Specialist Mother and Baby Mental Health service

What we offer:

• preconception advice, pregnancy and birth planning if you’ve previously experienced mental illness
• advice about prescribing medication for mental health reasons during pregnancy and during breastfeeding e.g. anti-depressants
• consultation to assess risk and treatment options
• assessment which reflects what’s important to you during your pregnancy
• shared development of a care plan that meets your personal needs
• planning for your postnatal period to promote wellness and prevent relapse
• information about other support services
• help to build a positive relationship with your baby
• psychological therapy
• occupational therapy

Therapies

Some women may find talking therapies or parent-infant therapy helpful. Other women may find that activities, doing different things, can help their mental well-being.

We offer a range of different therapies. For example, we offer therapies:

• to help you understand your experience and to work out different ways of thinking and feeling;
  • to help you recover from traumatic events that are distressing to you;
  • to help you bond with your baby;
  • to help you change behaviours, which in turn change how you are thinking and feeling;
  • to help relieve physical discomfort.

We will talk with you to work out together what therapy may be may most useful to you and we will explain what we will do together if you decide that you want to make use of a therapy.

We understand that mums need to be able to care for and enjoy their babies and so the therapies we offer focus on helping you to be able to do this. Because we can only work with you up to a year after the birth of your baby, we offer a limited number of sessions of therapy but we also help work out if you may benefit from other therapies in the future and where you can get these.

• •  Bradford and Craven Talking Therapies -offers a range of treatments for mental health issues such as stress, anxiety and depression.
  • First Response service – 24 hour mental health crisis support
  • Compassion for Parents and Babies Well-being scheme
  • Royal College of Psychiatrists  – rcpsych.ac.uk
  • Action on Postpartum Psychosis – app-network.org
  • Lisa Milne’s blog – born ready to relate

We provide advice and support for women who are at high risk during the perinatal period because they have a history of, or current, severe mental health problems. We also provide pre-conception advice about risks and treatments when considering a future pregnancy.  Women experiencing mental health problems during the perinatal period have specialist treatment needs. We focus on preventing problems and intervening early to promote early recovery.

Information for referrers

Referral form – adult mental health services
Referral criteria form

 Who is the service for?

We support women with a range of mental health problems who are considering having a baby, are pregnant or have a baby under the age of one and have a GP within the Bradford, Airedale, Wharfedale or Craven area. The range of mental health problems includes:

• bipolar disorder
• post-partum psychosis
• schizophrenia
• depression or anxiety (OCD, panic, phobia, birth trauma) if the woman has a first degree relative with bipolar disorder or postpartum psychosis, and/or the woman has a significant change in mental state in late pregnancy or early after birth
• eating disorders
• personality disorders
• severe fear of pregnancy and childbirth 

Referral process

Please discuss the referral before sending in a referral.

A referral form will need to be completed, available by downloading from our website. This will need to be sent/faxed to SPoA (single point of access).

Urgent referrals – for women experiencing a mental health crisis.

Please call the First Response team for an urgent assessment on telephone: 0800 9521181

Red Flags

The following are ‘red flag’ signs for severe maternal illness and require urgent psychiatric assessment:

• Recent significant change in mental state or emergence of new symptoms,
• New thoughts or acts of violent self-harm,
• New and persistent expressions of incompetency as a mother or estrangement from the infant.

Admission to a mother and baby unit should always be considered where a woman has any of the following:

• rapidly changing mental state,
• suicidal ideation (particularly of a violent nature),
• pervasive guilt or hopelessness,
• significant estrangement from the infant,
• new or persistent beliefs of inadequacy as a mother,
• evidence of psychosis

To discuss a referral

Please email perinatalsmabs@bdct.nhs.uk for general advice and liaise about potential referrals. Please leave your telephone number for a call back.

Access and discharge

Women who meet our criteria will be offered an assessment and where appropriate a personalised package of care. We also provide joint work with women who need care coordination by other mental health services.

The service cannot work with mothers after their child’s first birthday.  If the women still need help and support they will be referred on to the most appropriate services available.

