Perinatal Mental Health Toolkit

Up to one in five women and one in ten men are affected by mental health problems during pregnancy and the first year after birth. Unfortunately, only 50% of these are diagnosed. Without appropriate treatment, the negative impact of mental health problems during the perinatal period is enormous and can have long-lasting consequences on not only women, but their partners and children too. However, this is not inevitable. When problems are diagnosed early and treatment offered promptly, these effects can be mitigated.

How can the Perinatal Mental Health Toolkit be used?

This toolkit is a set of relevant tools to assist members of the primary care team to deliver the highest quality care to women with mental health problems in the perinatal period. As well as offering a diverse collection of resources, the Perinatal Mental Health Toolkit gives details of additional learning for individual practitioners.

GPs: please share your opinion on perinatal mental health resources. Take our 5 min survey.

Please send any comments or suggestions to circ@rcgp.org.uk. Any agreed updates will be made on a routine basis, unless immediately necessary for factual reasons.

Clinical resources for professionals

The following resources offer information on presentation, diagnosis and treatment both with medication as well as psychological treatment. There is significant geographical variation in the provision of specialist perinatal mental health services across the UK and it is important GPs know where to access further information.

Top tips

The importance of perinatal mental health

Guidelines

Tommy’s Charity have developed a wellbeing plan to help women plan for a health pregnancy and birth.

Resources for practice waiting rooms

Medication in pregnancy and breastfeeding

The decision to use medication to treat a mental health problem during the perinatal period is a complex one and individual to each woman. Clinicians should be able to help women make an informed decision and the following resources may be assist them to do so.

Further information on psychological treatments

Quality Improvement

To access shared learning networks to assist you in applying practical QI methodologies to better treat this clinical area, join our QI Ready platform.

Managing suicide risk, safeguarding, and intimate partner violence

Safeguarding principles underpin the work of all health care professionals who care for women and their families in the perinatal period. GPs should be confident and competent in knowing when to refer cases to third parties.

Managing suicide risk

Safeguarding

Intimate partner violence

Sexual violence

Resources for women and their families

This section contains websites, information leaflets, media and literature recommendations that health care professionals can direct women and their families towards to assist with the understanding of Perinatal Mental Health problems. It also provides links to social support organizations for families and self-help resources, including novel social media approaches.


Internet resources for perinatal mental health

Information leaflets for perinatal mental health

Resources aimed at partners and carers

Self-care resources for perinatal mental health

Community and social support for perinatal mental health

  • Home-Start Charity Practical support and friendship for families with young children.
  • Family Action Practical, emotional and financial support to those experiencing poverty, disadvantage and social isolation across England. Self care resources, also offering peer support services.
  • Action for Children offering support for families, help on fostering, adoption, children in care and disabled children.
  • Gingerbread Advice, information and practical support for single parents.
  • MumsAid free evidenced based counselling with creche support for women during pregnancy and in the two year postnatal period as well as a service for teen mums YoungMumsAid for 16-19 year olds
  • NHS Choices Teenage. Pregnancy Support  
  • Family Nurse Partnership A voluntary NHS programme for first time young mothers, aged 19 years or under. A specially trained family nurse visits from early pregnancy until the child is two, working in partnership with the mother to optimize outcomes for the new family.
  • Cry-Sis Support for parents of babies with challenging behaviour, excessive crying and sleeplessness.
  • Birth Companions London charity providing support to vulnerable pregnant women and new mothers who are, have been or are at risk of being detained.
  • Aware NI Charity supporting people with mental health problems in Northern Ireland.

Peer support and online support

Social media and digital technology support for perinatal mental health

The following are examples of social media and digital technology that women may find supportive.  The RCGP cannot take responsibility for social media content and health professionals are advised to cautiously assess their suitability for individual patients.

  • NHS Start for Life Information Service Weekly emails texts and videos from the to support families from pregnancy and infancy
  • Baby Buddy App for Smart Phone An award winning app developed by the charity Best Beginnings which includes videos, information and updates about the user’s pregnancy and postnatal journey.
  • PNDandMe A peer support Twitter network for perinatal mental health run by Rosey who has lived experience. Rosey can be followed on Twitter @PNDandMe, and has a website with information. A weekly ‘Twitter chat’ (Wednesdays at 8-9pm) can be followed using #PNDHour. #PNDChat and #PNDFamily can also be used to view related tweets.
  • BirthTraumaChat A peer support Twitter network dealing with birth trauma and PTSD run by Emma Jane Sasaru and Susanne Remic. Emma @unfoldURwings and Susanne @maternitymattrs host #BirthTraumaChat weekly on Twitter (Mondays at 8-9pm). #PTSD and #birthtrauma can also be used to view related tweets.
  • Maternity Experience (MatExp) A grassroots campaign connecting healthcare professionals and parents to identify and share best practice across the nation’s maternity services. Also has a closed forum on www.facebook.com/groups/matexp 
  • Sheffield's Forging Families Organisation that supports, offers information and promotes health and wellbeing for Sheffield families during the perinatal period. Health promotion materials and discussion are shared via their Facebook page.

