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Antenatal and postnatal mental health
Short Text
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. NICE clinical guideline 45 (2007)
Quality standards
Quality statements
Effective interventions library
Successful effective interventions library details
Implementation
Commissioning
These resources include support for commissioners to plan for costs and savings of guidance implementation and meeting quality standards where they apply.
These resources will help to inform discussions with providers about the development of services and may include measurement and action planning tools.
Education and learning
NICE produces resources for individual practitioners, teams and those with a role in education to help improve and assess users' knowledge of relevant NICE guidance and its application in practice.
Service improvement and audit
These resources provide help with planning ahead for NICE guidance, understanding where you are now, and conducting improvement initiatives.
Pathway information
Information for the public
NICE produces information for the public that summarises, in plain English, the recommendations that NICE makes to healthcare and other professionals.
NICE has written information for the public explaining its guidance on each of the following topics.
Patient-centred care
Patients and healthcare professionals have rights and responsibilities as set out in the NHS Constitution for England – 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, the code of practice that accompanies the Mental Capacity Act and the supplementary code of practice on deprivation of liberty safeguards. 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. If a young person is moving between paediatric and adult services their care should be planned and managed according to the best practice guidance described in the Department of Health's Transition: getting it right for young people.
Updates to this pathway
25 January 2013 Minor maintenance updates.
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' pathPreventing mental disorders
View the 'Preventing mental disorders during pregnancy and the postnatal period' pathPrediction, detection and initial management
View the 'Prediction, detection and initial management of mental disorders during pregnancy and the postnatal period' pathBalancing risks and benefits of treatment
View the 'Balancing risks and benefits of treatment of mental disorders during pregnancy and the postnatal period' pathTreating specific disorders
View the 'Treating specific mental disorders during pregnancy and the postnatal period' pathService 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 tools
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Failed to load fragment (default behaviour with no loader supplied): staticcontentfragments/source-guidance-nodePaths in this pathway
- Principles of care for women with a mental disorder
- Preventing mental disorders during pregnancy and the postnatal period
- Prediction, detection and initial management of mental disorders during pregnancy and the postnatal period
- Balancing risks and benefits of treatment of mental disorders during pregnancy and the postnatal period
- Psychotropic medication for mental disorders during pregnancy and the postnatal period
- Treating specific mental disorders during pregnancy and the postnatal period
- Depression in women planning pregnancy, during pregnancy and while breastfeeding
- Anxiety disorders in women planning pregnancy, during pregnancy and while breastfeeding
- Eating disorders in women planning pregnancy, during pregnancy and while breastfeeding
- Bipolar disorder in women planning pregnancy, during pregnancy and while breastfeeding
- Schizophrenia in women planning pregnancy, during pregnancy and while breastfeeding
Pathway created: November 2011 Last updated: January 2013
Copyright © 2013 National Institute for Health and Care Excellence. All Rights Reserved.