Specialist Perinatal Mental Health Services

Perinatal mental health services are specialist services for women with a mental health problem. The service is for pregnant women and women with a baby up to one year old who may have an existing or new mental health problem and also women with severer mental health problems and are planning a pregnancy.

Although as many as 1 in 5 women have mental health problems in pregnancy or after birth a perinatal mental health service will usually look after someone who has a more serious or complex mental health problem. So, not every woman with a mental health problem during pregnancy, or after their baby is born, will need this service. You can get good care from your GP and public health nurse (PHN) for milder mental health problems in pregnancy and after birth. If help from the GP or PHN is not enough, your GP can refer you to a perinatal mental health service.

Perinatal mental health services have now been developed in all maternity units/hospitals and provide specialist support to women experiencing mental health problems in pregnancy.

Read Michelle’s story here – outlining one woman’s experience with the perinatal mental health service. The National Programme for Specialist Perinatal Mental Health Services has developed a poster 10 things to know about Perinatal Mental Health  and more recently information on the importance of the development of Irelands first Mother and Baby Unit (MBU)

Click here to watch Michelle’s story

Click here to watch Lititia’s story

Access to the service

Women are now asked specific questions about their mental health as well as their physical health at maternity hospital booking clinic appointments. Women can talk to their midwife and ask for support from the perinatal mental health midwife in their hospital if needed. The GP and Public Health Nurse can also provide support and signposting to the most relevant service for each woman.

You can usually be referred to the SPMHS by any professional involved in your care, such as:

  • Midwife – particularly at booking visits
  • Perinatal Mental Health Midwife
  • Obstetrician
  • GP
  • Genera l Adult Psychiatrist

These services are provided in maternity hospitals and teams try to see women in convenient and child friendly locations. These include both Antenatal clinics and Maternity wards. However, in recent times because of covid-19 the use of Video Enabled Care through Attend Anywhere (AA) has supported women to connect with their perinatal mental health service.  For some women, clinicians can provide support and interventions online through this platform. Your clinician will decide if this is an option following discussion with you. For new mothers, it allows therapy to be provided in their own environment, without the constraints of travel or having to bring a newborn to an appointment. Video calls through AA may provide a blended approach to linking with the service; allowing accessibility for those who have limited transport links or cannot drive following a C-section.

Women with a Mental health problem who are planning a pregnancy

Women with a pre-existing mental health problem can ask their GP or psychiatrist, if they can be referred to a specialist perinatal mental health service to see a perinatal psychiatrist for advice when they are planning a pregnancy. This is particularly important if they have had Bipolar Disorder, Schizophrenia, a history of Postpartum Psychosis or any other psychotic illness. It may also be helpful if they have had other severe mental health problems (e.g. Depression or Obsessive Compulsive Disorder).

Specialist perinatal mental health teams and supports

SPMHS have developed a number of resources to support women at this time. Patient information leaflets are available to read here. They are also available to women and GPs and other frontline  services to order free of charge at www.healthpromotion.ie

Patient Information Leaflets

App for Healthcare Staff   

Image of Perinatal Mental Health app

Healthcare professionals can access the perinatal mental health App which gives specific perinatal mental health information including training materials and contact information for the SPMHS. This information was developed by the specialist teams to support frontline staff such as midwives, public health nurses, adult mental health teams, GPs and practice nurses.

Its aim is to support standardised quality evidenced based practice across the Health Services for women with perinatal mental health problems. It provides contact information for SPMHS newly established since the launch of the National Model of Care in November, 2017.

What is Perinatal Mental Health?

Perinatal mental health disorders are those which complicate pregnancy (antenatal) and the first postnatal year. They include both new onset and a relapse or reoccurrence of pre-existing disorders. Their unique aspect is their potential to affect the relationship between mother, child and family unit with consequent later development of significant emotional and behavioural difficulties in the child. The HSE’s National Specialist Perinatal Mental Health Services Model of Care describes the specialist (secondary and tertiary care) component of an overall perinatal mental health service. Helpful infographic on the estimated number of women affected by Perinatal Mental Health difficulties

Background to new services available

The Specialist Perinatal Mental Health: Model of Care for Ireland was launched on 30th November 2017. The HSE’s then Mental Health Division (MHD), in recognition of the importance of Perinatal Mental Health included in its 2016 Service Plan the development of a Model of Care for Specialist Perinatal Mental Health Services. A National Working Group chaired by Dr. Margo Wrigley completed this work on behalf of the then Mental Health Division in the HSE. Download the Specialist Perinatal Mental Health: Model of Care for Ireland.

