2002 International International Biennial Scientific Meeting

AN INTEGRATED CARE PATHWAY FOR PERINATAL MENTAL ILLNESS: IMPROVING DETECTION AND MANAGEMENT IN GLASGOW, SCOTLAND

Karen Robertson* and Roch Cantwell**

* Greater Glasgow Primary Care NHS Trust, Gartnavel Royal Hospital, Glasgow
** Department of Psychological Medicine, University of Glasgow, Gartnavel Royal Hospital, Glasgow

karen.robertson@gartnavel.glacomen.scot.nhs.uk

Objectives: To ensure standardised evidence based practice in the detection and management of perinatal mental illness and to improve the management of women who have a pre-existing serious mental illness during pregnancy and the first postnatal year.

Methods: The care pathway was designed by a multidisciplinary group and consists of 8 minimum care standards which reflect the recommendations of the evidence based SIGN National Clinical Guideline for Scotland on Postnatal Depression and Puerperal Psychosis. The pathway is commenced at initial booking for antenatal care and continues for the first postnatal year with midwives and health visitors leading the implementation of the care standards. The care pathway and recording tool has been piloted for 12 months and evaluated using qualitative and quantitative methods.

Results: The pathway has ensured women are screened antenatally for risk factors for puerperal psychosis and relapse of pre-existing serious mental illness. Women are being offered additional support during pregnancy and high-risk women are referred to psychiatric services for preventative management. All women are routinely screened postnatally for early signs of puerperal psychosis and the Edinburgh Postnatal Depression Scale is used to aid detection of depression at two recommended points postnatally. Women identified with mental illness are subsequently offered interventions at the appropriate level of service provision.

Conclusions: Emphasis on the detection and management of mental illness antenatally and postnatally is variable throughout Glasgow. Women receive differing standards and levels of care largely dependent upon the geographical area in which they live. The pathway ensures the delivery of a minimum evidence based standard of care for all women, with specific identification of variances from these standards.