This page has been created for professionals and therefore some of the content may not be understood by members of the public. 

  • Referrals are accepted from health professionals involved in the care of women during pregnancy and within 24 months of delivery where the woman has a moderate to complex or severe perinatal mental health disorder or is at high risk of serious postpartum mental illness.
  • Referrals are also accepted for women contemplating a pregnancy who complex or severe mental health problem (past or present)
  • The SPCMHT acts as a ‘one stop shop’ – maternity services should refer where appropriate even if the woman is already known to other mental health services.
  • Women with primary addiction problems should be referred to their local Community substance misuse team in the first instance.
  • Women under 16 years of age should be referred to CAMHS in the first instance.
  • Note: sudden changes in mental state in late pregnancy or the early postpartum period should always be taken seriously.
  • Women who have a learning disability where complex or severe mental health problems are also present.
  • If there is an emergency and the woman is unable to keep herself safe for the 4hr response or if the SPCMHT is not able to respond within 4hrs, then other emergency pathways should be considered, for example, HTT/MHLT and A&E (only if they have a medical emergency or the woman cannot keep themselves safe). For all cases in working hours, ring your local SPCMHT for advice.

Red flags

The most recent confidential enquiry into maternal deaths has identified that almost a quarter of women who died between 6 weeks and one year after pregnancy died of mental health related causes. One in seven of the women died by suicide. Analysis of the deaths identified the following ‘red flag’ signs for severe maternal illness that require urgent senior psychiatric assessment:

  • New thoughts or acts of violent self-harm
  • New and persistent expressions of incompetency as a mother or estrangement from the infant
  • Recent significant change in mental state or emergence of new symptoms

Pre-pregnancy – Pre-conception advice

  • Pre-existing bipolar disorder: Refer to SPCMHT
  • Pre-existing schizophrenia: Refer to SPCMHT
  • Previous postpartum psychosis: Refer to SPCMHT

During Pregnancy

  • Pre-existing bipolar disorder: Refer to SPCMHT
  • Pre-existing schizophrenia or other psychosis: Refer to SPCMHT
  • Previous postpartum psychosis: Refer to SPCMHT
  • Current suicidality, psychosis, severe depressive, severe anxiety or severe obsessive-compulsive symptoms, eating disorder: Refer to SPCMHT
  • Previous inpatient mental health care : Contact SPCMHT for advice
  • Mild depression or anxiety: Refer to GP/IAPT/Primary Care Mental Health Team, (or equivalent i.e. START) ,  unless (i.e., refer to SPCMHT  if)
    • 10 relative with bipolar disorder or postpartum psychosis
    • Significant change in mental state in late pregnancy
  • Family history of severe perinatal illness in first-degree relative: In absence of personal illness, ensure close monitoring by maternity and primary care. Refer if any change in mental state in late pregnancy.

Postpartum

  • Psychosis, moderate to severe depression, anxiety or severe obsessive-compulsive symptoms and eating disorders: Refer to SPCMHT
  • Current suicidality?: Contact SPCMHT for advice
  • Mild depression or anxiety: Refer to GP/IAPT/Primary Care Mental Health Team (or equivalent) refer to SPCMHT if First degree relative with bipolar disorder or postpartum psychosis or significant interference with mother-infant relationship
  • Family history of severe perinatal illness in first degree relative: In absence of personal illness, ensure close monitoring by maternity and primary care. Refer if any change in mental state in early postpartum.