Antenatal and postnatal mental health

Short Text

Antenatal and postnatal mental health: clinical management and service guidance

Introduction

Mental disorders during pregnancy and the postnatal period (up to 1 year after delivery) can have serious consequences for the mother, her infant and other family members. This pathway covers all mental disorders, including anxiety disorders, depression, bipolar disorder, schizophrenia and postnatal psychotic disorders (often termed puerperal psychoses). It aims to help clinicians balance the risks of treating a mental disorder (in particular with psychotropic medication) with the risks of not treating it.
When treating any psychotic disorder, clinicians should refer to the sections on bipolar disorder and schizophrenia. The pathway avoids the term 'postnatal depression' because this is often used inappropriately as a term for any perinatal mental disorder.

Source guidance

The NICE guidance that was used to create the pathway.
Antenatal and postnatal mental health: clinical management and service guidance. NICE clinical guideline 45 (2007)

Quality standards

Quality statements

Effective interventions library

Successful effective interventions library details

Implementation

Audit support

Audit support provides ready-to-use criteria, including exceptions, definitions, suggested data sources and a data collection tool.
Antenatal and postnatal mental health: audit criteria

Commissioning guides

Commissioning guides provide information on key clinical and service-related issues to consider during the commissioning process. Each guide contains a commissioning and benchmarking tool, which is a resource that can be used to estimate and inform the level of service needed locally as well as the cost of local commissioning decisions.
Antenatal and postnatal mental health services: commissioning guide

Costing support

Costing support includes national cost impact reports that summarise the national costs and savings and discuss the assumptions used; costing templates to assess the impact on local budgets; and costing statements when the impact is not significant or impossible to quantify at a national level.
Antenatal and postnatal mental health: costing report
Antenatal and postnatal mental health: costing template

Slide sets

Slide sets provide a framework for discussion and assist in local dissemination of the guidance. The slides contain the key messages from NICE guidance and can be tailored for local presentations.
Antenatal and postnatal mental health: presenter slides

Pathway information

Information for patients and the public

NICE produces booklets for patients and the public, called 'Understanding NICE guidance'. They summarise, in plain English, the recommendations that NICE makes to healthcare and other professionals.
NICE has written a booklet for patients and the public explaining its guidance on the following topic.
Mental health problems during pregnancy and after giving birth

Patient-centred care

Patients and healthcare professionals have rights and responsibilities as set out in the NHS Constitution – all NICE guidance is written to reflect these. Treatment and care should take into account individual needs and preferences. People should have the opportunity to make informed decisions about their care and treatment, in partnership with their healthcare professionals. If someone does not have the capacity to make decisions, healthcare professionals should follow the Department of Health's advice on consent and the code of practice that accompanies the Mental Capacity Act. In Wales, healthcare professionals should follow advice on consent from the Welsh Government. If the person is under 16, healthcare professionals should follow the guidelines in Seeking consent: working with children.

Supporting information

Off-label drug indications

No psychotropic drug has marketing authorisation specifically for pregnant or breastfeeding women.
For additional considerations on the use of psychotropic drugs and other medications for women planning, during and following pregnancy (including the assessment of the relative risks and benefits), please refer to the British national formulary and individual drug summaries of product characteristics (SPCs).

Glossary

Cognitive behavioural therapy
Computerised cognitive behavioural therapy
Electroconvulsive therapy
Eye movement desensitisation and reprocessing
Interpersonal psychotherapy
Selective serotonin reuptake inhibitor
Tricyclic antidepressant

Services for women of child-bearing potential with a mental disorder and all women planning and during pregnancy and in the postnatal period

Services for women of child-bearing potential with a mental disorder and all women planning and during pregnancy and in the postnatal period

Principles of care

View the 'Principles of care for women with a mental disorder' path

Preventing mental disorders

View the 'Preventing mental disorders during pregnancy and the postnatal period' path

Prediction, detection and initial management

View the 'Prediction, detection and initial management of mental disorders during pregnancy and the postnatal period' path

Balancing risks and benefits of treatment

View the 'Balancing risks and benefits of treatment of mental disorders during pregnancy and the postnatal period' path

Treating specific disorders

View the 'Treating specific mental disorders during pregnancy and the postnatal period' path

Service organisation

Service organisation

Service organisation

Clinical networks should be established for perinatal mental health services, managed by a coordinating board of healthcare professionals, commissioners, managers, and service users and carers. These networks should provide:
  • a specialist perinatal service in each locality, able to provide direct services, consultation and advice to maternity services, other mental health services and community services; in areas of high morbidity, these services may be provided by separate specialist perinatal teams
  • access to specialist advice on the risks and benefits of psychotropic medication during pregnancy and breastfeeding
  • clear referral and management protocols for services across all levels of the existing stepped-care frameworks for mental disorders to ensure effective transfer of information and continuity of care
  • pathways of care for service users, with defined roles and competencies for all professional groups involved.
Each managed perinatal mental health network should have designated specialist inpatient services and cover a population of between 25,000 and 50,000 live births a year depending on the local psychiatric morbidity rates.
Each specialist perinatal inpatient service should:
  • provide facilities specifically for mothers and infants (typically with 6–12 beds)
  • be staffed by specialist perinatal mental health staff
  • be staffed to provide appropriate care for infants
  • have effective liaison with general medical and mental health services
  • have available the full range of therapeutic services
  • be closely integrated with community-based mental health services to ensure continuity of care and minimum length of stay.

Implementation

Failed to load fragment (default behaviour with no loader supplied): staticcontentfragments/implementation-node-multiple
Antenatal and postnatal mental health: audit criteria
Antenatal and postnatal mental health: commissioning guide
Antenatal and postnatal mental health: costing report
Antenatal and postnatal mental health: costing template
Antenatal and postnatal mental health: presenter slides

Source guidance

Failed to load fragment (default behaviour with no loader supplied): staticcontentfragments/source-guidance-node
CG45

Paths in this pathway

Pathway created: November 2011 Last updated: November 2011

Copyright © 2012 National Institute for Health and Clinical Excellence. All Rights Reserved.

Recently viewed

(Clear all)