• joint work for women currently within secondary mental health services
• specialist assessment and risk assessment
• care coordination
• perinatal outpatient care
• specialist psychological and occupational therapies
• parent-infant assessment, interventions and therapy
• signposting and referral to appropriate interventions and services including Leeds Mother and Baby Unit where appropriate

Referral criteria for pre-conception counselling

• Women of child-bearing age who have a personal history of serious mental illness including bipolar affective disorder, schizophrenia, schizoaffective disorder and severe depressive illness, particularly if associated with psychotic features.
• Women who have had a previous episode of severe perinatal mental illness including post-partum psychosis, severe depressive illness, particularly if associated with suicidality or psychotic features.
• Women with a family history of post-partum psychosis, bipolar disorder, or other serious mental illness, particularly if requiring in-patient treatment.
• Women on Sodium Valproate, Lithium or other anti-epileptic drugs prescribed as a mood stabiliser in bipolar or schizo-affective disorder. 

Pre-conception information for women and referrers

Pre-conception advice is provided to women of child-bearing age who are at risk of developing significant mental health difficulties during pregnancy or postnatally and are considering a pregnancy.

Women can be advised on their individual risk of becoming unwell and management options if they are planning a pregnancy.

A clinic is held at the perinatal service at the BRI Maternity Unit. If demand exceeds our capacity some women may be referred to the Yorkshire and Humber Perinatal Outreach Service in Leeds. The consultation will be with a senior psychiatrist from the perinatal service. In most cases a single 90 minute appointment is sufficient however follow-up appointments can be arranged if required.

The pre-conception counselling clinic provides consultation, information and advice, not ongoing care. Referral to the service for advice on further management in the light of a future pregnancy may be one of the recommendations arising out of the consultation.

Partners and/or other significant family members are encouraged to attend the appointment to involve them in understanding risks and management decisions.

The following areas may be covered during the consultation:

• The woman’s individual risk of becoming unwell.
• Which treatment options may be beneficial during pregnancy.
• Risks and benefits of different medications during pregnancy and breastfeeding; this may include meeting with a pharmacist and discussing the most recent information on medication.
• Relapse prevention strategies.
• Support and monitoring during pregnancy and post-delivery.
• Early warning signs of illness.
• Care planning should the woman become unwell in the perinatal period.

Following the consultation a letter to the woman will be sent to the referrer, GP, and other relevant professionals involved in the woman’s care so that they are aware of the recommendations regarding risks and treatment decisions.

Responsibility for affecting any advice provided in the consultation will reside with the referrer and other professionals involved in the woman’s ongoing care. 

Referral Process for pre-conception counselling

Referrals would usually need to come from the Community Mental Health team or Consultant Psychiatrist. Discussions are welcome and advice to Psychiatrist may in some cases be sufficient.

For women in secondary mental health services a letter from the referring consultant psychiatrist outlining the current situation and reasons for request for pre-conception counselling. Referrals for pre-conception counselling must provide detailed information regarding previous mental health history including in-patient treatment, and a comprehensive drug history to enable a meaningful discussion to take place.

Some women who have been well for a number of years may not be under the care of secondary mental health services currently in which case the GP may make a referral any letters of previous psychiatric involvement, risks and inpatient admissions should be attached – particularly when the woman is from out of area.

We aim to see referrals for pre-conception counselling within 28 days.

We can only accept referrals where the patient has been advised of the purpose of the referral and consents to referral. It should be clarified with the patient by the referrer that this is for information and advice and not for ongoing care and treatment.

We are happy to discuss potential referrals through advice line or email the Perinatal Specialist Team perinatalsmabs@bdct.nhs.uk and Dr Chua or one of the team will respond.

We welcome your views, feedback and suggestions about how we can improve our service. The Patient Advice and Liaison service (PALS) office is open, Monday to Friday from 9.00am – 5.00pm. Telephone 01274 251440 or email: advice.complaints@bdct.nhs.uk

Thinking about how to manage and support infant mental health

Mums, dads, main carers –

Your world may feel like it has suddenly changed. Sometimes it can be helpful to slow down a little and take some time to get to know your baby better.

If you are feeling anxious and worrying about things, pause for a moment and try wondering about what your baby might be thinking or feeling. Remember that their experience may be very different from yours. Your baby is very good at being focused on the now. Sometimes this may help us too. It can take our minds off worrying about what might happen in the future. Spend a little time trying to see the world through your baby’s eyes. Take time to breathe, in particular take a slow breath out, it helps you feel calmer. Your baby is sensitive to how you are feeling and if you are calmer that can help your baby too.

