Caring for Women with Mental Health Problems...midwifery and maternity care for women whose pregnancy, birth and postnatal experience may be complicated by mental health problems.

Caring for Women with Mental Health ProblemsStandards and Competency Framework for Specialist Maternal Mental Health Midwives

2 | The Royal College of Midwives

Foreword

Midwives ensure that women have a safe and satisfying pregnancy, childbirth and post-natal period. The care that they provide to women, babies and their families is of the utmost importance to our society. The importance of maternal mental health during pregnancy and after birth has gone without the prominence that it deserves for too long, and I am proud of the work that the RCM have done in furtherance of perinatal mental health.

This document sets out the recommendations that we intend will develop a standards and competency framework for specialist midwives, to deliver a capability that is aligned to world-class standards. System-wide problems will however demand system-wide solutions to address the dramatic impact on long-term outcomes for mothers, fathers, children, families and society. By ensuring that all health professionals working with women and their families in the perinatal period are competent to identify women and families in need; by establishing a midwife who specialises in maternal mental health in every maternity trust; and by addressing the disparity of esteem between physical and mental health in pregnancy, childbirth, and postnatal periods, I believe that these recommendations will best serve women, babies and their families both now and in the future. They should be implemented with urgency and vigour.

This work has been set within the political, legal, and technological challenges facing the NHS, and there are undoubtedly challenges in developing a common framework for these specialist midwives. In order to continue supporting women and their families, we will need a greater level of collaboration and awareness from across the workforce, including in the greater use of e-learning and e-networking.

Professor Lisa Bayliss-Pratt Director of Nursing & Deputy Director of Education and Quality, Health Education England.

Contents

Pg 3 RecommendationsPg 9 The Role of the Midwife in Maternal

Mental Health

Pg 4 Introduction Pg 11 Overview of the Framework

Pg 6 Background and context to this documentPg 13 Standards for the Specialist Maternal

Mental Health Midwife

Pg 8 Aims of this documentPg 14 Detailed definition of the competencies

for maternal mental health midwives

Appendices

Pg 27 References and Resources Pg 29 Blank competence sheet

Pg 28 Standards development advisory group members

Pg 30 The six Cs and how they fit into Caring for women with mental health problems

Pg 28 Acknowledgements Pg 30 Case Studies

Caring for Women with Mental Health Problems: Standards and Competency Framework for Specialist Maternal Mental Health Midwives | 3

Recommendations

The recommendations from the Royal College of Midwives (RCM) in relation to the management of women in the perinatal period who experience mental health problems are the following.

1. That every maternity trust has a midwife who specialises in maternal mental health at a senior level. While all midwives have a role in supporting women’s health throughout the perinatal period, a midwife with a specialism in mental health can ensure women, her baby, and her family get the best possible care. Additionally they will support the wider midwifery team and have a key role within the multidisciplinary team in supporting each woman in need.

2. There needs to be a whole system approach to perinatal mental health within each Trust/Health Board. The midwife specialising in maternal mental health needs structures in place to function optimally. There needs to be a well defined role, job description, development plan and clear remit for their work within a local multidisciplinary team that meets national quality standards.

3. That all health professionals working with women in the perinatal period have a basic awareness, knowledge and understanding of perinatal mental health. Professionals in midwifery, health visiting and general practice should be competent in identifying women in need. They should know when to refer women appropriately. This is consistent with the ethos of the NHS Mandate regarding the delivery of high quality, effective, compassionate care and developing the right people with the right skills and the right values. Pre-registration training should equip professionals in this respect.

4. That education and training in perinatal and infant mental health is appropriate to the role. Midwives specialising in this area should be demonstrating enhanced specialist skills as outlined in this document. They will be champions not only for the women in their care, but for highlighting the importance of perinatal mental health in the wider health, social and emotional context. Training providers for midwives should ensure that the courses designed and developed to meet the needs of those striving for specialist status are of high quality.

5. That all maternity professionals should be equally concerned with mental as well as physical health in pregnancy, childbirth and postnatal periods.