Perinatal mental health from a different perspective – media and literature

The stories of women with lived experience can help both healthcare professionals and patients to understand perinatal mental illness and help to improve patient care. Click here for a collection of books, film, television and digital resources that offer a different perspective.

Supporting parenting

This section contains resources to support parents’ wellbeing, parents with mental health problems and consequently, the mental health of their infants.

Fathers and perinatal mental illness

One in ten fathers develop postnatal depression following the birth of their child and the partners of women affected by perinatal mental health problems are at increased risk of depression themselves.

Supporting parenting and infant mental health

An infant's emotional and social development can be affected when parents are regularly unable to respond to its needs. The most effective interventions for Perinatal Mental Health are also those that promote maternal-infant interaction. Maternal and infant mental health needs can be assessed at every contact and further support offered as necessary.

Resources to support parenting challenges:

Parental relationships:

Resources aimed at parents with mental health problems

Further learning for primary care staff:

Infant feeding

Breastfeeding is recommended by the Department of Health and promotes bonding and attachment. Consistent, impartial information assists parents in making decisions around infant feeding.  The early months of feeding a baby can be challenging, and skilled compassionate feeding support is important for mental wellbeing.

Resources to support infant feeding:

Organisations which offer breastfeeding support in the UK:

Supporting health professionals personally affected

Due to the nature of their work, health professionals may face additional barriers to disclosure, diagnosis and management. If this is the case, the following links may be helpful.
 

Complex clinical situations

The following sections highlight some of the areas in which GPs may need specific information and resources to support their clinical management of perinatal mental health problems.
 

Culturally sensitive care

Sadness post birth occurs in all countries but is not always considered an illness. Migrant women therefore may be unable to express their feelings and present more frequently with somatic symptoms. Unfamiliarity with healthcare pathways, lack of social support, economic hardship, cultural stigma and traumatic past experiences may pose a barrier to seeking help, in addition to language.

Perinatal mental health information in other languages:

Traumatic birth and complex neonatal cases 

The risk of postnatal mental health problems increases if a woman experiences a traumatic birth or if there are serious health concerns for baby. Members of the Primary Care Team should assess needs and offer support as necessary at every contact.

Pregnancy Loss 

Pregnancy loss and neonatal bereavement can put a substantial strain on the mental health of the mother and other members of the family, in addition to the related physical issues. Primary Care staff should treat a pregnancy loss at any gestational stage with respect and sensitivity. Women should be reassured that they can attend later if they do not feel ready to discuss in the early stages.

Termination for fetal anomaly

  • Antenatal Results and Choices Charity offering non-directive information and support through antenatal testing and its consequences for fetal abnormality.

Miscarriage and stillbirth

Further learning for primary care staff

Substance misuse including alcohol

Mothers who misuse substances may feel reluctant to access help due to the associated stigma and concerns about the involvement of social services. Maternal substance misuse can harm a child's development both directly and indirectly, through its impact on parenting capacity. Supportive and coordinated care is recommended in order to minimize harm to the whole family.

Best practice training and appraisal

The role of the general practitioner is to offer accurate up to date information, continuous support and evidence based treatments. The following resources may be used to improve knowledge and understanding of perinatal mental health illness.

Best practice

Training

Online learning:

Some of these resources have been included in other sections but this a collection of all e-learning to help the user of the toolkit find the most appropriate

Further reading:

Reports, commissioning and acknowledgements

There have been some excellent publications in recent years that have done much to highlight the need for improvement of perinatal mental health care and have now started to influence commissioners and policymakers putting the mental health and wellbeing of women having children high up the political agenda.

The RCGP works in collaboration with the Maternal Mental Health Alliance which is a coalition of over 70 national professional and patient organisations committed to improving the mental health and wellbeing of women and their families in the perinatal period.

Acknowledgements

The toolkit has been supported by NHS England and developed by Dr Carrie Ladd and Dr Louise Santhanam who is a member of the RCGP PMH Special Interest Group. The authors would like to thank all those who contributed to the production of this toolkit for their time, thoughts and enthusiasm for this project, and in particular:

i) RCGP PMH Steering Group
ii) RCGP PMH GP Special Interest Group
iii) CIRC team within RCGP
iv) Review group of women with lived experience
v) Social media contributors
vi) MMHA – much of the information has been obtained from the websites of members of this alliance, of which there are over 80 and the names can be found here.
vii) the developers of all the resources credited within the toolkit.

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