From birth, babies are born ready to relate.

Your baby needs to build a relationship with you, and get to know you and you them, so you both grow together. Take some time to notice what your baby is feeling – by looking at their expressions and body posture. Are they relaxed? Looking happy? Or frustrated? What could you do to show you understand?

When babies show us they are ready to relate (engage) they will have bright eyes – with a new baby, just looking into one another’s eyes is really good for you both. This will release lots of positive hormones in both of your bodies and can help you both feel in tune and relaxed. Your baby will love the sound of your voice! Sing to your baby, they will even recognise songs you sang before they were born. You will notice your baby loves it when you copy their expressions – try making faces with your baby.

As your baby gets a bit older, share simple games like peek- a- boo, or action songs.

Laughter helps your brain feel safer. Find some time to share joy with your baby, in a simple way. Look out for their signs (cues) that they are ready to play, and also ready to stop or have had enough. Sometimes your baby enjoys a game but then after a while they will need a break.

Chat to your baby about what you see and what’s going on. They will engage with the sound of your voice and it helps them learn to understand you.

The more you are able to be in tune with your baby, the easier time will be to spend together. Babies don’t always fit into routines, however if you are able to enjoy time with them they can become your companion and you can both learn to fit into each other’s lives.

Doing every day things together can help feelings of loneliness, you are together. Try having a bath together – skin to skin is great for you both, the warm water is relaxing too, splashing is also fun!

Share feeding times – it can be relaxing for both of you. Take time to enjoy these moments with your baby. If your baby is over 6 months, eat together – you can share tastes of foods and your baby will enjoy exploring food, in particular how it feels, and they will be learning lots too.

Your older baby can do much more but they will still enjoy these things. Going back to the familiar things, which help calm a baby, will calm an older child too. Babies and young children enjoy repetitive games, rhythms, and familiar things such as toys or things you do together. There is no need for lots of toys or busy interactions, which are less easy to keep up now anyway. For example, with an empty cardboard box, hide a toy in it, and enjoy the surprise of finding it: babies can enjoy this again and again and again. Quiet times are important too, this helps your child process all the things they are taking in. When you need to get on with daily tasks, see if there are simple ways to help your child join in – let them try sweeping, or taking things out of the washing machine, or wiping things with a cloth. Children learn by copying the things you do.

Try this with your baby or child:

Attending Exercise

This exercise will help you learn about and appreciate your own individual baby, help you relax with your baby and learn to respond sensitively to your baby.

Try to build the exercise into each week, 5-10 minutes a day, when you are with your baby:

• Get onto the floor or the bed with your baby and watch your baby.
• Let your baby take the lead/initiative.
• You follow your baby’s lead.
• Let your baby explore and you respond to them.
• If your baby asks for some help then do so, but be careful not to start leading.
• A young baby may gaze at your face, you may watch them back, perhaps your baby pulls a face and you could respond by doing the same.
• An older baby may play with some toys, you would respond by playing too but by following their lead and doing as they have done – dropping a ball, putting a piece of cloth in a tub, examining a soft toy.
• Be interested in what they are doing, watch how they may communicate with you and respond to them.

When you are trying to focus on your baby, a worrying thought pops into your head, just notice it and then try to re-focus back on your baby.

After this time think about what you noticed about your baby – what did they do? How did they communicate with you? What did you do? How did they react? What might have been going on in their mind?

Notice that you do not have to keep your baby entertained by initiating things to do, they enjoy you responding to them. You may find this slows things down and you get to understand more about your baby’s pace.

Take time to stay connected to family and friends who you feel supported by. Share your concerns but also have moments when you can talk with them about lighter subjects. Having these moments can help you keep the energy you need to care for your baby.

If you have concerns about your mental well-being make sure you ask for the help you need. Babies need their caregiver to be well. Remember to call your SMABS worker for support for you and for your relationship with your baby: 01274 221180. If you feel frustrated or find it difficult to cope with your baby or toddler, you can also speak to your Health Visitor: 01274 221223.

Have a look on the 0-19 Better Lives, Healthy Futures website for lots of useful information.

The best gift for your child is time shared together with you.

Find out how our Ready to Relate service aims to improve and enhance the parent‐infant relationship and promote infant attachment and optimal infant development.