Introduction

At least one in ten women is affected by mental disorders in pregnancy and the postnatal period. Around 11% of pregnant women and approximately 13% of early postnatal women experience depressive symptoms, and approximately 5% have a major depressive disorder1. Anxiety disorders in the perinatal period (pregnancy, childbirth and the first postnatal year) are also common, affecting around 13% of women1. Non psychotic mental health disorders are among the most common

morbidities of pregnancy and the postnatal period, with disorders ranging across the whole diagnostic spectrum. Although rates do not differ between pregnant and non-pregnant women2, identification and treatment is lower in pregnancy1. Poor identification and a lack of appropriate and timely support have an impact on the outcomes for mothers, their babies and their families. Women with existing or previous mental health conditions have a higher risk of relapse at this time.

“ Anxiety disorders are common in the perinatal period (pregnancy, childbirth and the first postnatal year) and affect around 13% of women.”


The recent update to the National Institute for Health and Care Excellence (NICE) guidance on Antenatal and postnatal mental health CG1922 provides a wealth of advice and recommendations for maternity teams caring for women with mental health problems in the perinatal period. This covers both women with pre-existing mental illness, and those who develop symptoms within the perinatal period.

Identification and treatment of mental health deterioration during the perinatal period is crucial because the impact can be potentially serious, not only for the woman but also her fetus, child, partner and wider family if the condition is left unrecognised and untreated. Suicide remains a leading cause of maternal death3, and a mother’s poor mental health can potentially negatively affect her child’s cognitive, social, emotional and behavioural development4.

In addition to the cost for individual lives, the financial implications of untreated perinatal mental health problems in line with NICE guidance has been estimated to cost society £8.1bn for every annual birth cohort, largely due to the costs for child mental health support as a result of inadequately or untreated mothers at their time of need5.

It is estimated that approximately half of all cases of perinatal depression and anxiety go undetected despite regular contact with health professionals in the antenatal and postnatal period, and for those that are detected adequate treatment is not received5. This occurs for many reasons including: a fear by women of disclosing their true feelings and symptoms due to a lack of trust in professionals; stigma; a knowledge of time constraints during appointments; and a fear of infant removal by social services6. Equally, health professionals report barriers including a reluctance to open discussions due to lack of time, lack of training, lack of services to refer on to6,7. At the time of writing, almost half of the UK does not have access to specialist perinatal mental health services8 with more than 40% of England’s Clinical Commissioning Groups (CCGs) having no specialist service at all and a similar situation for about 40% of Health Boards in Scotland, 70% of those in Wales and 80% of those in Northern Ireland. Less than 15% of localities in the UK offer comprehensive provision. However there is optimism for the future with a national drive to improve services and develop Perinatal Mental Health Clinical Networks.

Good care can make a significant difference with recovery likely. Most women will not require specialist services, and the range of effective interventions outlined by the Scottish Intercollegiate Guidelines Network9 and CG1922 identify the variety of support options depending on a woman’s needs. Universal services provided by midwives, health visitors and General Practitioners (GPs) are a crucial part of the care pathways recommended. Midwives are identified as a workforce that can play a significant role in promoting the emotional wellbeing of women during pregnancy, and in ensuring those women who are or become unwell get the support and care they need10. The recognition of the universal workforce in the perinatal period as a priority area for improvement was outlined in the recent publication ‘Closing the Gap’: Priorities for Essential Change in Mental Health11 and within the NHS Mandate12. The emphasis on improving training and the standardisation of specialist roles within the midwifery, health visitor and GP workforce has been championed by the Maternal Mental Health Alliance (MMHA) and the Department of Health (DH) has mandated Health Education England (HEE) ‘to ensure pre and post registration training in perinatal mental health to enable the provision of specialist staff for every birthing unit by 2017’ (Dr Dan Poulter, 2013).

Maternity services need to be proactive in addressing the needs of women locally to ensure appropriate care is delivered to support and deliver the best outcomes are achieved for mother, child and wider family.

“ It is estimated that approximately half of all cases of perinatal depression and anxiety go undetected despite regular contact with health professionals in the antenatal and postnatal period, and for those that are detected adequate treatment is not received5.”


The RCM supported by the Department of Health (DH) and the MMHA has developed this document to underpin and strengthen midwifery and maternity care for women whose pregnancy, birth and postnatal experience may be complicated by mental health problems.

