There has been a lot of discussion about the patchiness of perinatal services across the UK: some areas have very good services and excellent Mother and Baby Units while others have little or no service to speak of.
Clare Dolman talks to psychiatrist Dr. Jenny Cooke, who has been trying to improve access to services in her area of East Sussex.
When Dr. Cooke became a higher trainee in psychiatry four years ago, she was surprised at the lack of specialist help for expectant mothers with mental health problems. ‘As a trainee psychiatrist we are allocated time to develop an area of specialist expertise and I was very interested in perinatal psychiatry’, she says. ‘Fortunately, the local Mental Health Commissioning lead was a GP who shared my interest so we undertook some research to find out what the current clinical pathways were for women with psychiatric needs in the perinatal period. We talked to all local professionals – psychiatrists, midwives, health visitors and community psychiatric nurses – about where they refer in to services and what the problems were’.
She found many gaps. ‘Many professionals didn’t know how to refer women on, the system was very unwieldy and complicated, and even if a woman got referred to a psychiatrist, he or she often didn’t have any specialist training in perinatal treatment. It was really hit and miss’.
‘I discovered that one of the obstetricians who had an interest in mental health had set up her own clinic for midwives to refer into but she was a bit overwhelmed so in my ‘Special Interest’ time, I started helping her. It was only one morning every fortnight and sometimes we were seeing women with minor anxiety whereas women with bipolar disorder or schizophrenia who had been well for some time and so been discharged from the system but were now pregnant and so at high risk of illness, were being missed’.
Dr. Cooke could also only see women antenatally so it was impossible to have continuity: ‘We had to think about how we could improve the care pathway so we got a steering group together and are working with local mental health and maternity commissioners who see that this is a priority. We’ve improved the Midwives’ Booking Form, and we’re hoping to provide some mental health training for them so that they can recognize the women who are at greatest risk even if they appear well. Funding for my time has been doubled to one morning per week for up to a year, which will allow psychiatrists, health visitors and GPs to refer in directly’, she says.
If women do suffer from a severe postpartum illness, there is no NHS-provided Mother and Baby Unit for them to go to: they have to be sent to a private unit in Eastbourne, which is difficult to refer into and so not used as much as it could be.
Dr. Cooke is keen to see the perinatal clinic go on developing: ‘At the moment we can’t of course respond to emergencies and, as demand grows, one morning a week will not be enough to see everyone. I am hoping we might be able to have a psychiatric nurse linked to the clinic to be a more regular point of contact, and who can visit those women in the community who can’t make it into the clinic for whatever reason’.
She supports APP’s campaign to impress upon funding bodies that good perinatal care should be a priority as it not only helps to keep mothers well and give children the best possible start in life but, if seen in terms of preventing lengthy hospital or MBU admissions, it can also prove cost-effective in the long run. ‘Our local commissioners have been very supportive but, as we all know, funding is very stretched at the moment, and so we have to be hopeful that the importance of this service is recognized’, says Dr. Cooke.
She feels it is important for both clinicians and NHS consumers around the UK to do what they can to bring this to the attention of their local commissioners. ‘We have had the NICE guidelines since 2007 saying that we should be providing these services but in so many areas of the country they don’t exist, ‘ she says. Perhaps it will take local campaigning from enthusiastic health professionals like Jennifer Cooke, supported by charities such as APP and the newly-formed Maternal Mental Health Alliance, to get more of them in place.