Maternal Mental Illness What can we do Dr

Maternal Mental Illness What can we do? Dr Andrew Mayers amayers@bournemouth. ac. uk

Perinatal Mental Illness § Focus on improving attachment § Looking for signs § Signposting - systems and support § NHS § Charities § Support groups § Social media § Campaigns § Training 2

Perinatal Mental Illness § What does perinatal mean? § Covers pregnancy and (typically) 1 st year after birth § § Antenatal depression relatively under-researched Mums AND dads § Dads can get ‘perinatal mental illness’ too § § Less well-researched A few support groups (e. g. Fathers Reaching Out – see later) § Coping with partner/spouse mental illness § Dads can develop symptoms independently § Causes for dads often relate to ‘changes’ § Income, relationship, responsibility, emotions, dynamics… § Managing expectations 3

Importance of maternal bond § § We saw this slide earlier – but worth revisiting… § Early mother–infant bond may have sig. impact on developing infant (e. g. Bowlby, 1953; Ainsworth, 1993) Infant’s internal working model (IWM) is very important § Expectations about themselves in relation to others § Model of self and of other If infant’s carer attends positively and responds to needs § Infant has positive IWM: § High self-worth, availability of others, resolution of crises Infant’s carer inconsistent response and attention § Infant’s has negative IWM: § Low or ambivalent self-worth, unavailable others, crises not resolved 4

Attachment – what can we do? § How well is mum bonding? § Does she maintain eye contact? § Is she comfortable with baby? § Does mum appear distressed about feeding and bonding? § Does baby appear distressed? § Be positive § Take care not criticise § Empathise and encourage § Praise and reinforce § Make mum feel good about herself § Don’t give too much advice 5

Looking for signs and risk factors § Vulnerability factors § Genetic vulnerability § Life stresses § Moving house, developmental or behavioural difficulties in other children, relationship breakdown… § § § Social support Experience of childhood Protective factors § Self-compassion § Mindfulness § Reflection and insight 6

Signposting to services § GP surgeries § Specialist midwife team § Mother-and-baby unit (MBU: if your area has one!) § Charities and support groups § PANDAS § Fathers Reaching Out § Action on Postpartum Psychosis (APP) § Maternal OCD § Local/specialist charities and groups 7

PANDAS § http: //www. pandasfoundation. org. uk/ § Twitter: @Pandas_uk § Facebook: https: //www. facebook. com/PANDASFoundation? fref=ts 8

PANDAS § National charity supporting all perinatal mental health § Mums, dads, and families § Especially antenatal and postnatal depression § Support groups across UK § Telephone support line § E-mail support group § Campaigns § Information § Sign-posting 9

Action on Postpartum Psychosis (APP) § http: //www. app-network. org/ § Twitter: @Action. On. PP § Facebook: https: //www. facebook. com/Action. On. PP? fref=ts 10

APP § National charity offering specialist support § Postpartum psychosis & bipolar disorders § Information and education § For women, their families & health professionals § National events & workshops § Signposting to resources or support § Secure and confidential online peer-support § For women and partners § Specialist advice (via panel of experts) § Free referral to specialist second opinion psychiatry service § Research 11

Maternal OCD § http: //www. maternalocd. org/ § Twitter: @maternalocd 12

Maternal OCD § National charity offering specialist support § Specifically focuses on Maternal OCD § Talks and presentations – education and advice § Service users § Professionals § Support for 'drop ins' § Interactive training workshops § Research § Currently working with C 4 to make documentary § See recruitment clip: https: //www. youtube. com/watch? v=Vcgh. Erj. T 5 GQ 13

Social media § § § Great way to get message out § Support for service users and families § Promote information § Campaign § Tackle discrimination § Encourage talk Examples § #PNDHour § Wednesday 8 -9 pm § #Bumpsandmumsocdhr § Monday 7 -8 pm § #APPchat – restarting very soon Follow me @Dr. Andy. Mayers to see more about how we support 14

Raising awareness - campaigns § § Do you know where the local MBUs are? How many areas of UK have specialist community teams? § Those that are ‘accredited’ to RCPsych standards § How much does perinatal mental illness cost the UK? § How much does UK Government need to spend to put it right? 15

Campaigns § Maternal Mental Health Alliance http: //maternalmentalhealthalliance. org. uk/ § Coalition of 60 national charities, groups and Royal Colleges § Everyone’s Business campaign http: //everyonesbusiness. org. uk/ § Every mother has access to proper MH services across UK § Major milestones § Mapping of perinatal mental health services – July 2014 § Less than 1/6 th of UK has sufficient services § See - http: //everyonesbusiness. org. uk/? page_id=349 § Economic impact of perinatal mental health – Oct 2014 § Long-term costs £ 8. 1 b per one-year cohort births § Perinatal depression, anxiety, psychosis § £ 335 m investment (only) to deliver services needed to address this § See – http: //everyonesbusiness. org. uk/? p=742 16

Campaigns § Everyone’s Business – who needs to know this? § National Government – Department of Health § § § We launched economic report in Parliament Oct 21 Need long-term financial commitment Local government, MPs and Clinical Commissioners § I have been in touch with all Dorset MPs § These are vital issues for constituents § I am leading plans with local councils (esp. Dorset CC) § Contacting all Clinical Commissioning Groups § They spend the NHS money allocated by Government 17

MMHA goes to Parliament 18

Campaigns § Perinatal Mental Health Partnership § Collaboration of local groups, service users and experts § Local charity leaders, GPs, midwives, health visitors, campaigners, people with lived experience § Working ‘bottom-up’ to influence change § Develop materials for ‘birthing packs’ § Training health professionals § Informing local and national media § Campaigning and raising awareness § We have just had first steering meeting § Watch this space! 19

Training § Maternal Mental Health Alliance campaigning for ALL health professionals to get training § § Midwives, health visitors, antenatal/birthing nurses, obstetricians, occupational therapists… Some prof bodies (Royal Colleges, etc. ) running some courses § Other centres running additional training § § § Pre- and post-registration I am doing some right now! Content § § Diagnosis, symptom recognition, warning signs, risk factors, medication safety, treatment and therapy options, support groups, service user and family education Mental Health First Aid 20

What next § § § More campaign work through national groups § Maternal Mental Health Alliance § Perinatal Mental Health Partnership Research § Working my BU team – academics and students § Links to charities and those they support § Bournemouth perinatal mother and baby unit Training § Health professionals § Existing health visitor courses § Start new courses at BU § HVs, midwives, GPs, obstetricians… § PGDip Health Visitors – training post-qualification students 21

What have we learned § Focus on improving attachment § Looking for signs § Signposting - systems and support § NHS § Charities § Support groups § Social media § Campaigns § Training 22