ll be happy to talk through any concerns about your wellbeing to see if this service is right for you.

To ensure you get the right care, you may be offered information about other psychological services that may better suit your needs.  Where appropriate, a joint assessment with another NHS mental health service may be offered to help you and your mental well-being.

Discharge

The Specialist Mother and Baby Mental Health Service provides care based on your particular mental health needs. However, the service can only work with you until your baby’s first birthday. If you still need help and support at this time we will refer you to the most appropriate services available.

What to do in a mental health crisis

If you’re in crisis you should call First Response, 01274 221181, to see how they can help.

If a woman in the perinatal period experiences any of the following please contact the First Response:

  • Recent significant change in mental state or emergence of new symptoms.
  • New thoughts or acts of violent self-harm or thoughts of suicide.
  • New and persistent feelings of guilt and failure as a mother or not wanting to look after the infant.

We provide advice and support for women 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 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
Leaflet for professionals

 Who is the service for?

We support women 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 has a first degree relative with bipolar disorder or postpartum psychosis, and/or the woman 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

Referral Process

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 experiencing a mental health crisis.

Please call the First Response team for an urgent assessment on telephone: 01274 221181

Red Flags

The following are ‘red flag’ signs for severe maternal illness and require urgent psychiatric assessment:

  • Recent significant change in mental state or emergence of new symptoms,
  • New thoughts or acts of violent self-harm,
  • New and persistent expressions of incompetency as a mother or estrangement from the infant.

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

Telephone 01274 251343. The team is available from 8.30am -12.30pm Mondays, Tuesdays, Wednesdays and Fridays and can provide general advice and advise on potential referrals.

Access and discharge

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

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

  • joint work for women 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

  • Women 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.
  • Women 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.
  • Women with a family history of post-partum psychosis, bipolar disorder, or other serious mental illness, particularly if requiring in-patient treatment.
  • Women 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 and referrers

Pre-conception advice is provided to women of child-bearing age who are at risk of developing significant mental health difficulties during pregnancy or postnatally and are considering a pregnancy.

Women can be advised on their individual risk of becoming unwell and management options if they are planning a pregnancy.

A clinic is held at the perinatal service at the BRI Maternity Unit. If demand exceeds our capacity some women may be referred to the Yorkshire and Humber Perinatal Outreach Service in Leeds. 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:

  • The woman’s individual risk of becoming unwell.
  • Which 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 to the woman will be sent to the referrer, GP, and other relevant professionals involved in the woman’s 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 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 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 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 when the woman is 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 perinatalspecialistt@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