The Community Perinatal Mental Health Service Team welcomes referrals across the NHS Lothian area for women in the perinatal period (from pre-conceptual advice, until the baby’s 1st birthday). Direct referrals are accepted from any health professional.
Please note that the team can only accept referrals for women who are, or will be, the primary carer for the baby.
The Lothian CPNMHS consists of perinatal psychiatrists (Dr Gleadow Ware, Dr Argent, Dr Coyle), Team Leader (Joanne Paterson) Community Psychiatric Nurses (designated nurses covering specific Lothian regions), Nursery Nurses, a Perinatal Social Worker and Occupational Therapy.
Professionals Clinical Advice Line
We offer routine perinatal mental health advice to all professionals across Lothian:
- Monday, Wednesday, Thursday and Friday 10:00 – 12:00 each week, except public holidays.
- Please call on 01506 523918 (53918) during these times.
Should you wish to discuss an urgent clinical matter or referral you can contact us on 01506 524176 (54716) Monday – Friday 09:00-17:00 or the Mother & Baby Unit on 01506 524175 (54175) out with these times.
Advice can also be sought by email: pnmhs@nhslothian.scot.nhs.uk
PLEASE NOTE THAT THESE PHONE NUMBERS / EMAIL ADDRESS ARE FOR PROFESSIONAL USE ONLY.
Emergency response
If you suspect post-partum psychosis and/or have concerns about the safety of the mother or baby, then we recommend a low threshold for arranging emergency assessment.
Women who report new thoughts of violent self-harm, sudden onset or rapidly worsening symptoms, or persistent feelings of estrangement from their infant require urgent assessment.
The perinatal mental health service can be contacted directly by telephone to discuss urgent assessments and may advise assessment at A&E, MHAS, IHTT or ACAST (W Lothian).
Where admission is required, that should be discussed with the Regional Mother and Baby Unit (from 32 week’s pregnancy – end first postnatal year) or local adult mental health team (<32 weeks’ gestation or where the woman is not the main carer of infant).
Service provided.
The Lothian Community Perinatal Mental Health Service (PNMHS) is based at St John’s hospital, Livingston, and provides outreach across the City of Edinburgh, East Lothian, Midlothian and West Lothian. These outreach services include clinics at a variety of locations including Edinburgh Royal Infirmary, Musselburgh Primary Care Centre, Sighthill and Pennywell Health Centres. The Lothian PNMHS provides face to face and remote assessments (via telephone or video-consultation using ‘Near Me’) and can also undertake home visits.
The Lothian Perinatal Community Mental Health Service does not currently provide an emergency assessment service. If that is needed, please use existing local urgent referral pathways such as MHAS (see Emergencies Mental Health (Adult)) or self-presentation at A&E for assessment. However, the PNMHS is happy to receive onwards referrals from existing crisis services and to offer joint assessment where possible.
Services provided 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).
Maternity Liaison
The Lothian PNMHS provides in-reach to maternity wards at the Royal Infirmary Hospital in Edinburgh and St John’s Hospital in Livingston for patients on their caseload and works in collaboration with liaison psychiatry services on both sites regarding new referrals.
Outpatient maternity liaison is also available, for example referrals for people with tokophobia, needle phobia or birth trauma where the needs of the patient are complex, and their psychological distress may be impacting on their maternity care / mental health.
Referrals should be made following discussion with the Lothian CPNMHS advice line or via e-mail using the referral form (as above).
The Lothian PNMHS works in collaboration with local maternity services and alongside the Maternity and Neonatal Psychological Interventions service (MNPI).
In the future, psychological intervention will be available for women who meet the criteria of the Lothian PNMHS, including specific parent-infant therapist intervention. That is managed as a specialty service within Royal Edinburgh Associated Services.
Joint Working and Co-morbidity
- For patients who have an eating disorder requiring secondary care intervention it is expected that joint management with eating disorder services is provided and a referral to eating disorder services should also be made. Primary care management of physical monitoring should be followed as per existing guidelines. Physical monitoring findings should be shared actively with the maternity team involved (community midwife, obstetrician).
- For patients who have a co-morbid substance misuse disorder it is expected that joint management with substance misuse services is provided and a referral to substance misuse services should also be made.