The Standards Development Advisory Group (See Appendix 2) has brought together experts in midwifery, obstetrics, and mental health to develop a clear role, set of standards and competencies that all midwives specialising in maternal mental health should be aware of and adhering to in their everyday work. It also highlights the role and competencies expected of all post-registration midwives so providing guidance and direction for continuous professional development and assisting in meeting the standards and behaviours of all midwives to ensure good care. Together they also demonstrate a career progression for any midwife wanting to specialise in maternal mental health.

The document should support not only midwives with a role in maternal mental health, but the wider midwifery team, the multidisciplinary teams supporting women with mental health problems in the perinatal period, and commissioners of such services. It builds on the document ‘Specialist Mental Health Midwives, what they do and why they matter’10 by outlining in more detail the role, the standards and the competencies required in such a role, and also the framework with which to audit service provision. It is being developed at a time when both the health visiting profession and General Practitioners are also taking steps to improve the awareness and competencies in relation to perinatal mental health, collectively working towards a future with a proactive and knowledgeable primary care workforce.

Background and context to this document

“ This document builds on the Specialist Mental Health Midwives, what they do and why they matter publication. It outlines in detail the standards and competencies required for this role and a framework for auditing service provision.”


There are several examples of the specialist mental health midwife role currently across the UK and examples are highlighted within this document. However, the content, scope, allocated workload and focus of the roles vary considerably. If every maternity service is to work towards having a midwife specialising in maternal mental health then clearer competencies are required.

The RCM in collaboration with the NSPCC and the MMHA set out a very broad specification of the role of a specialist mental health midwife, recognising the requirement and needs of localities to determine the specifics of the role10. This built on two NSPCC reports13,14 which stressed the need for midwives (and other professionals) to discuss perinatal mental health with parents-to-be, to be confident and comfortable in asking women about their mental health and to be able to detect problems using evidence based tools while working within a multidisciplinary and multi-agency way to support the needs of families.

The mapping of specialist maternal mental health midwives was undertaken in conjunction with Heads of Midwifery in the summer and early autumn of 2014. The result of this work is available at: http://bit.ly/1Iq8Nhx15. Identified midwives were then invited to attend a workshop in November 2014 to discuss their views on the development of a network for midwives

working in the field of perinatal mental health, and on the skills, knowledge and education needed for a more specialist role.

In January 2015, professionals involved in the training and education of midwives and others in perinatal mental health met to discuss the training and education that was already available for professionals, and the requirements specifically needed by midwives in a specialist role.

Both events highlighted the provision of training for midwives in perinatal mental health is currently catered for by a number of organisations and these are listed at: www.maternalmentalhealth.org.uk. However it was identified that not all midwives have undertaken pre-registration education programmes which develop adequate awareness of perinatal mental health and how to identify women at risk. For those midwives who proactively wanted to further their knowledge and skills in perinatal mental health there are courses available across the UK but there are currently no standards, quality assurance nor recommendations from professional bodies on what these courses should include.

Despite the plethora of training opportunities available for midwives, it was apparent from the discussions that midwives across the NHS were providing different levels of service and support to women. It was identified that what was required was a clear role for a midwife specialising in maternal mental health and a national standards document to provide advice, and guidance to midwives, the maternity team and commissioners of service.

“ It was apparent from the mapping that midwives across the NHS were providing different levels of service and support to women with mental health problems.”

To build further on this work the RCM received funding from the Department of Health in the summer of 2014 to:

a. map the number of specialist maternal mental health midwives (SMMHMW) in the UK

b. create a network for midwives in the specialist role

c. develop training in perinatal mental health for post-registration midwives

d. develop standards and an audit toolkit for specialist midwives.


Aims of this document

1. Describe the competencies expected of all post-registration midwives in relation to maternal mental health.

2. Set out the standards and competencies expected of midwives specialising in maternal mental health within a locality (Trust/Health Board).

3. Provide examples of good practice within midwifery to demonstrate the skills and competencies required and expected of midwives leading in maternal mental health.

4. Provide guidance on how the specialist midwife needs to be supported and embedded within organisations (Trusts/Health Boards), multidisciplinary teams and through appropriate training.

5. Provide an audit framework with which to assess local midwifery practice in relation to maternal mental health.

“ This document provides examples of good practice in midwifery to demonstrate the skills and competencies required and expected of midwives leading in maternal mental health.”

