Devon Partnership Trust Perinatal Service provides community-based mental health support for women planning a pregnancy and during the perinatal period. The service is part of the Southwest Perinatal Clinical Network and consist of three teams working across maternity antenatal clinics and a team seeing women in children’s centres and antenatal clinics in, Plymouth. As well as strengthening working relationships with midwifery and obstetric teams, this means that woman can be seen in the same department for their mental and physical health.
Specialist assessment – Devon Partnership Trust Perinatal Service
Devon Partnership Trust Perinatal Service provides community-based mental health support for women planning a pregnancy and during the perinatal period. The service is part of the Southwest Perinatal Clinical Network and consist of three teams working across maternity antenatal clinics and a team seeing women in children’s centres and antenatal clinics in, Plymouth. As well as strengthening working relationships with midwifery and obstetric teams, this means that woman can be seen in the same department for their mental and physical health.
meeting the recommended response time for Pathway 2 with at least 50% of women having completed a biopsychosocial assessment, with an agreed care plan in place and have been allocated to a named professional within two weeks of referral and 95% of women within 6 weeks.
women referred to this service with suspected mental health problem in pregnancy or the postnatal period will receive a comprehensive mental health assessment in line with NICE quality statement 5.
the specialist multidisciplinary team will be available to support women with an existing mental health problem in pregnancy or the postnatal period, in line with NICE quality statement 7.
women’s emotional wellbeing is checked at each routine antenatal and postnatal contact, in line with NICE quality statement 4.
Referrals
The majority of referrals to the service are from midwives, with referrals also accepted from GPs, mental health practitioners, health visitors, obstetrician’s and self-referrals. Referrals are triaged weekly with three main outcomes:
a template letter with evidence-based information
a telephone consultation intervention, or
an assessment.
The service offers a robust prediction and detection pathway with midwives. In line with NICE guidance, women are routinely asked the Whooley questions for depression at their first booking.
Delivering NICE-recommended care
Comprehensive assessments
In line with Pathway 2 of the perinatal mental health care full implementation guidance, the service offers comprehensive assessments for woman during the perinatal period. This focuses on both the woman’s presenting problems, as well as her previous experiences of the postnatal period and mental health. Consideration is also given to attachment patterns between the woman and her unborn baby, a baby, or children; as well as her physical health. Where appropriate, onward referrals may be made (for example to the parent and infant specialist team, GP or a midwife). Women identified with complex prescribing needs are offered a routine assessment with the perinatal psychiatrist in collaboration with a pharmacist, to discuss the benefits and risks of the medication during a pregnancy or a breastfeeding stage.
As the service covers a partly rural population, appointment dates for assessment are usually set to coincide with physical health checks (such as obstetric appointments or scans). Women whose referrals flagged as a priority (current mental health relapse, risk, prescribing that requires a review) are seen within the recommended response time, with 50% seen within 2 weeks of a referral.
Interventions
Following assessments, the service offers a range of NICE-recommended interventions including access to psychological therapies via IAPT and secondary mental health.
Where a woman chooses not to engage with the service and there are significant mental health concerns, the team complete a professional-only (midwife, health visitor, GP, mental health community team) birth plan, which ensures a shared understanding of risk, mental health concerns, relapse indicators and relevant contacts.
Monitoring and measurement of outcomes
The Devon Partnership Trust Perinatal service monitors and record outcome measures via service’s own devised ‘service evaluation’ measure (PROM) and others, such as:
patient outcome and experience measure (PROM)
friends and family measure (PREM)
Health of the Nation Outcome Scale (HoNoS)
Workforce, staff training and supervision
Workforce
(WTE hours and roles)
The Devon Partnership Trust Perinatal service team is staffed by a team that consists of:
· perinatal psychiatrists (2 X 0.5 WTE)
· a perinatal service manager (1 X 1.0 WTE Band 8a)
· a perinatal clinical team leader (1 X 1.0 WTE Band 7)
· perinatal mental health practitioners ( 12 X 9.2 WTE)
· admin (6 X 5.5 WTE Band 1, Band 3, Band 4, Band 4.5)
Note: RAID = Rapid Assessment, Interface and Discharge; WTE = whole time equivalent.
All staff receive individually-tailored training, and regular management and clinical supervision. There is a safeguarding and parent–infant supervision every 6 weeks.
