Development of as specialist perinatal mental health service and ongoing service evaluation of clinical and cost effectiveness.
This example was originally submitted to demonstrate implemention of NICE guideline CG45. This guideline has now been updated and replaced by CG192. The practice outlined in this example has been reviewed and is consistent with the updated NICE guidance. The updated guidance should be referred to if replicating practice described in this example.
Aims and objectives
Re-audit and compare data regarding perinatal inpatient admissions.
- To look at demographic trends in admissions.
- To gain perspectives on the types of illness that precipitate a mother and baby admission.
- To compare data on recovery.
- To collect data on the impact of the specialist perinatal mental health service on perinatal occupied bed days.
Reasons for implementing your project
Following request from commissioners, it was agreed that one of the service standards for the funding of the perinatal team was continuous audit against national standards. Also, we are responsible for the out of area budget, so need to gather this data routinely to ensure value for money.
A previous audit report published in January 2009 (Denny et al, 2009) concluded that, in relation to its overall population size, there was a lower than expected demand for inpatient perinatal services in Sussex compared with national averages and recommendations provided by the NICE guidance (68%). Following this initial audit commissioning of services in Sussex for women who have severe mental health problems related to pregnancy has changed, in line with recommendations made by NICE for the development of clinical perinatal networks that are closely integrated with community-based mental health services to ensure continuity of care and minimum length of stay should a mother and baby admission be necessary.
The re-audit was timely in the context of the original findings and service development.
How did you implement the project
The new service has five consultant psychiatrists with a special interest in perinatal psychiatry and three part time mental health practitioners. The service provides a coordinated specialist approach for women who develop severe mental health problems related to pregnancy, mothers with post natal mental illness and those with pre-existing psychiatric conditions who become pregnant.
The SPMHS works with women throughout their pregnancy until one year post childbirth, and also takes referrals of young mothers under the age of 18. The service offers direct clinical work in the form of telephone advice, information and signposting, outreach assessment and follow up from the practitioners; access to specialist consultant psychiatry time for those appropriate for the service; and indirect work such as teaching, training, consultation and advice to other healthcare professionals, in particular to primary care and acute medical trusts. The service provides weekly clinics and community outreach across East and West Sussex, usually in collaboration with other teams / services as required.
The results show that admissions to these units continue to be low compared with national data and statistics. This suggests that mainstream psychiatric services may be preventing admissions by providing interventions within the community. This has substantial financial benefit and improves the recovery outcomes and quality of care for women and their families. Domestic violence was indicated on risk assessments for 12 of the 25 women in this more recent sample.
Key learning points
- A mixed model of specialist perinatal mental health service is both clinically and cost effective.
- Domestic violence is increasingly highlighted as a risk factor for this population and the newer NICE guidance on pregnancy and complex social factors should be incorporated within local clinical care pathways.
- Service evaluation and clinical audit is a vital component of implementing this type of service.