Caring for women with mental health problems: Standards and a competence framework for specialist maternal mental health midwives | 9

Together with other colleagues in primary care (health visitors, GPs, practice nurses), midwives are in a strong position to identify women who are at risk of, or are already suffering from, perinatal mental illness, and to ensure that these women and their families get the care they need at the earliest opportunity. They also have a role in highlighting a lack of services for referral, where none exist.

All midwives need to be aware that any woman in their care can be affected by mental health problems during the perinatal period. They have a role in identifying women with existing mental health conditions and those at risk of developing one in order to ensure the women receive the specialist care they need. All midwives should be aware of their local services and care pathway (if one exists) and know specifically where to refer women to should the midwife suspect a need for intervention. This may be the GP or a specified person or service outlined in the local care pathway. All midwives have a professional responsibility, as outlined by the NMC, to ensure the delivery of good practice and care to women and this relates as much to their mental health as to their physical health. This includes speaking out when local services for referral are lacking.

The wider role of all midwives in improving maternal mental health and promoting optimal mother-infant dyads from pregnancy includes:

The Role of the Midwife in Maternal Mental Health

• Raising awareness From the very first antenatal visit, midwives can ensure women, their partners and wider family know how to look after their mental wellbeing, what signs and symptoms to look out for that need attention and who to turn to should they be concerned. There may also be opportunities to raise awareness of the emotional development of the baby and signposting to relevant resources for more information to help support early attachment.

• Building trust Often the first point of contact in a pregnancy, the midwife has the opportunity to build a trusting relationship to support open discussions about all facets of health in pregnancy, including mental health. Ensuring continuity of carer where possible and fostering a trusting relationship is more likely to facilitate identification of a problem early.

• Reducing stigma Through confident and competent communications and care, stigma around mental health can be reduced.

• Strengthening emotional wellbeing Providing sensitive and supportive antenatal and postnatal care that increases parents’ emotional wellbeing and self-efficacy, and reduces anxiety and their vulnerability to mental illness.

• Identifying risk and current wellbeing Discussing and documenting details of women’s past and current mental health, and being sensitive to any indicators that this may be deteriorating. Midwives can use validated tools, such as the Whooley questions, the Generalised Anxiety Disorder 2 (GAD 2), Edinburgh Postnatal Depression Scale (EPDS) or Public Health Questionnaire (PHQ9) to strengthen their skilled clinical assessment. These are recommended in the CG1922.

• Securing appropriate care Signposting or referring women who require additional care, supporting women to access this care, and enabling opportunities to develop their social networks.

• Supporting family members Midwives need to be sensitive of the potential effects that poor parental mental health can have on the family and should be aware that mental health problems, which can also affect many fathers, are often missed. Midwives can have a valuable impact by fostering emotional and practical support for mothers through finding opportunities to engage a partner, family members and the wider social support network where appropriate.


Building on the original recommendations in ‘Specialist Mental Health Midwives, what they do and why they matter’10, the midwife specialising in maternal mental health can act as a local champion for women with mental health problems. Such midwives would be in a position to provide an advisory role to other midwife colleagues and demonstrate advanced levels of clinical decision-making and responsibility. They should be a key point of liaison for other professionals involved in a woman’s care not only for individual level care, but also in the development of local care pathways.

The knowledge, skill, expertise and experience of the midwife undertaking a specialist role will be at a level above competence or proficiency at the point of registration. It is anticipated that midwives undertaking this more specialist role will have consolidated their post-registration experience in all aspects of midwifery and have developed further their understanding of perinatal mental health and its impact on pregnancy, birth, postnatal life and future health of the woman, child and wider family. Additional training in psychological approaches may also be undertaken. The role will work alongside those with specific clinical expertise in mental health theoretical knowledge and practice including mental health nurses, psychologists, occupational therapists, psychotherapists and psychiatrists as well as key antenatal partners such as health visitors and GPs.

In summary, all midwives should be equipped to be aware of mental illness in the perinatal period and its impact on women, babies, children and the wider family. This awareness should be part of the required skills of a registered midwife from the point of registration, to enable identification and support or appropriate referral of women with deteriorating mental health. It is important that midwives are able to access ongoing training to refresh their knowledge and skills in perinatal mental health and emerging evidence in this field so that they remain equipped to support women at this important time in their lives.

