Agenda item

PERINATAL MENTAL HEALTH SERVICE UPDATE (OXLEAS)

Minutes:

Adrian Dorney, Associate Director – Oxleas NHS Foundation Trust (“Associate Director”), Dr Sushma Sundaresh, Consultant Perinatal Psychiatrist and Clinical Lead – Oxleas NHS Foundation Trust (“Consultant Perinatal Psychiatrist and Clinical Lead”) and Sarah Hooton, Perinatal Team Manager – Oxleas NHS Foundation Trust (“Perinatal Team Manager”) provided an update in relation to Perinatal Health Services.

 

Since 2014, there had been an evident need to prioritise perinatal mental health. A small service had been provided from 2016, and Oxleas NHS Foundation Trust had applied for NHS England funding to develop the service they provided today. When this service went live on the 28th February 2019, it had turned the map of London green, indicating that all women had access to a perinatal service. Almost a quarter of women who died between six weeks and one year after pregnancy died from mental health related causes, with one in seven women dying by suicide. A report on the costs of perinatal mental health problems had found that the known costs per year’s births in the UK totalled £8.1 billion. Of these costs, 28% related to the mother, and 78% related to the child. Up to 20% of women developed a mental health problem during pregnancy, or within a year of giving birth, however women in around half of the UK had no access to specialist perinatal mental health services.

 

The Oxleas Perinatal Mental Health Team was a multi-disciplinary mental health service for pregnant and postnatal women with severe and complex mental illness. The aim of the Perinatal Mental Health Team was to detect, prevent and treat perinatal mental health problems. The team saw women who were residents, or registered at GPs, in the London Boroughs of Bexley, Bromley and Greenwich. The service had adopted a ‘hub and spoke’ model, and the team was based at Queen Mary’s Hospital, Sidcup. The service had external interfaces with three local maternity sites (two within the borough and one in a neighbouring borough), one health visiting service provider, two Improving Access to Psychological Therapies (IAPT) providers, and three Local Authorities. Internally, the service had interfaces with two health visiting services, one IAPT service, two Mental Health Liaison services, three Home Treatment / Crisis Teams and nine Community Mental Health Teams. The large number of interfaces highlighted that it was vital for there to be good communication between the services.

 

The service continued to work closely with third sector organisations through various co-produced activities which included: a Mind support worker / Mindful Mums group; a co-facilitated group with Mums Aid (Greenwich); Maternal Journal; and resilience intervention for fathers which was CCG led. There was also involvement from women with live experience in the form of focus groups, recruitment, publications, implementation groups and overall service development. In response to a question, the Consultant Perinatal Psychiatrist and Clinical Lead said that through the Trust’s work with Mind there was buddy model and peer support group for patients in Bromley. The Perinatal Team Manager noted that there was also a Perinatal Forum, which allowed them to identify best practice from other boroughs.

 

The team saw women with a number of mental health problems including Bipolar Affective Disorder, Schizophrenia / Schizoaffective disorder, previous Postpartum Psychosis, severe depression, other psychotic illness and those with a family history of Postpartum Psychosis. It was noted that partners were asked to refer these women, even if they were currently well. In response to a question, the Consultant Perinatal Psychiatrist and Clinical Lead said that between 10% and 15% of the women they saw had pre-existing conditions. Other care co-ordinators were being trained to recognise mental health problems, which would allow discussions to take place early on to keep the women well.

 

The team also saw women with severe or complex mental illness, such as Post Traumatic Stress Disorder, Obsessive Compulsive Disorder, eating disorders and personality disorder, and also provided pre-conception advice to women with severe mental illness. Women under 18 years old could be referred if perinatal mental illness dominated the clinical picture. These women were also referred to Child and Adolescent Mental Health Services (CAMHS), and the Perinatal Mental Health Team would provide advice.

 

Feedback had been obtained at the time of discharge from twenty four patients, and the comments had been very positive and encouraging for staff. In response to a question, the Consultant Perinatal Psychiatrist and Clinical Lead said that in the first six months, the team had received 531 referrals. They had taken on 320 of these patients, and seen around 273.

 

Looking ahead, to consolidate the work that had been done a service evaluation would be carried out at the end of the first year. Work would also be undertaken in terms of the development, retention and wellbeing of the workforce – the team had increased from four to thirty two staff, and it was important that they all felt valued.

 

The Associate Director said that this was a “good news story” for Bromley, as it had been the good practice of the Bromley service that had been expanded across the Trust.

 

The Chairman thanked Adrian Dorney, Dr Sushma Sundaresh and Sarah Hooton for their excellent presentation, and wished the team well with their future work.

 

RESOLVED that the update be noted.