What Are The Challenges Of Working With Mentally Ill Mothers Jerina Spicer

Challenges of working with mentally ill mothers during pregnancy and post-partum period and implications with safeguarding issues

Jerina Spicer

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October 2009

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

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Screening and early detection “Tell them I’m in here please mum!” “Tell them how you feel please mum!”

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Screening & early detection cont.. Identifying women with mental health needs who become pregnant or have had a baby Women with severe mental health illness,

psychosis for example, are more likely to become pregnant and not be aware Early detection minimises risk of women slipping through the care net Early detection ensures appropriate care planning

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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) 7

Cultural factors/influences

•Ethnicity •Culture – Ramadan and fasting, for example •Language 8

Diagnosis Importance of well formulated diagnosis

- Maternal depression during pregnancy is a risk factor for low foetal birth weight and premature delivery - A woman with postpartum depression may regard her child with ambivalence, negativity or disinterest. An adverse effect on the bonding between mother and child may result.

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Diagnosis

cont

- Anxiety disorders, eating disorders and psychotic illness, may also predict adverse birth outcomes.

The sooner the condition is diagnosed, the more effective the treatment.....

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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 breastfeeding for example SSRIs taken after 20 weeks’ gestation may be associated with an increased risk of persistent pulmonary hypertension in the neonate (Nice guidance) Olanzapine for example, is not recommended for breast-feeding mothers as it is excreted into human milk

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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

Think mother, think child, think family...

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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 Mother’s rights as a patient and as a

parent need to be respected

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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

Jerina Spicer October 2009

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