Perinatal Mental Health

Service Provision:

The perinatal mental health service aims to provide mental health assessment and treatment to women who are either at risk of, or are affected by, significant mental illness during pregnancy and/or in the first year after childbirth.

The service consists of:

• Lothian Perinatal Community Mental Health Service – which provides outpatient assessment and treatment pre-conceptually, during pregnancy and up to the end of the first postnatal year across the Lothian region.
• The Regional Mother and Baby Unit – a regional specialist mental health inpatient service for pregnant women (from 32 week’s gestation) and postnatal mothers with their babies (up to one year postnatal) that is available to women across Scotland who are the main carers of their infants.

The Lothian Perinatal Community Mental Health Service has recently undergone considerable development and expansion and no longer operates as a tertiary referral service.  

The team accepts direct referrals (with referral criteria) from professionals working across Lothian.  Referrals are triaged daily offering a rapid response. The team also offers a professional’s advice line, giving the opportunity to discuss routine enquiries with the specialist team.  The Service encourages out-of-hours colleagues carrying out any perinatal mental health assessments to contact the team the next working day for discussion and sharing of information.

The service provides outpatient clinic appointment at a number of sites and can arrange home visits if required.

Services include:

•  Pre-conceptual counselling for patients with significant psychiatric illness and/or complex medication regimes (e.g. history of bipolar affective disorder)
•  Mental health assessment and management during pregnancy and the postpartum period (moderate-severe illness)
• Pre-birth planning and monitoring for patients who are at high risk of significant perinatal illness (e.g where there is a history of bipolar affective disorder, previous postpartum psychosis, schizophrenia, significant affective disorder, eating disorder)

The Lothian Perinatal Community Mental Health Service provides a service for patients with established or new diagnoses known to carry particular risks in the perinatal period:

• Post-partum psychosis
• bipolar affective disorder
• schizophrenia, schizoaffective disorder and other psychotic illness
• other severe perinatal mental illness requiring secondary care treatment (e.g. severe perinatal anxiety, OCD, eating disorder)
• severe depression (requiring secondary care treatment)
• a family history of bipolar affective disorder or postpartum psychosis if there is also a personal history of moderate to severe mental illness.
• The Lothian Perinatal Mental Health Service provides advice and consultation to other services including assessment, pre-birth planning and joint working. 

Lothian Perinatal Mental Health Professionals Advice Line

• Lothian Perinatal MH routine advice line for all professionals across Lothian
• Open Monday, Wednesday, Thursday & Friday 10:00 – 12:00  (except public holidays)
• Call: 01506 523918

  Urgent Perinatal Mental Health Advice

• To discuss an urgent clinical matter please contact the team Monday – Friday 09:00 – 17:00 on 01506 524 176
• Out-of-hours the MBU can be contacted on 01506 524175 for advice.

Emergency response

If you suspect post-partum psychosis and/or have concerns about the safety of the mother or baby due to mental illness, then we recommend a low threshold for arranging emergency assessment, through local mental health emergency services. Patients should be directed to A&E, MHAS, IHTT or ACAST (West Lothian) – please see Emergencies Mental Health (Adult) for more detail.  Where indicated, consideration of admission to the mother and baby unit should be made (from 32 week’s gestation until the end of the first postnatal year).  Where appropriate, support and information sharing should be undertaken with local children’s services if there are concerns about infant safety.

Local crisis services should notify the Lothian community perinatal mental health service within one working day, with a view to onwards referral to the Lothian PNMHS where appropriate, including consideration of joint assessment, advice and consultation where indicated.

  Please see the Primary Care Management Section for:

• Background to perinatal mental health and which interventions help
• Identifying high risk women and their management
• Screening for mental health problems (principally done by Midwives and Health Visitors)
• Information on prescribing.