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Perinatal Service

How our service can help you

The Perinatal Mental Health Team is a multidisciplinary mental health service for pregnant and postnatal women with severe and complex mental illness.

The team aims to prevent, detect and treat perinatal mental health problems. We work to improve the experience of pregnancy and the postpartum period for women and their families, as well as early life experiences for babies.

Women at risk of relapse in pregnancy and following delivery are assessed early in pregnancy to allow them time to consider the treatment and care options available. The Perinatal Mental Health Team works collaboratively with women, their families and other professionals to plan care during pregnancy and the early postpartum period.

The Perinatal Mental Health Teams work jointly with adult mental health services already providing care for a woman when she becomes pregnant. We work in partnership with maternity services, children and families’ social services, primary care and other Trust mental health services.

Our service consists of psychiatrists, psychologists, perinatal nurses, perinatal nursery nurses, midwives, occupational therapists and administrators. The service works with women who cannot be effectively managed in primary care.

Lambeth Perinatal Mental Health Team:
St Thomas’ Hospital
Call: 020 7188 6011

Southwark Perinatal Mental Health Team:
King’s College Hospital Call: 020 3299 3234

Lewisham Perinatal Mental Health Team:
University Hospital Lewisham Call: 020 3228 9354 or 020 3228 9358

Croydon Perinatal Mental Health Team:
Bethlem Royal Hospital
Call: 020 3228 0304

Mother and Baby Unit:
Bethlem Royal Hospital
Call: 020 3228 4265 or 020 3228 4255
Referrals: email mbunurses@slam.nhs.uk or submit through WebBeds at www.nhswebbeds.co.uk

  • Service Type: Adult Mental Health Services (National) Service Borough Covers: Lambeth Treatment type: Outpatient
  • Contact the service

    Site Location: Multiple sites Fax Number: 020 3299 3234
  • Disabled Access:

    Yes - inpatients

  • Address: Multiple sites,
  • Business Hours/Visiting Hours:

    09.00 to 21.00 hrs – inpatients

  • Other essential information

  • Conditions: Addictions, Anxiety, Attention deficit hyperactivity disorder (ADHD), Autism, Bipolar disorder, Body dysmorphic disorder (BDD), Childhood degenerative disorders, Conduct disorder, Dementia, Depression, Dissociative disorders, Eating disorders, Learning disabilities, Neuropsychiatry, Obsessive compulsive disorder (OCD), Perinatal disorders, Persistent physical symptoms, Personality disorders, Post-traumatic stress disorder (PTSD), Psychosexual, Psychosis, Self-harm

Interventions

  • Pre-birth planning with our patients and the professionals involved in their care
  • Pregnancy and preconception advice for women with complex mental health difficulties and medication concerns
  • Medication advice
  • Clinical and evidence-based psychological therapies for individuals, couples and the mother-infant relationship are offered within the service, including cognitive behaviour therapy (CBT), family therapy and video interaction guidance (VIG)
  • Nursery nurse intervention to support bonding and relationships with baby
  • Support for partners

Eligibility criteria

Women can be referred for preconception counselling, in pregnancy, or up to one year after birth. Referrals are essential for women with current or previous:

  • Bipolar affective disorder
  • Schizophrenia or schizoaffective disorder
  • Postpartum psychosis
  • Severe depression
  • Emotionally unstable personality disorder
  • Other psychotic illness
  • Family history of postpartum psychosis

These women should be referred even if they are currently well.

Referrals are also accepted for women with other moderate to severe complex mental illness such as post-traumatic stress disorder (PTSD), eating disorders and obsessive compulsive disorder (OCD).

If a woman is already under the care of a community mental health team (CMHT) she should still be referred. The Perinatal Mental Health Team will work jointly with the CMHT.

In-patient Mother and Baby Unit (MBU)

Current or new episodes of moderate to severe mental illness during the last trimester of pregnancy and in the first year following the baby’s birth including:

  • Post-partum psychosis
  • Bipolar affective disorder
  • Schizo-affective disorder
  • Psychotic illness including schizophrenia
  • Severe depressive illness
  • Severe anxiety-based disorders including panic disorder, tokophobia
  • OCD and new onset maternal OCD
  • PTSD
  • Women experiencing severe emotional instability
  • Personality disorder

Exclusion criteria

  • The MBU does not accept referrals for young women under the age of 18 although will work collaboratively with CAMHS services as required
  • The MBU does not accept referrals for women who have a primary diagnosis of substance misuse or whom are currently using drugs or alcohol
  • The MBU does not accept referrals for women who have a significant forensic history, including violence and aggression towards others, fire setting, damage to property
  • The MBU does not accept referrals for women with a severe learning disability although will work collaboratively with learning disability services as required
  • The MBU does not accept referrals for women whose babies are over the age of one year

