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  • Referrals are accepted from health professionals involved in the care of women who are pregnant or who have given birth within the last 12 months who present with severe/complex mental health problems. Women may remain under the care of the service for up to 24 months when receiving psychological therapies.
  • Service users who are pregnant or who have given birth within the last 12 months with a history of severe/complex mental health problems, who may be at risk of relapse. For service users who have been open to perinatal in the 12 months postnatal period can be referred for a perinatal review if they relapse within the 24 month postnatal period.
  • Service users who have given birth within the last 24 months, presenting with any of the perinatal service inclusion criteria, that were missed in the first 12 months postnatal. In these circumstances the service may offer a one off assessment to support care planning with the referring team or advice on signposting to the most appropriate service.
  • Referrals are also accepted for women contemplating a pregnancy, who have had or have severe mental health problem.
  • 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.
  • Women who have a learning disability where complex or severe mental health problems are also present.
  • If there is an emergency (suspected Postpartum Psychosis) and the woman is unable to keep herself safe for the 4hr response or if the SPCMHT* is not able to co-ordinate a response within 4hrs such as out of hours, then other emergency pathways should be considered, for example, Initial Response Service (if in the community) Mental Health Liaison Team (if in A&E/Urgent Care, None LSCFT ward), or Ambulance (only if they have a medical emergency or the woman cannot keep themselves safe). *Note: MHLT will respond to all emergency assessment requests for A&E/UC/None LSCFT wards in Pennine Lancs, MHLT will liaise with Pennine Lancs SPCMHT for support/advice/guidance with these cases as required.

Perinatal Red flags

The following perinatal ‘red flag’ risk signs, require an urgent (within 2 working days) 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
  • Severe Insomnia. (Sleep disturbance is very common in relation to MI and psychological issues). However, in these women the severity of insomnia is very marked and persisted despite the use of hypnotic medication.

Pre-pregnancy:

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

During Pregnancy

  • Pre-existing bipolar disorder: Refer to SPCMHT
  • Pre-existing schizophrenia or other psychosis: Refer to SPCMHT
  • Previous postpartum psychosis: Refer to SPCMHT
  • 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/Talking Therapies/Primary Care Mental Health Team (or equivalent)
  • Current suicidality: Contact SPCMHT for advice
  • Family history of severe perinatal illness in first-degree relative: In absence of personal illness, ensure close monitoring by maternity and primary care. Refer to SPCMHT if any change in mental state in late pregnancy.

Postpartum

  • Psychosis, severe depression, severe 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.
  • Moderate Perinatal Mental Health symptoms with one or more of the following (refer to SPCMHT):
    • History of severe mental illness, or first degree relative with SMI.
    • Significant Risk of postnatal relapse identified
    • Risk / Perinatal Red Flags identified
    • Comorbidity exists such as in the case of physical health, alcohol/ substance misuse, disordered eating, complex trauma or personality disorder, a learning disability (alongside mental health symptoms).
    • Has completed talking therapy approaches in the last 6months, with little effect.
    • Has tried psychotropic medications with little effect.
    • Significant self-harm or repeated suicidal ideation.
    • Significant impact on parent infant relationship / bonding.
    • Significant level of distress, related to mental health symptoms.
    • Significant impact on level of functioning, related to mental health symptoms.