Challenges of working with

mentally ill mothers during pregnancy

and post-partum period and
implications with safeguarding issues

Jerina Spicer October 2009

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 Introduction
Many pregnant women experience psychiatric disorders
in their childbearing years. Emerging research shows
mental illness not only affects the mother's well-being
but may also have significant effects outcome of fetus
Long-term effects on child– anxious child; child abuse;
child neglect; poorer language development;
behavioural problems; slower to learn etc
Long-term effects on mother - inability to care for self;
inability to care for child; inability to make rationale
decisions; Inability to keep self and/or child safe

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 Challenges
Screening/early detection
Assessment
Cultural factors
Diagnosis
Pharmacological treatment

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 Screening and early
detection

“Tell them I’m in here please

mum!”

“Tell them how you feel please

mum!”

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 Screening & early detection
cont..
Identifying women with mental health needs
who become pregnant or have had a baby

Women with severe mental health illness,

psychosis for example, are more likely to
become pregnant and not be aware
Early detection minimises risk of women
slipping through the care net
Early detection ensures appropriate care
planning

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 Assessment
Mental Health assessment
Risk assessment
Psychosocial assessment
Needs assessment

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 Assessment cont..
Factors which can affect assessment
Complexity
Time
Lack of information
Biological factors – age (of mother & child)
Physical health/physical disability
Lifestyle – drugs/alcohol/smoking
Domestic violence
Immigration status (refugee, asylum seeker,
visitor)
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 Cultural factors/influences

•Ethnicity
•Culture – Ramadan and fasting, for
example
•Language
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 Diagnosis

Importance of well formulated diagnosis

- Maternal depression during pregnancy is a
risk factor for low foetal birth weight and
premature delivery
- A woman with postpartum depression may
regard her child with ambivalence, negativity or
disinterest. An adverse effect on the bonding
between mother and child may result.

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 Diagnosis cont
- Anxiety disorders, eating disorders and
psychotic illness, may also predict adverse
birth outcomes.

The sooner the condition is diagnosed,

the more effective the treatment.....

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 Pharmacological treatment
Type and dose of medication
Risk vs. benefits on both mother and child – taking into
account gestation period and/or whether mother is breast-
feeding for example

SSRIs taken after 20 weeks’ gestation may be associated with

an increased risk of persistent pulmonary hypertension in the
neonate (Nice guidance)

Olanzapine for example, is not recommended for breast-feeding

mothers as it is excreted into human milk

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 Implications for safeguarding
• Impact of mental illness on safety of child
• Impact of mental illness on safety of mother
• Planning care
• Providing care

Think mother, think child, think family...

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 Impact of mental illness on
safety of child
Consider child protection issues
Consider the impact of the mother’s mental
health problem on their ability to meet the
needs of their child
Establish whether the child may be at risk
of significant harm
Consider additional support even if the
child may not be at risk of significant harm
Child – as unborn or baby has rights

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 Impact of mental illness on
safety of mother
Consider additional support
Consider increased contact with mental
health professional
Consider admission to hospital

Mother’s rights as a patient and as a

parent need to be respected

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 Planning care
Consider needs of both mother and baby
Liaison with other professionals (H/V, midwives,
CMHTs, M&B unit, social services)
Family and other support network involvement
Confidentiality issues
Clear written care-plan and in place and adhered
to
Providing culturally sensitive information for
mothers and their carers

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 Providing care
Appropriate to level of need and risk
– CMHT; HTT; Inpatient; M&B unit
Ongoing evaluation and review
Effective communication with other professionals
and/or family or other support network

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 Conclusions
Mental Health professionals have responsibility
for assessing and meeting the needs of pregnant
women who are coincidentally experiencing
mental illness
The mother and child have individual needs and
their rights need to be respected
Communication between professionals is
paramount
 The sooner the condition is diagnosed, the more
effective the treatment
 Think mother, think child, think family...

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 Questions

?!?

Thank you
Jerina Spicer MA, PG Dip, RN(MH), Dip Ed
October 2009

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 Refs
 Lewisham Safeguarding Children Board Protocol (2008)- Supporting children and
families affected by parental mental health problems
 NICE Guidelines (2007) – antenatal and postnatal mental health
 SLaM (2008) Protecting children and the public MAPPA guidance
 SLaM (2006) Policy for the Care and Support of Pregnant Women with a
Diagnosis of Severe Mental Illness
 Southwark Area Child Protection Committee / Safeguarding Children Board(2005) -
Joint Service Protocol to meet the needs of children and unborn children whose
parents or carers have mental health problems

Jerina Spicer October 2009

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