Outcomes

  • To provide specialist medical, nursing, psychological and social care over the four community pathways
  • To respond in a timely manner to emergency requests for assessment and advice
  • Monitor the mental health of patients who have been assessed as being at risk of developing a serious mental illness in the perinatal period, and assist in the development of proactive management plans
  • Provide psychological assessment and therapy for mental health problems occurring during the perinatal period. This potentially covers the whole range of adult mental health disorders including depression (including post-natal depression), anxiety disorders such as tokophobia, panic disorder, generalised anxiety, obsessive-compulsive disorder, or post-traumatic stress (including birth trauma), psychosis (including post-partum psychosis) and personality disorder. Consistent with NICE guidelines, the majority of treatment is from a cognitive behavioural perspective, although other theoretical orientations are also drawn upon
  • Pre-birth perinatal mental health plans should be developed with the pregnant women, partner and professionals involved in her care at 28 to 32 weeks’ gestation
  • To achieve the earliest resolution of the maternal mental illness whilst promoting the care and developing relationship with the infant
  • To assess and proactively manage high risk women with a prior history of serious mental illness to prevent avoidable recurrences in pregnancy and the postpartum period
  • Provide appropriate information to women, their partners and families
  • Monitor, support and provide care for mothers discharged from mother and baby units
  • A perinatal psychiatric liaison consultation service to primary care, maternity, mental health and other involved services. The main function of this service is to advise and assist in the identification, assessment and treatment/management of pregnant and postpartum women with a current or previous serious mental illness and to promote early planning, intervention and treatment

Mother and Baby Unit (MBU)

  • Wherever possible, to ensure that women who are presenting with severe mental illness in the last trimester of pregnancy or during their first year post birth who are unable to be safely and appropriately cared for in the community are admitted to a MBU in order for them to receive care and treatment while they are with their baby
  • Wherever possible, mothers referred to the MBU will be cared for with their baby
  • Mothers admitted to the MBU will be assessed at the point of admission and will then receive on-going assessment and review. Care will be planned collaboratively with the mother, members of her family as appropriate (with the mother’s consent) and members of the multi-disciplinary team. Care plans will be reviewed regularly and updated as required
  • A thorough risk assessment is undertaken of all mothers admitted to the MBU in order to plan care that will address any risks identified, this may include a mother being placed on enhanced nursing observations for periods of time
  • Babies who accompany their mothers to the MBU are considered as guests. As well as observations for mental state, a mother will also be assessed regarding the level of support and supervision that she requires with baby care and will be placed on the most appropriate baby care level of observation
  • All mothers admitted to the MBU will be allocated a primary nurse, an associate nurse and a nursery nurse on admission
  • Nursery nurses and member of the wider multidisciplinary team will support mothers to develop parenting skills as assessed to be necessary
  • All mothers admitted to the MBU will be offered a psychological assessment and an occupational therapy assessment within the first week of admission or at the earliest opportunity that the mother’s mental state allows
  • All mothers admitted to the ward will have access to a therapeutic timetable which will include group and individual sessions
  • The MBU will ensure that communication is maintained with the mother’s community professionals in order to plan their on-going care collaboratively. Community professionals will be invited to attend the weekly ward round as appropriate including CPA meetings.
  • If a mother is not previously known to mental health services prior to admission or does not have a care co-ordinator a referral will be made at the point of admission to ensure that collaborative planning for after care can begin as soon as possible

MBU environment

The MBU has 13 bedrooms. Bedrooms are not en-suite however there are several toilets, shower rooms and a bathroom for use by the mothers and older babies. 

The MBU has a communal nursery area, a communal dining area, a sleep room which is able to accommodate eight babies, a baby change area / bathroom, a milk kitchen for the preparation of baby’s feeds and a laundry room. The MBU also has an enclosed grassed garden area and a separate couryard garden. In order for visitors to access the MBU, their identity will be checked by staff on duty.

Care Options

Outpatient

Care option: Outpatient assessment

Description: Outpatient assessment is the initial appointment by a doctor or specialist perinatal mental health nurse. This takes place in the outpatient clinic. This allows the clinician to determine the most appropriate treatment for a patient. 

 

Care option: Outpatient treatment

Description: Outpatient treatment may include interventions focusing on the treatment and management of the mother’s mental health, relapse prevention work, safety management, occupational therapy, advice on parenting skills, the mother-infant relationship and advice about child care. 

This takes place in the outpatient clinic. 

The attending staff member may be a consultant psychiatrist, perinatal mental health nurse, psychologist, nursery nurse or occupational therapist as required. 

Outreach

Care option: Outreach assessment

Description: Outreach assessment is the initial appointment. This would most likely be by a specialist perinatal mental health nurse. This takes place in the community, outside of the outpatient clinic. Settings include the patient’s home or the antenatal or maternity wards. This allows the clinician to determine the most appropriate treatment for a patient. 

 

Care option: Outreach treatment

Description: Outreach treatment may include interventions focusing on the treatment and management of the mother’s mental health, relapse prevention work, safety management, occupational therapy, advice on parenting skills, the mother-infant relationship and advice about child care. 

This takes place in the community, outside of the outpatient clinic. Settings include the patient’s home or the antenatal or maternity wards. 

The attending staff member may be a consultant psychiatrist, perinatal mental health nurse, psychologist, nursery nurse or occupational therapist as required. 

 

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