Emergency assessment – Birmingham Perinatal MH Service & Antenatal Liaison Clinics – NCCMH

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As part of its wider service offer, the Birmingham Perinatal Mental Health Service, in partnership with the Heart of England NHS Foundation Trust (HEFT), run antenatal mental health liaison clinics. These specialist perinatal clinics are provided for pregnant women with current or previous mental health problems.

Co-Production

  • From start: No
  • During process: Yes
  • In evaluation: No

Evaluation

  • Peer: Yes
  • Academic: Yes
  • PP Collaborative: No

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Emergency assessment – Birmingham Perinatal Mental Health Service and Antenatal Liaison Clinics

As part of its wider service offer, the Birmingham Perinatal Mental Health Service, in partnership with the Heart of England NHS Foundation Trust (HEFT), run antenatal mental health liaison clinics. These specialist perinatal clinics are provided for pregnant women with current or previous mental health problems.

The service demonstrates positive practice in their delivery of care in line with the Antenatal and Postnatal Mental Health NICE quality standard and Perinatal Mental Health Care Pathways. This includes:

  • meeting the recommended response time for Pathway 3. All women should receive an initial response within 1 hour of the referral to the service and within 4 hours a woman should:

(a)     have had a biopsychosocial assessment; and

(b)     have an urgent and emergency mental health care plan in place and as a minimum be en route to their next location if geographically different, or have started the referral process for admission for a mother and baby unit, or have been accepted and scheduled for intensive follow-up care at home or by the specialist community perinatal mental health team; or

(c)     have immediate access to care and support if she is waiting for an admission to a mother and baby unit; or

(d)     have started assessment under the Mental Health Act.

  • providing a comprehensive mental health assessment to women with a suspected mental health problem in pregnancy or the postnatal period should, in line with NICE quality statement 5.
  • providing specialist perinatal mental health services and access to inpatient psychiatric mother and baby units, as well as available support for women with a mental health problem in pregnancy or the postnatal period, in line with NICE quality statement 7.

The HEFT clinics are liaising with the HEFT rapid assessment interface and discharge (RAID) team to identify woman who are at high risk of mental health crisis or postpartum psychosis. To help the service achieve this:

  • there is high awareness of the risk of developing postpartum psychosis, by the woman, her family and all healthcare professionals involved
  • a care plan (which incorporates a crisis plan) is put in place by the antenatal mental health liaison clinic, as well as a plan for how to access routine advice should any concerns be noted
  • RAID liaises with social services, maternity teams, home treatment teams and the Birmingham Perinatal Mental Health Service
  • the well-developed, strong links between the clinics have reduced admissions to mother and baby units and enabled more women to be managed successfully in the community.

Referrals

Referrals are received in two ways:

  • The HEFT antenatal mental health liaison clinic receives routine referrals from community midwives and primary care services during pregnancy
  • The RAID team receives urgent direct referrals from the emergency department and maternity units via single point of access; patients are assessed within 4 hours from the point of referral by a team of psychiatric nurses, clinical psychologists and consultant psychiatrists.

Interventions

The Birmingham Perinatal Mental Health Service antenatal mental health liaison clinics at HEFT provide a number of services, including:

  • comprehensive mental health assessment with the development of co-produced, robust care management plans for women identified as being at high risk of developing postpartum psychosis (this takes place in the antenatal maternity department, as part of routine maternity care)
  • liaison with all professionals involved, ensuring that they are aware of the risk and the plan to manage this risk
  • identification and management of women at high risk of relapse; information and advice about medication is given to help to manage this risk
  • before delivery, women and their families are offered visits to the local inpatient mother and baby unit.

Monitoring and measurement of outcomes

Outcome measures are currently under review.

Workforce and staff training

Workforce

(WTE hours and roles)

 ·  a perinatal psychiatrist (1 x 0.4 whole time equivalent [WTE])

·  a perinatal community psychiatric nurse (1 x 0.4 WTE)

·  administrative staff (2 x 0. 5 WTE)

·  closely working with Specialist Midwives for Mental Health (2.2 WTE)

The above workforce is for HEFT antenatal mental health liaison clinics only (in addition the team has access to a fully-staffed RAID team).
Note: HEFT = Heart of England NHS Foundation Trust; RAID = Rapid Assessment, Interface and Discharge; WTE = whole time equivalent.

The service provides staff training. Junior medics, student nurses and student midwives frequently shadow its clinics.

Contact details

Provider: Birmingham and Solihull Mental Health NHS Foundation Trust

Commissioner: Heart of England NHS Foundation Trust

 

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