Perinatal Psychiatry Masterclass for SAS Doctors resources

Please note that these resources are for your information only and should not be used or duplicated elsewhere.

This programme will run from 27 February - 3 March 2023.

Themes

Monday 27 Feb 2023 - Day 1 - Introductions Overview of perinatal mental health service development in the UK and Ireland, perinatal frame of mind and assessment and communication; the infant

Tuesday 28 Feb 2023 – Day 2 – Mental disorders in the perinatal period and pre-birth planning

Wednesday 1 March 2023 - Day 3 – Personality disorder; psychological interventions, infertility, perinatal loss, birth trauma and late TOP requests

Thursday 2 March 2023 – Day 4 – Prescribing in pregnancy and lactation; eating disorders; partners

Friday 3 March 2023 - Day 5 – Child safeguarding; risk; implementation

The aims of this masterclass programme are to:

  • enable and support SAS doctors to develop skills and knowledge in their assessment, understanding and care of the complex clinical work involved in working with women of childbearing potential and in the perinatal period
  • encourage participants to integrate current evidence into clinical practice
  • develop self-reflection skills
  • emphasise the importance of the perspectives of women, infants, partners and families throughout the perinatal pathway
  • improve patient safety
  • improve the experience of women and families during the perinatal period and within perinatal mental health services.

The following key issues are fundamental aspects of perinatal mental health care and will be discussed and considered throughout the programme:

  • safeguarding children and adults
  • culture and difference
  • collaborative working with women, partners and families
  • women’s own experience of perinatal mental disorders and care
  • legal issues

Programme

The full programme for the Masterclass for SAS Doctors is now available. 

Learning objectives and reading lists will be provided before each day.

Each session within the day will have a didactic component and small group work/discussion.

Facilitators: Dr Liz McDonald, Dr Lucinda Green 

Speakers: Dr Clare Dolman, Dr Lucinda Green, Dr Liz McDonald and Dr Maddalena Miele

Intended learning objectives

At the end of day 1, participants will be able to:

  1.  Understand the development and delivery of PMH services within the different nations.
  2.  Describe the range of factors that can affect a woman’s mental health in the perinatal period and her experience of pregnancy and parenting.
  3. Summarise, formulate and communicate assessments to enable women, families and professionals to understand the factors which have contributed to her mental health problems, associated risks and/or her risk of developing a perinatal mental illness.
  4. Demonstrate an awareness of the barriers to care for women in the perinatal period
  5. Understand the factors influencing women’s decision-making around pregnancy and childbirth
  6. Outline the determinants of a sensitive parent-infant interaction
  7. Understand the key ways in which perinatal mental health problems can affect the ability of women to interact with their infant
  8. Demonstrate a basic knowledge of the current clinical approaches to assessing parent-infant relationships

Recommend reading

  1. Perinatal Mental Health Services - CR232 (rcpsych.ac.uk)
  2. Scotland:https://www.pmhn.scot.nhs.uk/delivering-effective-services/delivering-effective-services-report/
  3. Scottish care pathways
  4. England care pathways
  5. Wales: together-for-mental-health-delivery-plan-2019-to-2022.pdf (gov.wales)
  6. Ireland:https://www.hse.ie/eng/services/list/4/mental-health-services/specialist-perinatal-mental-health/specialist-perinatal-mental-health-services-model-of-care-2017.pdf
  7. NHS England (2019) The NHS Long Term Plan
  8. 8. Dolman, C., Jones, I., & Howard, L. M. (2013). Pre-conception to parenting: a systematic review and meta-synthesis of the qualitative literature on motherhood for women with severe mental illness. Archives of women's mental health, 16(3), 173–196.
  9. 9. Svanberg, P.O., Barlow, J., & Tigbe, W.W. (2013). The Parent–Infant Interaction Observation Scale: reliability and validity of a screening tool. Journal of Reproductive and Infant Psychology, 31, 14 - 5.
  10. 10. Stein A, Pearson RM, Goodman SH, et al. (2014) Effects of perinatal mental disorders on the fetus and child. Lancet, 384(9956), 1800‐1819.

