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Oxfordshire Integrated Maternal Mental Health Care Pathway Integrated Antenatal Mental Health Care Pathway for HV Guidance Much of the care given to pregnant women with mental health problems will follow the care pathway for healthy pregnant women developed in accordance with the NICE guidance. This additional pathway supplements the routine pathway and should be used in conjunction with individual professional groups guidelines MW/GP at 1st contact or booking use the Whooley questions to ask all women about their current mental health, past mental health and family history of serious mental illness. Give all women the leaflet ‘Antenatal and Postnatal Depression’ It is essential that there is liaison between MW/GP/HV to ensure all relevant information is made available. No history of mental health problems Mild/moderate mental health problems Continue with routine antenatal care with ongoing assessment of mental health. Discussion on PND at antenatal classes and provide information on support e.g. EI HUB*. Revisit PND leaflet at 36wks. Mental health problems treated with support/counselling or antidepressants from GP or facilitate self-referral to TS. Discuss support networks offer referral to EI HUB*. Ensure ongoing communication between GP/MW/HV. 28-34 weeks all parents offered Ante-natal Health Review HV Contact using Promotional Guide Framework. Whooley Question and GAD 2 to be asked and EPDS done if indicated. If significant low mood or anxiety identified refer to GP. General low mood/anxiety facilitate self-referral to Talking Space (can be stepped up to step 4 PTS where appropriate). If relating to pregnancy or motherhood consult with IPPS. Ensure ongoing communication between all services involved on A/N and P/N care plan. Offer CAF process and additional support (see supporting notes to care pathway). Significant/severe previous or current mental health problems GP/AMHT to refer to MW pregnant women on caseload or previously on caseload . GP/MW refer to specialised antenatal clinic for Consultant Obstetric care and to AMHT (see list) for assessment and initiation of pre-birth planning meeting as appropriate. A copy of the agreed care plan needs to be documented in client’s maternity electronic record. HV and MW to discuss care plan during liaison meetings and AMHT contact numbers. Ensure ongoing communication between AMHT with GP/MW/HV. Consider Social Care referral and CAF process. AMHT to invite MW/HV all involved parties to CPA. Visit as needed and ensure family have 24 hour contact numbers. AMHT to consider referral to Step 4 PTS where appropriate. If HV unclear of care plan can contact Public Health Midwives on 01865220113. If HV unclear of For sudden onset emergency (if unknown to AMH) please contact the GP, if out of hours ring 111. You can contact your locality AMHT for advise, they are available 7am – 9pm. There is a Night Assessment team available for out of hours on 01865 901 100. If physical harm has occurred refer to A&E. All professionals need to liaise and agree a plan of care accessible to all which must be documented in the woman’s maternity record. Version 7: 01 2016 Oxfordshire Integrated Maternal Mental Health Care Pathway Integrated Postnatal Mental Health Care Pathway From Birth to One Year for HV Guidance All Postnatal Women are assessed, using the Whooley questions, by HV during the P/N period about their feelings and mood. No or only Mild concerns about mental health Continue routine P/N care ensuring effective communication between maternity and Primary Care Services at transfer of care. HV to ask Whooley and GAD 2 questions at core Healthy Child Programme contacts EPDS assessment to be used if the client: Is taking medication for mental health or anxiety Has an open referral to adult mental health Has a history of mental health problems Universal contacts with parents New birth Review 6-8 week Review 3-4 month Review 8-12 month Review Whooley questions asked at: 6-8 weeks - GP post-natal examination 3-4 months - Practice nurse at immunisation Moderate concerns about mental health. Anxious or low mood identified Ongoing assessment from community MW and effective handover to HV team. Ensure ongoing communication between GP/MW/HV and involved partner agencies. Health visitors offer up to 6 active listening visits/therapeutic listening visits Referral to local therapeutic PND Wellbeing Group programme Consider additional support from partner agencies – EI HUB*, HomeStart… All families with parental mental health problems to be offered CAF EPDS where indicated and review Significant low mood or anxiety from birth to 1year: refer to GP and consider either IPPS or TS or PND group (HV) and ensure ongoing communication between GP/MW/HV on care plan. Problems bonding with baby: inform GP and consider referral to IPPS. Offer CAF process and additional support e.g. EI HUB* Significant/severe postnatal depression or presence of psychotic symptoms Maternity Inpatient: Call OUH Psychiatrist for sudden onset urgent/emergency assessment or out of hours Community If Unknown to Mental Health. Urgent referral to GP ( or 111 if out of hours), inform HV/community MW. GP will refer to AMHT where