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Job planning in perinatal psychiatry
Learn about the structure and activities specific to perinatal psychiatry and read guidance regarding what would constitute an acceptable job plan.
Consultant perinatal psychiatrists have expertise in the prevention, assessment, and management of mental disorders newly occurring or coexisting with pregnancy or the postpartum period, including assessment of the parent-infant relationship.
Perinatal mental health services see patients for pre-conception assessments, during pregnancy, and in the postnatal period until the end of the first postnatal year. In England, patients can be offered continued access to perinatal services into the second postnatal year.
Consultant perinatal psychiatrists see patients with severe mental illness and moderate mental illness with additional complex psychosocial needs or comorbid conditions. This extends to pre-conception care for patients with severe mental illness and caring for patients with a history of severe mental illness who are currently well but who are at high risk of relapse during the perinatal period.
Consultant perinatal psychiatrists work in collaboration with fathers/co-parents and other family members to help them support the patient in their recovery. In England, this extends to offering partners an assessment and signposting for further mental health support. Posts may include inpatient mother and baby unit, perinatal community, and maternity liaison responsibilities.
Consultants in perinatal psychiatry have the expertise listed below.
- understanding of the normal psychological changes that take place in pregnancy and in the early postnatal period, in relation to identity, becoming a parent, couple relationships, and the developing relationship with the infant from pregnancy onwards.
- understanding of psychopharmacokinetic and psychopharmaco-dynamic alterations occurring in pregnancy, the early puerperium, and in breastfeeding.
- understanding of physical problems that may arise during the patient's journey through pregnancy and the puerperium, including the physiology and complications of childbirth, and ensuring patients have access to assessment, monitoring, and interventions to improve their physical health.
- understanding of legislation and guidance in relation to child and adult safeguarding including child protection and domestic abuse.
- understanding of embryology, fetal, and early infant development.
- Understanding of the normal parent-infant relationship and its development through early childhood.
- understanding the prevention, detection, and management of mental disorders in pregnant and postnatal patients, the interrelationship between mental disorders and pregnancy and the postpartum period, and the wider effects of mental disorders on child development and the parent-infant relationship.
- diagnose and formulate management plans in complex cases, including decisions on prescribing in pregnancy and breastfeeding.
- formulate individualised comprehensive perinatal care plans following pre-birth planning meetings.
- assess and manage risk, including understanding the risk of relapse associated with specific mental illnesses in the perinatal period, the risk of suicide, and the risk to children.
- deliver care which responds to maternity time scales and adjust thresholds to distinctive perinatal needs and complexity.
- perinatal psychiatrists see the full range of psychiatric disorders and when needed are required to joint work with other mental health teams, such as adult mental health, learning disabilities, addictions, eating disorders, and child and adolescent teams.
- provide prescribing advice on psychotropic medication in pregnancy and breastfeeding to patients and their families, general psychiatry, maternity and primary care services.
- provide expert assessment of the parent-infant relationship in the context of acute parental mental disorder, recognising any disturbances in bonding and attachment, and identifying areas necessitating support and intervention.
- understanding of policies and national guidelines relating to perinatal psychiatry, and parental and child health, including those from the Confidential Enquiry into Maternal Deaths, NICE, Scottish Intercollegiate Guidelines Network (SIGN), and relevant government strategic policy documents.
- ensure that perinatal mental health services meet the standards set out by the accreditation and peer review processes of Perinatal Quality Network (PQN), a member of the Royal College of Psychiatrists Centre for Quality Improvement (CCQI)
- work collaboratively with other psychiatric services, maternity services, primary care, health visiting, social care, and other safeguarding teams, to ensure optimum outcomes for the patient and child.
- work by involvement of the patient, and their family where appropriate, as an active partner in treatment, including facilitation of the patient’s ability to make informed decisions about their care and the welfare of their pregnancy/child.
- awareness of guidelines and national frameworks for service provision as these develop. Leading the process of revision and accreditation of their own and other perinatal services, in accordance with national guidelines.
- skills in the participation in, and responsibility for, clinical governance activities and quality improvement activities, including audit of practice and encouraging and supporting colleagues in their participation.
- liaising with health commissioners and providers to promote an understanding of the epidemiology and needs of the patient group, including updates in evidence-based practice, to inform service development and delivery.
- advocating for the mental health needs of pregnant and postnatal patients and the promotion of infant health and development in the context of parental mental illness.
- ensuring that underrepresented communities access perinatal mental health care and that there are strategies in place to ensure effective engagement of all communities, including minority ethnic, LGBTQ, and those with other protected characteristics.
- developing partnerships between agencies involved in the care of pregnant and postnatal patients who experience mental disorders, including primary care, health visiting, maternity services, social care, general psychiatry, the voluntary sector, and services providing urgent and emergency care such as A&E, liaison services, and crisis teams.
- ensure perinatal services routinely collect recommended process and outcome measures on patients’ mental health and experience of care, and the parent-infant relationship and receive feedback from patients and their carers.
- challenging stigma and discrimination against pregnant and postnatal patients with mental disorders, by teaching and raising awareness with the public, public representatives, professionals, and patients.
- designing and delivering training packages including provision for the specialist perinatal mental health workforce and for non-specialists involved in the care of pregnant and postpartum patients, including general psychiatric teams, GPs, obstetricians, re doctors, midwives, health visitors, and psychological treatment services such as NHS Talking Therapies and other national equivalents.
- enhancing public mental health through physical health promotion in pregnancy, and education for patients and professional groups on transgenerational effects of poor parental mental health.
SAS psychiatrist job plans should follow the same principle as above. The College supports 8 DCC; 2 SPA for both speciality and specialist psychiatrists. The model job plan for SAS psychiatrists should reflect the 0.5 SPA difference, which should be added to patient facing DCC.
If the SAS doctor does not have formal or informal educational responsibilities in relation to resident doctors, medical students and other health professionals, the specific time allocated for this in the consultant model job plan should be added to DCC activities for either patient reviews or for liaison with families/carers/other professionals in relation to patient care as appropriate to the service and their role in the team.
Perinatal – Mother and baby unit
| Description | Professional activities |
|---|---|
| Direct clinical care, including: | 7.5 |
| Multidisciplinary team meetings and support for team members outside the meeting | 2 |
| Meetings with patients and carers | 1 |
| Clinical administrative tasks | 1 |
| Out-patient and maternity liaison work | 1.5 |
| Emergency work/maternity liaison visits | 0.5 |
| Complex patient reviews, including multi-professional meetings for high-risk patients/child safeguarding meetings/mental health legislation work | 0.5 |
| Supporting professional activities (SPAs) including CPD, QI activity, supervision, appraisal and job planning | 2.5 |
Perinatal – Community services
| Description | Professional activities |
|---|---|
| Direct clinical care, including: | 7.5 |
| Out-patient work/home visits | 3 |
| Multidisciplinary team meeting/support for team members outside the meeting | 1 |
| Emergency work/liaison visits | 0.5 |
| Complex patient reviews/child safeguarding meetings/mental health legislation work | 1 |
| Clinical administrative tasks | 2 |
| Supporting professional activities (SPAs) including CPD, QI activity, supervision, appraisal and job planning | 2.5 |
Factors that should be taken into consideration in a job description include the following:
The expected workload of a full-time consultant perinatal psychiatrist is dependent on a range of factors, including the local birth rate, whether all elements of service provision are included, the size and composition of in-patient and community teams, the number of maternity units, geographical distribution, and the population served.
In addition, those providing maternity liaison services in larger centers will have to take account of a 'drifting in' of more complex cases to centers of maternity expertise.