Mental Health Summit 7 June 2016 Presentation 5 by Dr Alain Gregoire
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Transcript of Mental Health Summit 7 June 2016 Presentation 5 by Dr Alain Gregoire
Working together to improve the lives of mothers and their infants in Wessex
Dr Alain GrégoireConsultant/Hon. Senior Lecturer in Perinatal Psychiatry, Southampton
Chair, UK Maternal Mental Health Alliance
I can announce today a £290 million investment by 2020, which will mean that at
least 30,000 more women each year will have access to
evidence-based, specialist mental health care during or
after pregnancy.
Why perinatal MH?Clear evidence of individual needsClear evidence of economic and social needClear evidence of investment for NHS,
public purse and societyClear and consistent NICE and scientific
evidence baseSuccessful models for delivery of careQuality standards & assurance systemActive and consistent support from all
stakeholders
0%
2%
4%
6%
8%
10%
12%
14%
maj
or dep
ress
ion
hyper
tensi
onPPH
prete
rm
diabet
es
precl
ampsi
aIU
GR
place
ntal a
bruptio
n
Depressive illness: the most common major complication of maternity
Global Burden of Disease: DALYs (life years lost through death or illness) for women aged 15–44
WHO, 2008
Highest ever risk of psychosis
Ad
mis
sio
ns
Weeks before Weeks after
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
Birth
Puerperal psychosis: more rapid onset, more severe, and higher risk than at any other time (Oates, 1996; Appleby et al 1998)
Kendell, 1987
The combined effects of raised anxiety (or depression) both antenatally (32 weeks) and postnatally (33months) on child outcome up to 13 years
O’Donnell et al 2014
Children depressed at 16 all had mothers who were depressed, mainly during pregnancy No maternal depression No children depressed at 16
0
10
20
30
40
50
60
70
% o
f ad
ole
sce
nt
off
spri
ng
Never In utero 1st year Earlychildhood
Middlechildhood
Adolescence
When mother first depressed
Depressedadolescents
Welladolescents
Pawlby et al 2009
More than 1 in 10 women develop a mental illness during pregnancy or the first year after having a baby
7 in 10 women hide or underplay the severity of their illness
Delivery episodes with identified MH problem
Source: Hospital Episode Statistics, Health and Social Care Information Centre
Postnatal depression care(Gavin et al in press)
40%
24%
10%3%
0%
20%
40%
60%
80%
100%
Prevalent PNDCases
RecognizedClinically
AnyTreatment AdequateTreatment
AchievedRemission
Simplified Perinatal MH Pathway
Support from GP, HV and MW, plan continued close monitoring in the
early postnatal period. Obtain specialist advice as necessary.
Other agenciesTalking
therapies
GP assessment for medication and talking therapies & continued
support from GP, HV and MW
Pe
rina
tal t
ele
ph
on
e a
dvi
sory
se
rvic
e t
o
pro
fess
ion
als
Specialised perinatal
care pathways:Bipolar disorderSchizophrenia
Complex PTSDDepression
AnxietyOCD
Support from GP, HV and MW
History of mental illness and current mental health assessed at first contact
and booking
Coping with daily living problems
Pe
rina
tal t
riage
an
d a
sse
ssm
en
t p
roce
ss
History of possible severe mental illness or current severe illness,
identified by any service
If persists or worsens
Current severe illness
Current moderate illness
Current mild illness
If persists or worsens
Routine antenatal care Mental health care
Perinatal specialist inpatient
care (mother
and baby unit)
Any positive responses to questions (communicate for
information)Communicate for information
Routine postnatal care
Q
Maternity services
GP, primary care, IAPT
General adult MH services
Perinatal MH services
3rd sector
NB! At every stage assess and
enhance mother-infant relationship
Economic costs if we continue as we are(LSE & Centre for Mental Health, 2014)
Cost if we don’t act
£8.1bn£337m
Cost of taking action
7 Guiding Principles of the NHS(NHS Constitution 2011)
and perinatal mental illness in most of the UK
1. NOT comprehensive
2. NOT based on clinical need
3. NOT providing highest standards
4. NOT listening to patients
5. NOT working across boundaries
6. NOT providing best value
7. NOT accountable
Specialist Perinatal Community Services: 2004-15
0
5
10
15
20
25
30
35
40
45
2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
1 professional
2 professionals
full team
Parity with specialist physical health care in maternity
• UK maternity care = £2800/woman• Specialist perinatal mental health across the UK
= £67/woman
• Total NHS maternity budget £2.6bn• Cost of 60 more MBU beds = £6m (0.23% of
maternity costs)
(Costs if we stay as we are = £8.1bn)
5YFV, Future in Mind, Better Births
• Clear pathway across all services, within waiting time standards
• Specialist community perinatal mental health teams meeting national quality standards/accreditation
• Access to therapy, including parent-infant therapy and C-PTSD/PD within waiting time standards
• Mental health in maternity and health visiting • Specialist Mental Health Midwives and
Health Visitors
What are they doing about it?• Ministerial commitment• Funding• HEE Mandate: training & workforce• Future in Mind, 5YFV, Better Births• NHSE Transformation Board• National Clinical Directors• MMHA: Professional Bodies; 3rd Sector;
Everyone’s Business; Lottery Toolkit development; scrutiny; quality improvement
• Wessex PMH Network
5YFV, Future in Mind, Better Births: Wessex Commissioners (CCGs/LAs)2016/17 (NOW): •Contracts for maternity, health visiting, general adult MH, liaison, IAPT to specify national/regional quality and waiting time standards for perinatal careBY 2018:•Specialist community perinatal mental health teams meeting national quality standards/accreditation•Access to therapy, including parent-infant therapy and C-PTSD/PD within waiting times
5YFV, Future in Mind, Better Births: Wessex providers (acute/MH/LAs)
2016/17 (NOW): •Maternity: appoint specialist perinatal MH midwives Health visiting: as above•General adult MH, liaison: prioritise therapy access to perinatal; valproate prescribing.•IAPT: Prioritise perinatal; training; tailored access and interventions•CAMHS: include parent-infant services in modernisation plans •All: agree pathways for identification, prevention and care; training and workforce