1
Introduction
Many pregnant women experience psychiatric disorders
in their childbearing years. Emerging research shows
mental illness not only affects the mother's well-being
but may also have significant effects outcome of fetus
Long-term effects on child– anxious child; child abuse;
child neglect; poorer language development;
behavioural problems; slower to learn etc
Long-term effects on mother - inability to care for self;
inability to care for child; inability to make rationale
decisions; Inability to keep self and/or child safe
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Challenges
Screening/early detection
Assessment
Cultural factors
Diagnosis
Pharmacological treatment
3
Screening and early
detection
4
Screening & early detection
cont..
Identifying women with mental health needs
who become pregnant or have had a baby
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Assessment
Mental Health assessment
Risk assessment
Psychosocial assessment
Needs assessment
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Assessment cont..
Factors which can affect assessment
Complexity
Time
Lack of information
Biological factors – age (of mother & child)
Physical health/physical disability
Lifestyle – drugs/alcohol/smoking
Domestic violence
Immigration status (refugee, asylum seeker,
visitor)
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Cultural factors/influences
•Ethnicity
•Culture – Ramadan and fasting, for
example
•Language
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Diagnosis
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Diagnosis cont
- Anxiety disorders, eating disorders and
psychotic illness, may also predict adverse
birth outcomes.
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Pharmacological treatment
Type and dose of medication
Risk vs. benefits on both mother and child – taking into
account gestation period and/or whether mother is breast-
feeding for example
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Implications for safeguarding
• Impact of mental illness on safety of child
• Impact of mental illness on safety of mother
• Planning care
• Providing care
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Impact of mental illness on
safety of child
Consider child protection issues
Consider the impact of the mother’s mental
health problem on their ability to meet the
needs of their child
Establish whether the child may be at risk
of significant harm
Consider additional support even if the
child may not be at risk of significant harm
Child – as unborn or baby has rights
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Impact of mental illness on
safety of mother
Consider additional support
Consider increased contact with mental
health professional
Consider admission to hospital
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Planning care
Consider needs of both mother and baby
Liaison with other professionals (H/V, midwives,
CMHTs, M&B unit, social services)
Family and other support network involvement
Confidentiality issues
Clear written care-plan and in place and adhered
to
Providing culturally sensitive information for
mothers and their carers
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Providing care
Appropriate to level of need and risk
– CMHT; HTT; Inpatient; M&B unit
Ongoing evaluation and review
Effective communication with other professionals
and/or family or other support network
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Conclusions
Mental Health professionals have responsibility
for assessing and meeting the needs of pregnant
women who are coincidentally experiencing
mental illness
The mother and child have individual needs and
their rights need to be respected
Communication between professionals is
paramount
The sooner the condition is diagnosed, the more
effective the treatment
Think mother, think child, think family...
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Questions
?!?
Thank you
Jerina Spicer MA, PG Dip, RN(MH), Dip Ed
October 2009
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Refs
Lewisham Safeguarding Children Board Protocol (2008)- Supporting children and
families affected by parental mental health problems
NICE Guidelines (2007) – antenatal and postnatal mental health
SLaM (2008) Protecting children and the public MAPPA guidance
SLaM (2006) Policy for the Care and Support of Pregnant Women with a
Diagnosis of Severe Mental Illness
Southwark Area Child Protection Committee / Safeguarding Children Board(2005) -
Joint Service Protocol to meet the needs of children and unborn children whose
parents or carers have mental health problems
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