This Model of Care supports the seven actions on mental health to be implemented by the HSE’s National Women & Infants Health Programme outlined in Ireland’s first National Maternity Strategy and launched by the Minister for Health in January 2016. The Maternity Strategy maps out the future for maternity and neonatal care from 2016 to 2026, to ensure that it will be safe, standardised, of high-quality and offer a better experience and more choice to women and their families.

Focus of the National Model of Care

The Working Group’s task was to design a specialist Model of Care. The terms of reference encompassed both the strategy for and operation of a specialist perinatal mental health service for Ireland taking into account:

  • The interests of women, infants and their families.
  • Relevant national and international research and evidence based practice and standards.
  • Relevant national and international policy documents and reports.

Whilst the focus of this specialist service will be women with moderate to severe mental illness, it ensures women with milder mental health problems will be both identified and receive appropriate help from skilled staff within maternity services through the development of the role of the mental health midwife nationally. This also plays a central role in educating and training all involved in the delivering of services to women during the antenatal and postnatal periods.

Service Provision

There are 19 maternity services in Ireland. In each hospital group, the maternity service with the highest number of deliveries is the designated hub. In the smaller maternity services, mental health midwives are being employed to work with liaison mental health teams. Access to the service is through your GP or through the booking clinic and the mental health midwife in both hub and spoke sites.

The contact details for Specialist Perinatal Mental Health Service in hub hospitals are:

  • National Maternity Hospital
  • Rotunda Hospital
  • Coombe Women & Infants University Maternity Hospital
  • University Maternity Hospital Limerick
  • Cork University Maternity Hospital
  • Galway University Hospital

Each hub within a hospital group should have a specialist perinatal mental health service. It’s staffing is multidisciplinary and led by a consultant psychiatrist in perinatal psychiatry. In the remaining maternity units (13) referred to as "spokes", the liaison psychiatry team continues to provide the input to the maternity service with the addition of a mental health midwife. This team will be linked to the hub specialist perinatal mental health teams for advice, regular meetings, training, education and clinical opinions.

There are 19 maternity services in Ireland. In each hospital group, the maternity service with the highest number of deliveries is the designated hub. In the smaller maternity services, mental health midwives are being employed to work with liaison mental health teams. Access to the service is through your GP or through the booking clinic and the mental health midwife in both hub and spoke sites. See a full map of Hubs and Spokes in the Specialist Perinatal Mental Health Network.

Hubs Spoke

Goals 2021

  • Support the recruitment of the remaining staff for the 6 hub sites and 1 spoke site
  • Design and deliver a specific training and education schedule to specialist perinatal mental health teams and perinatal mental health midwives
  • Further develop online supports for women seeking information on mental health in
    pregnancy
  • Support other healthcare professionals with the continued updating of the SPMHS App:  https://PMH.healthcarestaff.app
  • Revise core clinical outcome datasets for perinatal mental health services and link with the OoCIO and other key stakeholders to develop a bespoke data system
  • Continue to work closely with the National Women & Infants Health Programme and other relevant service areas
  • Continue to work to establish links with other key clinical areas such as Directors of Midwifery, Primary Care, Mental Health Services and other key partners
  • Support the design and development of the first Mother & Baby Unit in Ireland

Related links

National Standards for Antenatal Education in Ireland

Service Standards for Mother and Baby Units, 6th Ed., (March, 2018)

Contact

Dr. Margo Wrigley, National Clinical Lead, National Programme for Specialist Perinatal Mental Health Services, Clinical Design & Innovation, HSE.

Ms. Fiona O'Riordan, Programme Manager, National Programme for Specialist Perinatal Mental health Services, Clinical Design & Innovation, HSE spec.perinatalmhs@hse.ie