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Guidelines

Maternity and Neonatal Psychological Interventions

The Maternity & Neonatal Psychological Interventions (MNPI) teamsupports common and/or mild to moderate psychological needs of the maternity and neonatal population. It provides in- and out-patient assessments and evidence-based psychological interventions and is based at The Simpson Centre for Reproductive Health, RIE, and St John’s hospital, Livingston. The MNPI team includes clinical psychologists, clinical associates in applied psychology, and specialist midwifery staff. It works closely with NHS Lothian colleagues in maternity and neonatal care, the Parent and Infant Relationship Service (PAIRS), Community Perinatal Mental Health Team (CPMHT), local sector mental health teams, and third sector specialist partners. Further details are available on the intranet: MNPI intranet link.

Services offered include: inpatient maternity mental health review and signposting service (RIE); inpatient neonatal coping support (RIE and St John’s); pan Lothian outpatient assessment and treatment. Patients may be offered consultation, assessment, group and individual based treatments, in line with Scottish Government guidance – please see the referral criteria section for more detail. Appointments may be face-to-face, telephone, video-consultation using ‘Near Me’ or home visits. 

Those referred need to have:

  • mental health issues directly related to a previous or current pregnancy;
  • or have an infant whose health has been significantly compromised;
  • or have a mental health issue directly affecting maternity care and amenable to psychological therapies.

The MNPI service does not provide an urgent or emergency assessment service for outpatient referrals. Please use existing local emergency referral pathways.

Mild to moderate mental health difficulties outwith MNPI criteria.

Women and birthing people with a mild-moderate mental health condition, not meeting the criteria for the MNPI service, should engage initially with first-line treatment in primary care, including options such as local counselling services, cCBT, and medication where indicated. Where appropriate, please also refer to third sector organisations, such as CrossReach Perinatal counselling, Aberlour neonatal befriending project, JUNO peer support groups, DadsRock, Pregnancy Counselling & Care (Scotland). Please see Primary Care Management and the Resources & Links sections for further information and contact details, particularly in the ‘alternatives to referral’ section.

Where additional parenting support is required, this should be discussed with the Health Visitor and local agencies such as Home Start, Sure Start, Early Years Centre and Children’s Services. Children’s planning meetings should be considered, in line with GIRFEC guidance.

Where there are concerns about domestic violence or child protection – please manage in line with national and local guidance. Referral to NHS Lothian’s MNPI should not be a substitute for involving local children’s services where indicated. Please see Child Protection for further detail.

Accessibility

NHS Lothian’s MNPI service is keen to ensure equity of access to service users from our diverse communities, including where English is not the first language.  In this case, please inform the service so that interpreting services can be arranged where appropriate, or other approaches to facilitate engagement. The service is keen to ensure equity of access to services for individuals from LGBTQ+ backgrounds including gestational fathers where they meet the referral criteria.

    Referral Guidelines

    Who can refer:

    Any health professional as well as allied and other mental health professionals.

    Neonatal/Special care families only: Professional referral as above, or self-referral to the MNPI team during inpatient stay or in the first year following baby’s discharge.

    Who to refer:

    Referral criteria comply with the “Delivering Effective Services (DES)” Report (2019), providing psychological interventions for women and birthing people with: 

    • Previous pregnancy complication, loss or birth trauma affecting mental health in the current pregnancy 
    • Infants whose health is significantly compromised and who require NICU or SCBU care (up to 1 year post baby’s discharge from neonatal care)
    • Pregnancy complication, loss, or birth trauma* affecting mental health (*up to one year postnatal)
    • Mental health difficulties amenable to psychological therapies which directly affect maternity care, e.g., tokophobia 

    [NB – needle phobia pathway – consultation support only – due to resource limitations referral for needle phobia in pregnancy follows the pre-existing pathway with local adult mental health teams].

    Direct referrals are accepted from any health professional for difficulties including:

    Emotional difficulties e.g., anxiety or re-emergent PTSD during a current pregnancy for women and birthing people who present with specific difficulties amenable to psychological intervention and:

    • have had previous experiences of significant pregnancy complications, birth trauma, neonatal care, or baby loss and this is assessed to be negatively impacting mental health and maternity care in the current pregnancy
    • present with significant pregnancy or birth related anxiety negatively impacting engagement with maternity care or preparation for birth e.g., tokophobia (fear of childbirth)
    • present with complex problems of adjustment to pregnancy and childbirth that affect maternity care and are amenable to psychologically informed supportive interventions e.g., previous experiences of sexual abuse.

    Mental health and/or parent-infant relationship difficulties in the first postnatal year for women, birthing people, (and partners if baby had inpatient neonatal care) when:

    • baby is currently receiving inpatient neonatal or special baby care and parent(s) present with associated acute stress and/or significant emotional difficulties
    • baby had inpatient neonatal or special baby care in the past year and parent(s) currently present with significant emotional difficulties e.g., PTSD, and/or negatively impacted parent-infant relationships associated with these experiences that have persisted for more than 4 weeks (this support is available over the first year from date of baby’s discharge from the unit).
    • mother/birthing person experienced birth as traumatic and presents with emotional difficulties e.g., PTSD, and/or negatively impacted parent-infant relationships that have persisted for more than 4 weeks.
    • mother/birthing person meets criteria for PTSD in addition to grief response after baby loss in the past year (NB: MNPI has been resourced to support baby loss when gestation more than 24 weeks gestation or less than 24 weeks if baby has received care in the neonatal unit) and would benefit from a time-limited intervention targeting trauma responding. MNPI is not a specialist bereavement service, and first line supports for individuals facing baby loss can be accessed via local 3rd sector supports e.g., Held in Our Hearts, SANDS, Scottish Cot Death Trust, SIMBA, as well as through non-baby loss focussed supports such as CRUSE.

