The RCGP Perinatal Mental Health position statement

Dr Judy Shakespeare, RCGP Clinical Champion for Perinatal Mental Health

The RCGP position statement on perinatal mental health was endorsed by RCGP Council in September 2016.

Perinatal mental illnesses (PMI) are the commonest complications of pregnancy, affecting around 15-20% of all pregnancies. Not all PMI is postnatal depression or even a single diagnosis, for example depression and anxiety are often co-morbid. Childbirth and new motherhood carries an expectation of happiness, but it is also a time of emotional upheaval and adjustment to changes in lifestyle and relationships. Mental illness at this time causes enormous distress and can seriously interfere with the adjustment to motherhood, the care of the newborn baby and relationships with existing children and a woman’s partner.

PMI has been a leading cause of maternal mortality for the last two decades. Over half of women who tragically die during this time have a previous history of severe mental illness and over half of the deaths are caused by suicide.

Many of the competencies required for GPs managing PMI are generic mental health competencies, but there are some significant differences e.g. prescribing in pregnancy and breastfeeding that require additional training.

The position statement recommends that every GP practice proactively develops positive working relationships with midwives and health visitors attached to the practice and ensures that attached community midwives can access information about the medical history of all pregnant women, either by direct access to the electronic record or by an established system of communication.

It also recommends that every GP should maintain and develop knowledge and skills in perinatal mental illness, knows the local pathway of care and local services and how to access the RCGP perinatal mental health toolkit to answer their general queries about PMI.

What are the Position Statement's key messages for GPs?

  • There are current NICE (1), SIGN (2) guidelines, and NICE Quality Standards (3) covering identification and management of PMI. However many of the recommendations are based on evidence from other countries, specialist research or consensus and there is a paucity of good evidence directly relevant to UK general practice.
  • Many women are reluctant to disclose PMI. However, if a woman does disclose problems this is a “red flag”; it is possible that she is unwell, and the GP should explore in detail before reassuring or normalising her feelings.
  • Treatment is usually effective, so that GPs should offer women hope of recovery.
  • Don’t just stop the pills if a woman with mental health problems becomes pregnant, there’s time to think and plan. You could always take advice.

References

1. National Institute for Health and Clinical Excellence (2014) Antenatal and postnatal mental health: The NICE Guideline on clinical management and service guidance. Available at: http://www.nice.org.uk/guidance/cg192
2. Scottish Intercollegiate Guidelines Network (2012) Sign 127: Management of Perinatal Mood Disorders. A national Clinical Guideline. Edinburgh: Scottish Intercollegiate Guidelines Network. http://www.sign.ac.uk/guidelines/fulltext/127/
3. National Institute for Health and Clinical Excellence. Antenatal and postnatal mental health NICE quality standard [QS115] https://www.nice.org.uk/guidance/qs115 

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