The role of the midwife specialising in maternal mental health should be to have enhanced skills and knowledge in perinatal mental health, to be able to offer additional support to women, the wider midwifery and multidisciplinary team and to act as a central point for the care of each woman with mental health problems during pregnancy. This perinatal mental health midwife, as well as having enhanced clinical skills, will also have a strategic role in relation to perinatal mental health within the Trust or Health Board. The competencies for all midwives and those with a specialist role in maternal mental health are outlined in this document.

“ It is important that midwives are able to access ongoing training to update their knowledge in perinatal mental health issues and keep abreast of the emerging evidence in this field so that they can provide appropriate care and support to women.”


This publication aims to complement and not duplicate the NMC’s Standards of Competence for Registered Midwives16

which outline what is expected of registered midwives across all client groups and specialties. Together these documents identify the competences required for achieving person-centred, safe and effective care by registered midwives.

By not duplicating the general competences which apply to all groups and settings, this document focuses on the unique aspects of specialist maternal mental health midwives. Furthermore, it highlights learning and development purposes and sets clear expectations for each level of the career pathway.

For this reason, in depth competences covering the use of evidence-based practice, research, quality improvement, learning and development and leadership are not included.

In compiling the competencies and standards specific to all midwives and those leading in maternal mental health this document pulls together information provided and prescribed from a range of resources including:

• NMC standards for pre-registration midwifery education

• Antenatal and postnatal mental health: clinical management and service guidance CG1922

• Perinatal Mental Health Curricular Framework17

• NHS Skills for Health [mental health – adult]18

• The British Association of Counselling and Psychotherapy

• The British Psychological Society

• The Institute of Health Visiting

Three levels of knowledge and skills required by all midwives when working with women who have existing or potential mental health problems are outlined.

Registration (R) = required at the point of entry to the midwifery part of the Nursing and Midwifery Council’s register.

Core (C) = required for midwifery staff employed within community and hospital teams who through undertaking continuous professional development programmes acquire additional skills e.g. community midwives, those working specifically with teenage women or other vulnerable groups (for example, women with substance misuse problems, the bereaved, women enduring domestic violence).

Specialised Enhanced Skills (SES) = specialised enhanced skills are expected by those with a specialist role in maternal mental health.

Midwives must be able to undertake the following skills in a safe and professional manner within the NMC Code of Practice19. All skills in the green column are required at the point of entry to the midwifery part of the NMC register. Additional skills and competencies are expected to be gained through additional study and continuous professional development (CPD), and in some instances, additional qualifications e.g. at postgraduate level.

It is recommended that all midwives should receive annual mandatory updates on perinatal mental health within their Trust or Health Board to remain up to date with practices within their locality at a level commensurate with their role.

The provided set of competencies can be used as a tool to help individuals, employing organisations and training providers to improve performance. It is important to recognise that each level is integral to the next and as such individuals need to demonstrate progression by achieving each level before moving on to the next.

Overview of the Framework


Competencies generally contain two key components, one that relates to the individual’s performance, and one that relates to what the individual must know and understand. The NHS Skills for Health classification of the level of knowledge is valuable in making the transition from fundamental midwifery knowledge to expert level of knowledge in perinatal mental health.

Definition of levels of knowledge and understanding (NHS SfH 2010):

Factual knowledge: knowledge that is detailed on a factual level but does not involve more than superficial understanding of principles or theories. (R)

Working knowledge: the application of factual knowledge in a manner that takes account of widely understood technical principles and implications within the field of practice. (C)

In-depth understanding: a broad and detailed understanding of the theoretical underpinning of an area of practice, including theories and constructs. (SES)

Critical understanding: the ability to evaluate and devise approaches to situations that depend on the critical application of theories and conceptual constructs within the area of practice. (SES)

The competencies can be used by individuals to:

• create a checklist to measure personal performance;

• identify professional development needs and to help career progression.

They can be used by human resources and line managers to:

• design fair and transparent recruitment and selection procedures;

• design job descriptions, advertisements and interview questions;

• design induction programmes and information packs;

• carry out appraisals;

• identify individual or team learning needs.

They can be used by training and education providers to:

• make programmes more relevant to people’s needs;

• provide clear goals for structured learning;

• design tailored training packages and assess relevance and effectiveness;

• define learning outcomes.

They can be used with commissioners to:

• highlight the role of specialist midwives when considering local care pathways and service provision within a locality20.

