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Abstract
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BACKGROUND: For women giving birth in the UK, psychiatric illness and suicide in particular have been a leading overall cause of maternal mortality. Although the most recent Confidential Enquiry into Maternal and Child Health indicated that this is no longer leading causes, mental health problems before and after childbirth have a significant impact on the health of women, family relationships and children's subsequent development. Reports and policy recommendations have highlighted the need for early detection, appropriate referral and management.
AIM: To follow-up the findings of a previous survey that explored the extent to which policy recommendations had been implemented in practice in two strategic health authorities (SHAs).
METHOD: Health professionals from two NHS Trusts selected from the two SHAs involved in the earlier survey were identified, along with professionals from their associated mental health and primary care services. Semi-structured interviews were undertaken with eight participants to examine the facilitators and limiting factors in developing services for women with perinatal mental health problems.
RESULTS: Although women are now being screened for mental health problems at the booking interview, identification at subsequent points during pregnancy was less consistent and those interviewed felt that many women could be missed. There were pockets of good practice, such as a service in primary care for women with mental health concerns, a community psychiatric nurse who received referrals in relation to women during pregnancy and perinatal consultant psychiatrists to whom women may be referred. However, in some instances there were difficulties ensuring that women with mental health problems were followed up in the community, especially where there were complex catchment issues. The professionals interviewed felt that the services were often fragmented with poor liaison between professionals involved.
CONCLUSION: Despite evidence of local service development to enhance the care of women with mental health problems, it would appear from the survey and the follow-up interviews that identification, timely and appropriate referral of women with mental health problems and effective liaison between professionals need further development to meet policy and guidance recommendations. Barriers to progress include the complexity of service provision and funding across health sectors, and the fragmented nature of maternity services. © 2010 The Royal College of Midwives.
Language: en |