SHONA MCCANN SPECIALIST MIDWIFE INTEGRATING MATERNITY AND MENTAL

SHONA MCCANN SPECIALIST MIDWIFE INTEGRATING MATERNITY AND MENTAL HEALTH CARE – THE ROLE OF THE SPECIALIST MIDWIFE

Population Needs 6, 000 deliveries in Grampian each year of which 1, 000 are in Moray 20% of these women will have some form of Mental Health Need (1200) 12% will require some form of Mental Health Intervention (720)

Need for Specialist Service -Ensure rapid access to Mental Health services -Experienced in medication use during the antenatal and postnatal period. -Assessment of mother-infant interaction -Specialist Risk Assessment -Multi Agency liaison with child protection -Early Detection and Intervention for high risk mothers

Who is the Grampian Perinatal Team? Small team comprised of: - DR SELENA GLEADOW-WARE : Consultant Perinatal Psychiatrist - LESLEY FREWIN: Perinatal Psychiatric Nurse - SHONA MCCANN: Specialist Midwife in PMH - TRACEY SCORGIE: Midwife

We hold the following clinics: ABERDEEN MATERNITY HOSPITAL (AMH) -Twice weekly clinics by the Perinatal Psychiatrist and Perinatal Psychiatric Nurse -Weekly Specialist Midwife PMH clinic Outreach Specialist Midwife Peripheral Clinics -PETERHEAD Maternity Unit (twice monthly) -INVERURIE Medical Centre (monthly) -BUCKIE Seafield Hospital (monthly) -ELGIN Dr Grays Hospital (monthly)

Referral Screening and Triage Receive referrals from GP’s , Mental health and Maternity Services Screened according to our care pathways Able to offer routine appointments within 4 weeks If possible review in primary care prior to referral Don’t have capacity to see urgent referrals Recommend all women at risk of mental health problems/history of mental illness are screened at each maternity contact

Perinatal Psychiatry Outpatient Clinic Wednesday am and Thursday pm Provide assessment and advice on complex mental health needs including a history of current or previous serious mental illness such as: BIPOLAR AFFECTIVE DISORDER SCHIZOPHRENIA SCHIZOAFFECTIVE DISORDER SEVERE DEPRESSION Review and Advice given for: SEVERE ANXIETY/RECURRENT DEPRESSION OCD PERSONALITY DISORDER PTSD

Specialist Midwife Role Initially worked at clinic as a midwife with a special interest in PMH since January 2012 Saw gap in service Proposal put into Management Post created and commenced in September 2013.

Specialist Midwife Aims Improve Health Inequalites Reduce Stigma Early Intervention Reduce Waiting Times Clear Referral Pathways Improve awareness Link Person Support women fully in pregnancy Improve staff awareness and support staff

What was done? -Looked at other areas of the UK -Compiled new referral pathways -Recruited obstetrician with special interest in PMH -Training Needs Analysis -Developed a Perinatal Mental Health Forum -Monthly Specialist Midwife Statistics -Service User Feedback Questionnaires -Locally Accessible Midwife Clinics

Specialist Midwife in Perinatal Mental Health Assess and offer support to women affected by: Mild/Moderate emotional distress during pregnancy Mild/Moderate Anxiety and Depression Stillbirth/Early Foetal Demise Previous Traumatic Delivery Xetophobia/Needle Phobia/Tokophobia

What Impact has the role had? - Referrals have increased - Examples of Good Practice - Locally Based Support - Improved Communication - Good Collaborative Working

Specialist Midwife Statistics 2016 DIAGNOSIS TOTAL CONSULTATIONS - 385 Depressive Episode - 181 Needle Phobia - 8 Anxiety – 51 Xetophobia - 5 Dysthymia - 46 Primary Tokophobia - 4 Previous PND - 24 Previous Stillbirth - 2 Adjustment Disorder - 15 Personality Disorder - 1 G. A. D - 13 Anorexia Nervosa - 1 Recurrent Depressive Disorder - 13 Bulimia - 1 Previous Traumatic Delivery - 10 Schizophrenia - 1 ANTI-DEPRESSANTS - 108 PSYCH INPUT - 30

Service User Feedback “If it wasn’t for this service I would have taken my life, my unborn child’s and my 3 year old son as I was so consumed by negative thoughts, and the only thing stopping me committing suicide was leaving my son behind, which was why I decided to take him with me too. So thankful for the help and support – its a necessity and I owe my mind and my family to this service”. .

Service user feedback continued. . . “ It has been hard to be emotionally strong through my second pregnancy following the stillbirth of my first child. Sessions with Shona helped greatly, especially to talk with someone with so much experience in this area”. . . . “She understood and made me feel like I was not alone. A great support”. . . .

Future Development of Service -Develop a Regional Network across North East Scotland (Ongoing) -Antenatal Class Input -Birth plans specifying emotional needs -CBT Therapist/Psychologist -Specialist Health Visitor -Specialist Nursery Nurse

IT’S OKAY TO NOT BE OKAY!