    The Birth Reflections Clinic offers a single appointment review for women and birthing people who have unresolved emotional difficulties relating to the birth.

    If the referred woman or birthing person will not be or is not the primary carer for the infant and she would benefit from specific support related to her maternity care journey or following her birth experience in the ways described above, please contact the team to discuss in the first instance.

    Who not to refer:

    • Those requiring emergency assessment, which should be sought through existing local emergency referral pathways
    • Those whose mental health difficulties are longstanding, do not impact current maternity or neonatal care, and/or do not stem from experiences of maternity or neonatal care
    • Women who present with severe mental health difficulties should be referred to the Community Perinatal Mental Health Team:
      • For advice about referrals, please contact the Professionals Clinical Advice Line, available for all professionals across Lothian: 01506 523918 (53918): Monday, Wednesday, Thursday, and Friday 10:00 – 12:00 each week, except public holidays.
    • Women and birthing people whose babies are now over a year old (or more than one year post discharge from the neonatal or special care baby unit)
    • Women, birthing people, or partners who have sadly experienced baby loss, who are going through their individual, unfolding grief journey, and who would be better supported by a specialist bereavement service to ‘walk alongside’ such as Held in Our Hearts, SiMBA, SANDS and the Scottish Cot Death Trust, as well as through non-baby loss focussed supports such as CRUSE. Please see Resources and Links for further detail.

    How to refer:

    Please note that a SCI-Gateway protocol is under development.

    Pre-referral discussion:

    Please call 0131 242 1554 and your call will be redirected to the clinical team.

    Neonatal/special care inpatient or 1 year post baby’s discharge ONLY:

    Please give families the Neonatal Family Wellbeing Team patient information leaflet which describes the service but also lists resources.

    Professionals can refer by completing the MNPI referral form and emailing to mnpi.mail@nhslothian.scot.nhs.uk

    Families can self-refer by (NB self-referral is restricted to families whose babies have received inpatient neonatal/special care only):

    Email to mnpi.mail@nhslothian.scot.nhs.uk

    Telephone call to 0131 242 1554.

    Aberlour neonatal befriending

    A collaboration between MNPI and Aberlour charity currently for families in East Lothian or EH4. Professionals can refer families of babies who are in or have had inpatient neonatal or special baby care for befriending support. (LINK TO FOLLOW)

    Pregnancy and postnatal referrals:

    Consultation for professionals, group-based interventions, 1:1 interventions. Please discuss the MNPI team’s patient information with the family and with patient consent email a completed MNPI referral form to mnpi.mail@nhslothian.scot.nhs.uk

    Primary Care Management

    Adjustment following recent birth experiences – women, birthing people and partners who have recently experienced a difficult or potentially traumatic birth can be supported within the framework of acute stress responses. Initial responses such as disturbed dreams, some flash backs, or physiological responding can be a normal part of the brain’s processing and adjustment following difficult experiences. Alongside this, after childbirth, families are adjusting to the transition to becoming parents. Even if this is their second, third or more child, each new baby involves an emotional and psychological reorganisation. Some families may find a supported conversationand self-help information useful to understand and manage during this initial period (LINK TO FOLLOW)

    Perinatal mental health difficulties (mild): Silvercloud perinatal wellbeing cCBT – provides online programmes to reduce symptoms of stress, anxiety, low mood or depression. 

    Parent-infant relationship building – Solihull online resources (including resources for NICU parents) are currently available free funded by the Scottish Government and accessible with the code TARTAN. The Solihull resources are on the Inourplace website.  These resources include modules for parents when their baby is currently in or has come home from a neonatal unit.

    Resources and Links

    Alternatives to referral:

    Perinatal mental health supports

    • Referral to Silvercloud Perinatal cCBT – evidence based supported, online modules for perinatal wellbeing.
    • Self or GP referral to CrossReach Perinatal – a local source of counselling and therapeutic groups for parents with children under 2: www.crossreach.org.uk/our-locations/crossreach-perinatal-service 
    • Self-referral to Pregnancy Counselling and Care:  https://counsellingandcare.co.uk/
    • Self-referral to perinatal mental health peer support groups (online and face to face) –www.juno.uk.com
    • Self-referral to perinatal mental health peer support in East Lothian –  PANDAS East Lothian (eastlothianpandas@gmail.com)
    • Professional referral to therapeutic support via The Multicultural Family Base  http://www.mcfb.org.uk/
    • Practical and befriending supports via Home Start Edinburgh https://www.homestartedinburgh.org.uk/
    • Practical and befriending supports via Home Start East Lothian

    https://homestarteastlothian.co.uk/

    https://midlothiansurestart.org.uk/services/therapeutic-services/

    For families facing decision making related to medically complex pregnancies

    Support, information, and advice following baby loss

    Supports for siblings following experiences of baby loss

    Emotional supports for parents of neonatal and special care babies

    General mental health supports

    Helpful links to information and advice for parents

    https://education.gov.scot/parentzone/news-and-events/solihull-online-free-resources-for-parents-and-carers/

    Perinatal mental health and wellbeing information and resources

    • Information on perinatal mental health

    www.maternalmentalhealthscotland.org.uk  and

    www.mind.org.uk/information-support/types-of-mental-health-problems/postnatal-depression-and-perinatal-mental-health/about-maternal-mental-health-problems/

    Perinatal and birth trauma

    Supports for the couple relationship

    MNPI-Referral-form-Aug-2022.docx

    The-Neonatal-Family-Wellbeing-Team-PIL-Feb-2024.pdf

     Maternity-and-Neonatal-Psychological-Interventions-Service-PILS-Feb-2024.pdf

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