Perinatal Psychiatry Masterclass for senior trainees resources

Speakers and Facilitators: Dr Clare Dolman, Dr Lucinda Green, Dr Liz McDonald, Dr Maddalena Miele & Dr Roch Cantwell

Intended learning objectives

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

1. Understand service development and delivery of PMH services across the UK and the Republic of Ireland.
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. Recognise how healthcare professionals can improve the experience of women and families receiving perinatal mental healthcare.
7. Recognise the effect of a woman’s perinatal mental illness on her partner.

Recommend reading and links 

1. RCPsych: Perinatal Mental Health Services: Recommendations for the provision of services for childbearing women (2021) - CR232 /improving-care/campaigning-for-better-mental-health-policy/college-reports/2021-college-reports/perinatal-mental-health-services-CR232
2. RCPsych CCQI Standards for Community Perinatal Mental Health Services: /docs/default-source/improving-care/ccqi/quality-networks/perinatal/pqn-community-standards-6th-edition.pdf
3. RCPsych CCQI Standards for Inpatient Perinatal Mental Health Services: /docs/default-source/improving-care/ccqi/quality-networks/perinatal/pqn-inpatient-standards---eighth-edition.pdf
4. England: https://www.england.nhs.uk/mental-health/perinatal/
5. Scotland: https://www.pmhn.scot.nhs.uk/
6. Wales: https://executive.nhs.wales/networks-and-planning/wales-mental-health-network/perinatal-mental-health/perinatal-mental-health-programme-and-pathways/
7. Northern Ireland: https://www.health-ni.gov.uk/news/swann-approves-funding-new-perinatal-mental-health-delivery-model 
8. Republic of Ireland: https://www.hse.ie/eng/services/list/4/mental-health-services/specialist-perinatal-mental-health/
9. Darwin, Z., Domoney, J.,Iles, J. et al. Involving and supporting partners and other family members in specialist perinatal mental health services. NHS England (2021) https://www.england.nhs.uk/wp-content/uploads/2021/03/Good-practice-guide-March-2021.pdf

Further reading and links to resources will be provided by individual speakers

Speakers and Facilitators: Dr Lucinda Green, Dr Liz McDonald & Dr Maddalena Miele

Intended learning objectives

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

1. Understand the course of depression, OCD, Schizophrenia, Bipolar Disorder and Postpartum 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 and Links 

1. National Institute for Health and Care Excellence (2014). Antenatal and Postnatal Mental Health - Clinical Management and Service Guidance. Clinical Guideline 192. https://www.nice.org.uk/guidance/cg192/resources/antenatal-and-postnatal-mental-health-clinical-management-and-service-guidance-pdf-35109869806789
2. Pre-Birth Planning: Best Practice Toolkit for Perinatal Mental Health Services (2019) https://www.transformationpartnersinhealthandcare.nhs.uk/wp-content/uploads/2019/01/Pre-birth-planning-guidance-for-Perinatal-Mental-Health-Networks.pdf
3. Maternal OCD: https://maternalocd.org/
4. Action on Postpartum Psychosis: https://www.app-network.org/
5. Birth Trauma Association: https://www.birthtraumaassociation.org.uk/
   

Further reading and links to resources will be provided by individual speakers

Speakers and Facilitators: Dr Angelika Wieck, Dr Emily Finch, Prof Ian Jones, Dr Lucinda Green & Dr Maddalena Miele

Intended learning objectives

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

1. Understand the issues encountered in measuring how common substance misuse in pregnancy is.
2. Explore ways to identify substance misuse in pregnancy.
3. Understand what interventions are available to reduce the harm from substance misuse in pregnancy.
4. Demonstrate a basic knowledge of the current clinical approaches to assessing parent-infant relationships.
5. Outline the determinants of a sensitive parent-infant interaction.
6. Understand the keyways in which perinatal mental health problems can affect the ability of women to interact with their infant.
7. 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.

