The role of a Liaison Psychiatrist in perinatal mental health

.By Susie Lingwood, Liaison Psychiatrist, North Middlesex University Hospital

Susie Lingwood is a Liaison Psychiatrist in north London. The Mums and Babies in Mind team are working with Susie and her colleagues to improve perinatal mental health services in Haringey and the surrounding boroughs. In this blog Susie explains what her role involves, what she has done to improve services and how mums with perinatal mental health problems and their babies are being supported locally.

I work as a Liaison Psychiatrist in the Mental Health Liaison Service at the North Middlesex University Hospital in north London. This isn’t a specific perinatal mental health role, but involves liaising between psychiatry and maternity (and other services). Barnet, Enfield and Haringey (BEH) Mental Health NHS Trust provide the hospital with the service. Our boroughs are currently rated red on the Maternal Mental Health Alliance map as there is no Specialist Perinatal Mental Health service but in October 2016 we were successful in receiving funding from NHS England to develop a specialist team here and I am looking forward to being involved in its development.

The team and I cover the whole of North Middlesex University Hospital. We get referrals from all inpatient wards and the Emergency Department for anyone experiencing mental health problems. This covers a wide variety of presentations including self-harm and suicide, psychosis, depression and bipolar disorder, personality disorders, persistent unexplained physical symptoms, complications of alcohol and substance misuse, and psychological aspects of managing complex physical illnesses. We work directly with patients and families, and also hospital staff who we provide regular mental health teaching to. We liaise closely with mental health teams working in the community like Crisis teams and community mental health teams.

Historically there has been no specialist perinatal mental health service but our team works closely with the maternity service. Our aim is to support our colleagues in the maternity service to identify women presenting with mental health problems during pregnancy, and signpost to the most appropriate services for treatment and support. This is to ensure the right mental health pathway is in place to manage puerperal disorders and to support self-help options in mothers with milder forms of illness. IAPT (Improving Access to Psychological Therapies) in our hospital catchment area is now running clinics co-located at North Middlesex University Hospital and delivers part of the antenatal class programme to support wellbeing in parents and their babies. IAPT also work with Children’s Centres to run postnatal support groups. These community based services are invaluable alongside what we offer in psychiatry so support is available across the spectrum of need.

Our team also provides a direct service to the delivery suite, birthing unit and maternity ward. We have a system for identifying in advance which women would benefit from being offered a mental health review after delivery. Most often this involves ensuring the right support is available should postnatal depression develop, and that women know how to access help and what to expect. Occasionally this involves arranging for admission to a Mother & Baby Unit, or follow up from a Crisis team.

However, having worked in BEH since 2008 and in North Middlesex University Hospital since 2014, the lack of perinatal specialist services has been an issue because we know from reviewing audit data that fewer women are accessing the specialist skilled psychiatric and psychological care during pregnancy that they need, and fewer women are admitted to specialist Mother & Baby Unit beds from BEH than we would expect. This can lead to greater likelihood of relapse for women with known mental disorders, and increased rates of mental health admission and separation from their baby.

I’ve taken a lead in our team on improving pathways within the hospital and links with community services. There is no single Specialist Perinatal Mental Health Team, but there are many committed and skilled clinicians working across the patch based in CAMHS, Adult Mental Health teams, Maternity, Health Visiting, IAPT, and Parent-Infant Psychotherapy projects, to name just a few.

During early 2016, having returned to work after maternity leave (and having realised how rewarding yet challenging it is to have a new baby) I took on the task of mapping out services related to Perinatal mental health with the aim of establishing how well we meet the Pan-London Perinatal Mental Health Care Pathways (Green, Miele, Protti 2015). Fortunately the provision for mild to moderate perinatal disorders has improved significantly over the past couple of years. This is in large part due to IAPT Perinatal Champions and the Parent-Infant projects working closely with maternity services and adult mental health teams. However, for women with more severe perinatal disorders it still remains a significant challenge.

After mapping out services, and with support from the Medical Director of Barnet, Enfield and Haringey Mental Health NHS Trust, I decided to set up a Perinatal Mental Health Clinical Network across BEH. This was to invite clinicians working specifically in perinatal and parent infant related services to come together to share experience and expertise, to form relationships across and within boroughs and specialities and to support the perinatal training initiatives. Our original terms of reference included aims to support:

a) Development of new business (i.e. developing a perinatal & parent-infant mental health service)

b) Sustaining and/or expanding existing services (e.g. EPIP, Psychology provision)

c) Improving and coordinating care across existing services (e.g. awareness of current service provision, training for generic mental health services, psychiatry prioritisation of pregnant women, training for health visitors across the 3 boroughs etc)

The network held 6 meetings during 2016 and early 2017 and was attended by around 25 clinicians working across BEH. Several members contributed to the 2016 NHS England bid that was successful and one regular attender has recently been appointed as a Clinical Lead in the new team. The new service covers the 5 boroughs of Barnet, Enfield, Haringey, Camden & Islington and the network has now extended to cover all 5 boroughs under the auspices of the London Perinatal Mental Health Clinical Networks.

The new funding from NHS England will provide an opportunity for women with severe mental illness to access specialist support during pregnancy and the postnatal period. There is still a lot of work to do but we have a network of perinatal champions and skilled clinicians for the specialist team to link with which is a great start. There is a lot of passion here to improve services available to women suffering from mental health problems at this critical period of life and it’s exciting to be a part of that.


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