Speakers: Dr Lucinda Green and Dr Liz McDonald

Intended learning objectives

At the end of day 2 participants will be able to:

  1. understand the course of depression, OCD, schizophrenia, BPAD and Post-partum psychosis within the perinatal context
  2. understand how to organise and chair a perinatal mental health pre-birth planning meeting to ensure that the woman, her partner and other family members and the relevant professionals have a shared understanding of any concerns, needs and risks as well as the woman and family’s strengths.
  3. develop effective perinatal mental health care plans collaboratively with women, partners, other carers and professionals.

Recommend reading

  1. Di Florio A &Jones IR. (2019) Postpartum Depression. BMJ Best Practice. 4.
  2. Bergink, V., Rasgon, N., & Wisner, K. L. (2016). Postpartum Psychosis: Madness, Mania, and Melancholia in Motherhood. The American journal of psychiatry, 173(12), 1179–1188.
  3. Challacombe, F. L., Bavetta, M., & De Giorgio, S. (2019). Intrusive thoughts in perinatal obsessive-compulsive disorder. BMJ (Clinical research ed.), 367, l6574.
  4. Dazzan P. (2021). Schizophrenia during pregnancy. Current opinion in psychiatry, 34(3), 238–244.
  5. Forde R, Peters S, Wittkowski A. Recovery from postpartum psychosis: a systematic review and metasynthesis of women's and families' experiences [published online ahead of print, 2020 Feb 4]. Arch Womens Ment Health. 2020;10.1007/s00737-020-01025-z
  6. Howard, L. M., & Khalifeh, H. (2020). Perinatal mental health: a review of progress and challenges. World psychiatry : official journal of the World Psychiatric Association (WPA), 19(3), 313–327.
  7. Perry, A., Gordon-Smith, K., Jones, L., & Jones, I. (2021). Phenomenology, Epidemiology and Aetiology of Postpartum Psychosis: A Review. Brain sciences, 11(1), 47.
  8. Pre-Birth Planning: Best Practice Toolkit for Perinatal Mental Health Services (2019) Pan-London Perinatal Mental Health Networks. https://www.transformationpartnersinhealthandcare.nhs.uk/wp-content/uploads/2019/01/Pre-birth-planning-guidance-for-Perinatal-Mental-Health-Networks.pdf 

Speakers: Dr Lucinda Green and Dr Nic Horley

Intended learning objectives

At the end of day 3 participants will be able to:

  1. Understand how personality function may become disordered in pregnancy and postnatally
  2. Appreciate the importance of assessment and treatment for women who have a diagnosis of personality disorder in perinatal mental health services
  3. Understand the different psychological therapies for women with mental disorders and their use during the perinatal period
  4. Understand the factors which contribute to birth trauma (PTSD)
  5. Understand how pregnancy-related trauma and loss can affect women and partners.
  6. Demonstrate knowledge and understanding of the challenges and complexities for women and partners associated with assisted conception.
  7. Understand the mental health problems associated with infertility and infertility treatment.