appropriate for urgent/emergency or Mental Health Act Assessment. Further advice if needed is available from locality AMHT. Continual HV assessment of family health needs. Multi-professional care plan. HV to consider CAF, safeguarding concerns. Safeguarding SOP and individual health plan for each child to be in place. If Known to Mental Health. Refer to local AMHT for urgent/emergency assessment or Mental Health Act Assessment. Care overseen by Consultant Psychiatrist and Care Coordinator. If necessary, admission should be to MBU, consider available alternatives if not possible. If physical harm has occurred send straight to A&E All professionals need to liaise and agree a plan of care which must be documented on the client’s record Version 7: 01 2016 Oxfordshire Integrated Maternal Mental Health Care Pathway AMH Adult Mental Health services AMHT Adult Mental Health Team (formerly known as Community Mental Health Team): Provides mental health assessments within 4 hours for emergency cases, 7 days for urgent and 28 days for routine. Teams are comprised of assessment and treatment functions. Where appropriate, assessment function can provide up to four assessments and treatment function can provide treatment and care coordination. CAF Common Assessment Framework: Early intervention tool for children who appear to need multi-agency involvement, helps to avoid children and families having to tell their stories to multiple agencies and develop a shared understanding of a child's needs with the family and other agencies to meet them more effectively. EI HUB Early Intervention Hub (* Children Centres til Sept 2016) EDPS Emergency Department Psychiatric Services EPDS Edinburgh Postnatal Depression Score FASS Family Assessment and Safe-guarding Service: Specialist multi-disciplinary service which provides mental health assessment and treatment to enable safeguarding. Provides child and parenting assessments in families with high risk of severe parenting problems, high risk of major parent/child relationship difficulties and/or attachment disorder. HV Health Visitor IPPS Infant Parent Perinatal Service: Offers treatments to women who are experiencing or at risk of moderate mental health difficulties (parent-infant relationship difficulties, depression and low mood, anxiety and panic attacks, PTSD, OCD, eating disorders). MBU MW Mother-baby Unit: Inpatient psychiatric facility for mother and baby. Beds MBUs are funded by NHS England. Mid-wife PH Public Health Version 7: 01 2016 Oxfordshire Integrated Maternal Mental Health Care Pathway H&S score Health and Social Care assessment (also known as “assessment of need”): Assesses individual needs such as healthcare, equipment, home-help in order to create a package of care. Would be provided by midwifery department at OUH. PND Post-natal depression PTS Psychological Therapies Service (comprised of Talking Space and Step 4 Psychological Interventions) Step 4 PTS Psychological interventions for individuals with severe or complex mental illness or psychological distress. TS Talking Space: For mild/moderate depression or anxiety disorders. Offers Step 2 treatments (guided self-help by phone, psycho-education classes, computerised CBT) and Step 3 Treatments (individual and group treatments - CBT, IPT, Mindfulness). Adult Mental Health Team Contact Details. Please note: These numbers are for use if the women is an existing patient of the adult mental health team and not for new referrals. Please contact switch on 01865 901 000 if you need to speak with the Service Manager for AMHTs or experience any difficulty in getting through to the relevant AMHT. North AMHT City and NE Oxford AMHT South Oxon AMHT Team Manager: Tasmin Irving Community Lead: Angela Brown Team Manager: Catherine Sage Community Lead: Chris Morton Team Manager: Debbie Walton Community Lead: Julie Belfield Elms Centre Banbury Tel: 01865 902 563 Warneford Hospital Oxford Tel: 01865 902 200 Wallingford Community Hospital Wallingford Tel: 01865 904191 Version 7: 01 2016 Oxfordshire Integrated Maternal Mental Health Care Pathway Can provide assessment of Mental Health? Sees baby? Baby older Countywide? than 12 months? ✔ IPPS ✔ ✔ Talking Space Step 4 ✔ - ✔ ✔ ✔ - ✔ Adult Mental Health ✔ - Mother & Baby Unit Family Assessment & Safeguarding services ✔ ✔ Complex case/history of MH illness? ✔ High risk? Child Protection Plan? ✔ - Some cases - ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ Referral out of county ✔ ✔ ✔ ✔ ✔ ✔ ✔ Other? - Can provide advice on preventative treatment and management to GPs/MWs/HVs ✔ Support Groups and Helplines for clients and their family Local Children Centre’s Association for Postnatal Illness: http://www.apni.org Fathers Reaching Out: Web: www.fathersreachingout.uk MIND: Tel 02085192122 or mind infoline0845 www.mind.org.uk Netmums: Web: www.netmums.com Twitter - @PNDandMe #pndhour Twitter @dadsmatteruk Version 7: 01 2016 7660163 Web: Dads Matter UK www.dadsmatteruk.org Oxpip : 01865 778034 or www.oxpip.org.uk Relate: 0845 456 1310 Web www.relate.org.uk Rethink: advice line: 020 8974 6814, tel. 0845 456 0455 web: www.rethink.org Samaritans: helpline: 08457 90 90 90, textphone: 08457 90 91 92 web: www.samaritans.org Saneline : helpline : 0845 7678000