Recommend reading and links

1. Clinical Guidelines on Drug Misuse and Dependence Update 2017 Independent Expert Working Group (2017) Drug misuse and dependence: UK guidelines on clinical management. London: Department of Health - page 220 pregnancy section.  https://www.gov.uk/government/publications/drug-misuse-and-dependence-uk-guidelines-on-clinical-management
2. P.O. Svanberg , J. Barlow & W. Tigbe (2013) The Parent–Infant Interaction Observation Scale: reliability and validity of a screening tool, Journal of Reproductive and Infant Psychology, 31:1, 5-14.
3. The Association for Infant Mental Health: https://aimh.uk/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. https://www.bap.org.uk/pdfs/BAP_Guidelines-Perinatal.pdf
4. National Institute for Health and Care Excellence (2014). Antenatal and Postnatal Mental Health - Clinical Management and Service Guidance. Clinical Guideline 192.
5. MHRA: Valproate use by women and girls (2018). https://www.gov.uk/guidance/valproate-use-by-women-and-girls
6. Pre-conception advice: Best Practice Toolkit for Perinatal Mental Health Service (2019) Pan-London Perinatal Mental Health Networks. https://www.transformationpartnersinhealthandcare.nhs.uk/wp-content/uploads/2019/05/Pre-conception-advice-Best-Practice-Toolkit-for-Perinatal-Mental-Health-Services.pdf
7. 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
8. Best Use of Medicines in Pregnancy: https://www.medicinesinpregnancy.org/
9. Drugs and Lactation Database: https://www.ncbi.nlm.nih.gov/books/NBK501922/

 

Further reading and links to resources will be provided by individual speakers

Speakers and Facilitators: Dr Angelika Wieck, Professor Ian Jones, Dr Maddalena Miele, and Dr Lucinda Green

Mandatory reading:

For this day, we will be holding a session on ‘How do we interpret the evidence in relation to prescribing in pregnancy?’ with Dr Angelika Wieck & Professor Ian Jones.

For this session, there are mandatory papers you must read to participate in the session. Those are:

The letter from Dr Wieck and Professor Jones. Which outlines how the session will be run. The letter can be read here.

• Paper 1 with Dr Angelika Wieck – Grigoriadis et al. Pregnancy and Delivery Outcomes Following Benzodiazepine Exposure: A Systematic Review and Meta-analysis. Can J Psychiatry. 2020 Dec;65(12):821-834. doi: 10.1177/0706743720904860
  • Paper 1: supplement
• Paper 2 with Professor Ian Jones – Maternal Use of Specific Antidepressant Medications During Early Pregnancy and the Risk of Selected Birth Defects. Anderson et al. JAMA Psychiatry. doi:10.1001/jamapsychiatry.2020.2453

Intended learning objectives

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

1. Understand the kinds of methodological problems that hamper research into the reproductive safety of psychotropic drugs and be able to take these into account when interpreting peer-reviewed publications.
2. Be able to apply current evidence and general principles for the pharmacological management of pregnant and breastfeeding women to clinical scenarios.
3. 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.
4. 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.

Recommend reading and links

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. LARA-VP - Linking Abuse and Recovery through Advocacy for Victims and Perpetrators – A resource to help mental health professionals identify and respond to Domestic Violence and Abuse.
   

Further reading and links to resources will be provided by individual speakers.

Speakers & Facilitators: Dr Maddalena Miele, Dr Lucinda Green, Dr Nic Horley, & Dr Roch Cantwell

Intended learning objectives

At the end of day 5 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 of personality disorder by perinatal mental health services.
3. Understand the different psychological therapies for women with mental disorders and their use during the perinatal period.
4. Describe the epidemiology of self-harm and suicide in the perinatal period.
5. Describe the distinctive clinical features of maternal suicide.
6. Recognise risk in relation to maternal suicide and apply this to clinical assessment.
7. Understand the advantages of compassionate leadership approaches for leaders and teams.
8. Recognise the importance of self-compassion

Recommend reading and links

1. Oates M & Cantwell R (2011) Deaths due to psychiatric causes. Saving Mothers’ Lives: Reviewing maternal deaths to make motherhood safer 2006- 2008. British Journal of Obstetrics and Gynaecology, 118 (s1), 132-142.
2. 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.
3. 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
4. Andrew Cairns, Sara Kenyon, Roshni Patel, Kathryn Bunch and Marian Knight on behalf of the MBRRACE-UK mental health chapter-writing group (2022) In Knight M, Bunch K, Patel R, Shakespeare J, Kotnis R, Kenyon S, Kurinczuk JJ (Eds.) 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. https://www.npeu.ox.ac.uk/mbrrace-uk/reports

 Further reading and links to resources will be provided by individual speakers