Recommend reading

  1. Adshead, G. (2015). Parenting and personality disorder: Clinical and child protection implications. BJPsych Advances, 21(1), 15
  2. Bhat, A., & Byatt, N. (2016). Infertility and Perinatal Loss: When the Bough Breaks. Current psychiatry reports, 18(3), 31.
  3. Eyden, J., Winsper, C., Wolke, D., Broome, M. R., & MacCallum, F. (2016). A systematic review of the parenting and outcomes experienced by offspring of mothers with borderline personality pathology: Potential mechanisms and clinical implications. Clinical psychology review, 47, 85–105.
  4. Herbert, D., Young, K., Pietrusińska, M., & MacBeth, A. (2022). The mental health impact of perinatal loss: A systematic review and meta-analysis. Journal of affective disorders, 297, 118–129.
  5. McCluskey, G. and Gilbert, P. (2015) Implications counselling for people considering donor-assisted treatment. Fully updated version. BICA Publications
  6. Newman, Louise. & Stevenson, C. (2005). Parenting and Borderline Personality Disorder: Ghosts in the Nursery. Clinical Child Psychology and Psychiatry. 10, 385-394.
  7. Quagliata E (Ed.). (2013) Becoming Parents and Overcoming Obstacles: Understanding the Experience of miscarriage, premature births, infertility and postnatal depression. Karnac Books.
  8. Svanberg, E. (2019) Why Birth Trauma Matters. Pinter & Martin
  9. Risholm Mothander, P., C. Furmark, and K. Neander (2018), Adding “Circle of Security–Parenting” to treatment as usual in three Swedish infant mental health clinics. Effects on parents’ internal representations and quality of parent‐infant interaction. Scandinavian Journal of Psychology. 59: p. 262-272

Speakers: Dr Angelika Wieck, Prof Ian Jones, Dr Lucinda Green, Dr Liz McDonald and Dr Catia Acosta 

Intended learning objectives

At the end of day 4 participants will be able to:

  1. Be able to apply current evidence and general principles for the pharmacological management of pregnant and breastfeeding women to clinical scenarios.
  2. Be familiar with currently available evidence on the reproductive safety of the main psychotropic drugs, resources that provide high-quality evidence updates and current influential prescribing guidance
  3. Identify and assess women who have eating disorders in the perinatal period, including assessment of the risk to the woman, the foetus and the infant, requesting physical investigations and discussing risk concerns with women.
  4. Devise a perinatal mental health care plan for a woman who has an eating disorder in the perinatal period, in partnership with the woman, the eating disorder service and other relevant professionals.
  5. Recognise the effect of a woman’s perinatal mental illness on her partner.
  6. Recognise how healthcare professionals can improve the experience for partners and families of women receiving perinatal mental healthcare

Recommend reading

  1. Bye, A., Martini, M. G., & Micali, N. (2021). Eating disorders, pregnancy and the postnatal period: a review of the recent literature. Current opinion in psychiatry, 34(6), 563–568.
  2. Bye, A., Shawe, J., Bick, D., Easter, A., Kash-Macdonald, M., & Micali, N. (2018). Barriers to identifying eating disorders in pregnancy and in the postnatal period: a qualitative approach. BMC pregnancy and childbirth, 18(1), 114.
  3. Fogarty, S., Elmir, R., Hay, P. et al. (2018).The experience of women with an eating disorder in the perinatal period: a meta-ethnographic study. BMC Pregnancy Childbirth 18, 121.
  4. Acosta, C., Treasure, J. (2015) Eating Disorders: Overview and Management in Women. Current progress in obstetrics and gynaecology, volume 3. Ed: Studd J, Tan SL
  5. McAllister-Williams, R. H., Baldwin, D. S., Cantwell, R. et al (2017). British Association for Psychopharmacology consensus guidance on the use of psychotropic medication preconception, in pregnancy and postpartum. Journal of psychopharmacology (Oxford, England), 31(5), 519–552.
  6. National Institute for Health and Care Excellence (2014). Antenatal and Postnatal Mental Health - Clinical Management and Service Guidance. Clinical Guideline 192.
  7. MHRA: Valproate use by women and girls (2018). www.gov.uk/guidance/valproate-use-by-women-and-girls
  8. Pre-conception advice: Best Practice Toolkit for Perinatal Mental Health Service (2019) Pan-London Perinatal Mental Health Networks. www.healthylondon.org/wp-content/uploads/2019/05/Pre-conception-advice-Best-Practice-Toolkit-for-Perinatal-Mental-Health-Services.pdf
  9. Delivering preconception care to women of childbearing age with serious mental illness - https://www.tommys.org/pregnancy-information/health-professionals/free-pregnancy-resources/guide-delivering-preconception-care
  10. Ruffell, B., Smith, D.M. & Wittkowski, A J. (2019) The Experiences of Male Partners of Women with Postnatal Mental Health Problems: A Systematic Review and Thematic Synthesis. Child Fam Stud.28, 2772–2790.
  11. Darwin, Z., Domoney, J.,Iles, J. et al. (2021) Involving and supporting partners and other family members in specialist perinatal mental health services. NHS England. https://www.england.nhs.uk/wp-content/uploads/2021/03/Good-practice-guide-March-2021.pdf
  12. Lever Taylor, B., Billings, J., Morant, N., Bick, D., & Johnson, S. (2019). Experiences of how services supporting women with perinatal mental health difficulties work with their families: a qualitative study in England. BMJ Open, 9(7):e030208.

