Quality statement 5: Comprehensive mental health assessment

Quality statement

Women with a suspected mental health problem in pregnancy or the postnatal period receive a comprehensive mental health assessment.

Rationale

A comprehensive mental health assessment can support accurate diagnosis of a mental health problem in pregnancy or the postnatal period, and can ensure that women are offered the most appropriate treatment at the earliest opportunity. Factors specific to pregnancy or the postnatal period, such as a previous traumatic birth, loss of a child, and other individual circumstances, can help identify additional support needs.

Quality measures

Structure

Evidence of local arrangements and written protocols to ensure that women with a suspected mental health problem in pregnancy or the postnatal period receive a comprehensive mental health assessment.

Data source: Local data collection.

Process

Proportion of women with a suspected mental health problem in pregnancy or within 12 months of giving birth who receive a comprehensive mental health assessment.

Numerator – the number in the denominator who receive a comprehensive mental health assessment.

Denominator – the number of women with a suspected mental health problem who are pregnant or have given birth within the past 12 months.

Data source: Local data collection.

What the quality statement means for service providers, healthcare professionals and commissioners

Service providers (primary care and general mental health services) provide resources that support professionals to carry out comprehensive mental health assessments for women with a suspected mental health problem in pregnancy or the postnatal period.

Healthcare professionals (GPs and mental health professionals) carry out comprehensive mental health assessments for women with a suspected mental health problem in pregnancy or the postnatal period to aid diagnosis and identify appropriate support.

Commissioners (NHS England area teams and clinical commissioning groups) specify that comprehensive mental health assessments are carried out for women with a suspected mental health problem in pregnancy or the postnatal period.

What the quality statement means for patients, service users and carers

Women who may have a mental health problem in pregnancy or within a year after giving birth have a full assessment to find out if they have a mental health problem and whether they need extra support.

Source guidance

Definitions of terms used in this quality statement

Comprehensive mental health assessment

Assessment and diagnosis of a suspected mental health problem in pregnancy and the postnatal period should include:

  • history of any mental health problem, including in pregnancy or the postnatal period

  • physical wellbeing (including weight, smoking, nutrition and activity level) and history of any physical health problem

  • alcohol and drug misuse

  • the woman's attitude towards the pregnancy, including denial of pregnancy

  • the woman's experience of pregnancy and any problems experienced by her, the fetus or the baby

  • the mother–baby relationship

  • any past or present treatment for a mental health problem, and response to any treatment

  • social networks and quality of interpersonal relationships

  • living conditions and social isolation

  • family history (first‑degree relative) of mental health problems

  • domestic violence and abuse, sexual abuse, trauma or childhood maltreatment

  • housing, employment, economic and immigration status

  • responsibilities as a carer for other children and young people or other adults.

    [Antenatal and postnatal mental health (NICE guideline CG192) recommendation 1.6.1]

Postnatal period

Up to 1 year after childbirth.

[Antenatal and postnatal mental health (NICE guideline CG192)]

Suspected mental health problem

Women might be suspected to have a mental health problem if they have a history of a mental health problem or possible symptoms (such as mood difficulties or detachment from their pregnancy or baby).

[Expert consensus]

Equality and diversity considerations

Healthcare professionals should ensure that, in comprehensive mental health assessments with all women, they understand variations in the presentation of mental health problems, and are sensitive to any potential concerns about disclosing mental health problems. This includes ensuring that they are culturally competent in their discussions with women from black, Asian and minority ethnic groups to support full and meaningful discussion. Women should have access to an interpreter or independent advocate if needed.

When assessing or treating a mental health problem in pregnancy or the postnatal period, healthcare professionals should take account of any learning disabilities or acquired cognitive impairments, and assess the need to consult with a specialist when developing care plans.