- For patients with a co-morbid learning disability, it is expected that joint management with learning disability services and a referral to learning disability psychiatry should also be made.
- For patients under the age of 18 years, it is expected that joint management with Child and Adolescent Mental Health Services is provided and a priority referral to CAMHS services should also be made to ensure timely review.
Management of mild-moderate mental health conditions in primary care
Women who have a mild-moderate mental health condition should be engaged with first-line treatment in primary care, including options such as referral to local counselling services or primary care psychology, and medication where indicated. Where appropriate, please also refer to third sector organisations, such as Crossreach counselling, Aberlour perinatal befriending project, JUNO peer support groups, pregnancy and parents’ centres, and other relevant agencies such as Pregnancy Counselling & Care (Scotland). Please see Primary Care Management and the Resources & Links section for further information and contact details.
Where additional parenting support is required, this should be discussed with the Health Visitor and involvement with 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.
Medication information and advice can also be sought from NHS Lothian Medicines Information Service (0131 242 2920). Online resources, updated nationally, include:
- ‘Best Use of Medicines in Pregnancy’ – www.bumps.org.uk
- Choice and Medication portal (http://www.choiceandmedication.org/nhs24/ (then go to ‘Drugs in Pregnancy’ which covers from pre-conceptual to the postnatal period and includes ‘Handy Charts’ which provide a comparison of medication options).
The Lothian Perinatal Mental Health Service is happy to provide advice on management options to primary care if needed.
Domestic Violence
Where there are concerns about domestic violence, please also make a referral to local domestic violence services including Women’s Aid, local police protection units and children’s services, to ensure infant safety and wellbeing (see below).
Infant Safety, Wellbeing and Child Protection
The Lothian PNMHS has a duty to safeguard and promote children and young people’s welfare, and to recognise, respond and share concerns or worries about possible abuse and harm. Where there are concerns about significant harm or abuse of an unborn child, child or young person, a referral should be made to the responsible local children Social Work department immediately or direct to the child protection hub in line with the Edinburgh & Lothian’s Child Protection Procedures. Referral to the Lothian PNMHS should not be a substitute for involving local children’s services where appropriate.
Other supportive measures such as consultation with the infant’s health visitor and other infant wellbeing measures such as a child’s planning meeting within the GIRFEC framework may also be useful to consider.
Where welfare concerns are identified, practitioners should discuss these with the family before making a referral to the local children’s social work department, or perinatal mental health social worker, unless this discussion places the child at increased risk.
Who can refer:
Referrals are accepted from any health professionals including Midwives, GPs, Health Visitors, Psychiatrists and CPNs.
Referrals can also be accepted directly from Social Workers.
Who to refer:
- Women with current moderate/severe mental ill health that has not responded to management in Primary Care and/or where the risks cannot be managed safely in Primary Care.
- Women – even if they appear well – who:
- Have a previous history of perinatal mental illness (e.g. postnatal depression, postpartum psychosis, severe depression, anxiety, PTSD or OCD), that required treatment in hospital/secondary care.
- Have a diagnosis of bipolar affective disorder, schizophrenia, schizoaffective disorder, or other psychotic illness. Previous history of severe recurrent depression that required treatment in hospital/secondary care.
- Have a family history of bipolar affective disorder, schizophrenia or postpartum psychosis where there is also a personal history of moderate – severe mental ill-health.
- Are currently prescribed a complex psychotropic regime, Sodium Valproate, or other mood stabiliser, for pre-conceptual advice.
The Lothian PNMHS 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, which can arrange interpreting services where appropriate, or other approaches to facilitate engagement.
The Lothian PNMHS is keen to ensure equity of access to services from LGBTQ+ backgrounds including gestational fathers where there is a moderate-complex history of mental illness.
Who not to refer:
Women whose babies are over a year old or where the woman is not the primary carer for the infant.
Those requiring emergency assessment, which should be sought through existing local urgent referral pathways (see Emergencies Mental Health (Adults) for detail).
How to refer:
All Referrals to the PNMHS should be made using the following: PNMHS Referral Form. This should be emailed to the team inbox: pnmhs@nhslothian.scot.nhs.uk.
A SCI Gateway protocol is under development.