Speakers: Dr Roch Cantwell, Dr Lucinda Green and Dr Liz McDonald

Intended learning objectives

At the end of day 5 participants will be able to:

  1. Describe the factors highlighted in child serious case reviews which can affect children’s safety and wellbeing and increase the risk of abuse and neglect.
  2. Recognise how perinatal mental health services, working effectively in partnership with a range of professionals, can ensure child safeguarding concerns are identified early and that effective care, treatment and support for women and families can reduce the risk of harm to infants and children.
  3. Describe the epidemiology of self-harm and suicide in the perinatal period.
  4. Describe the distinctive clinical features of maternal suicide.

  5. Recognise risk in relation to maternal suicide and apply this to clinical assessment.

Recommend reading

  1. Department for Education (2018). Working Together to Safeguard Children: A guide to inter-agency working to safeguard and promote the welfare of children. London: HM Government
  2. Department for Education (2020) Complexity and challenge: a triennial analysis of serious case reviews 2014-2017. London: Department for Education.
  3. Department for Education (2022) Learning for the future: final analysis of Serious Case Reviews, 2017-19. London: Department for Education.
  4. Cantwell R, Knight M, Oates M, Shakespeare J on behalf of the MBRRACE-UK mental health chapter writing group (2015) Lessons on maternal mental health. In Knight M, Tuffnel D, Kenyon S, Shakespeare J, Gray R, Kyrinczuk JJ (Eds.) on behalf of MBRRACE-UK. Saving Lives, Improving Mothers’ Care – Surveillance of maternal deaths in the UK 2011-13 and lessons learned to inform maternity care from the UK and Ireland Confidential Enquiries into Maternal Deaths and Morbidity 2009-13. Oxford: National Perinatal Epidemiology Unit, University of Oxford 2015: p22-41.
  5. Cantwell R, Youd E and Knight M on behalf of the MBRRACE-UK mental health chapter-writing group (2018) Messages for mental health. In Knight M, Bunch K, Tuffnell D, Jayakody H, Shakespeare J, Kotnis R, Kenyon S, Kurinczuk JJ (Eds.) on behalf of MBRRACE-UK. Saving Lives, Improving Mothers’ Care - Lessons learned to inform maternity care from the UK and Ireland Confidential Enquiries into Maternal Deaths and Morbidity 2014- 16. Oxford: National Perinatal Epidemiology Unit, University of Oxford 2018: p42-60
  6. Cairns A, Kenyon S, Patel R, Bunch K and Knight M on behalf of the MBRRACE-UK mental health chapter-writing group. In Knight M, Bunch K, Patel R, Shakespeare J, Kotnis R, Kenyon S, Kurinczuk JJ (Eds.) on behalf of MBRRACE-UK. Saving Lives, Improving Mothers’ Care Core Report - Lessons learned to inform maternity care from the UK and Ireland Confidential Enquiries into Maternal Deaths and Morbidity 2018-20. Oxford: National Perinatal Epidemiology Unit, University of Oxford 2022: pp 10-15.
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