“ All midwives should receive annual mandatory updates on perinatal mental health within their Trust or Health Board to remain up to date with practices within their locality at a level commensurate with their role.”


Standards for the Specialist Maternal Mental Health Midwife

Five standards have been identified in which core competencies should be expected of all midwives. Each standard developed has a title, which summarises the area on which that standard focuses, followed by the rationale as to why the standard is considered important. In the tables ahead, competencies are outlined against each of the standards to clearly show what level of performance is required.

In addition to the standards set out below, all midwives should demonstrate and promote an understanding of ethical practice and professional values as outlined in the NMC Code of Conduct19.

Standard 1 – Knowledge

A thorough knowledge of what is mental health and what is the range of mental disorders and how these may present in or be affected by the perinatal context. This will include a knowledge of the key signs and symptoms, prevalence, potential impact on a woman’s life, on parenting and relationship with the infant, treatment and management as well as the ability to identify and care for women with mental health problems and support the mother-infant dyad. The knowledge base will also include an understanding of the importance of early attachment with the growing fetus in relation to infant mental health.

Standard 2 – Communication

Competence and confidence in effective and sensitive communication with women, their families and wider networks and other professionals within the multidisciplinary team. It is essential that the midwife can ensure that each woman feels involved in her care and is able to understand what is being discussed in order to assist decision making and planning.

Standard 3 – Training, education and supervision

Education, training and adequate supervision are needed to support midwives in delivering evidence based care. The midwife specialising in maternal mental health may consider additional training in psychological approaches as well as the health sciences to advance and broaden skills, knowledge and expertise. Higher level education in specialist topics pertaining to maternal mental health are welcomed.

Standard 4 – Management

Management of a woman’s care will, dependent on risk factors and current circumstances, be either midwife-led or part of a multidisciplinary team, which may include professionals across primary, secondary and tertiary care.

Standard 5 – Governance

All practitioners must work within professional and ethical guidelines. Practices should be audited to ensure appropriate and professional delivery.


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nic

ity

on

men

tal h

ealt

h.

• A

pp

reci

ate

the

imp

act

of:

–le

arn

ing

dis

abili

ties

–su

bst

ance

mis

use

–ex

per

ien

ce o

f m

ater

nit

y ca

re

–O

bst

etri

c an

d n

eon

atal

co

mp

licat

ion

s

–b

erea

vem

ent

–se

xual

ori

enta

tio

n

–fe

rtili

ty t

reat

men

t o

n a

wo

man

’s

men

tal w

ell-

bei

ng

.

• U

nd

erst

and

th

e im

pac

t o

f h

ealt

h

ineq

ual

itie

s an

d s

tig

ma.

• B

e aw

are

of

the

evid

ence

rel

atin

g

to t

he

infl

uen

ce o

f ag

e, d

isab

ility

, m

arri

age

and

civ

il p

artn

ersh

ip,

pre

gn

ancy

an

d m

ater

nit

y, r

ace,

re

ligio

n a

nd

bel

ief,

sex

an

d s

exu

al

ori

enta

tio

n a

nd

th

e im

pac

t o

f

soci

al d

epri

vati

on

on

mat

ern

al

men

tal h

ealt

h.

• B

e aw

are

of

the

imp

act

Pers

on

alit

y D

iso

rder

s

can

hav

e o

n p

reg

nan

cy, c

hild

bir

th a

nd

bec

om

ing

a m

oth

er.

• U

nd

erst

and

th

e sp

ecifi

c vu

lner

abili

ties

of

wo

men

ex

per

ien

cin

g a

cute

psy

cho

sis

in r

elat

ion

to

pre

gn

ancy

, la

bo

ur

and

ch

ild b

irth

.

• B

e aw

are

of

the

late

st e

vid

ence

su

rro

un

din

g m

enta

l w

ellb

ein

g a

nd

th

e p

erin

atal

per

iod

fo

r sp

ecifi

c

vuln

erab

le g

rou

ps.

• U

nd

erst

and

th

e im

pac

t o

f g

rief

on

a m

oth

er w

ho

se b

aby

h

as b

een

rem

ove

d o

n m

enta

l hea

lth

gro

un

ds

and

pro

vid

e n

on

-ju

dg

emen

tal c

are

and

en

sure

th

at s

he

has

a c

are

pla

n

in p

lace

to

en

sure

sh

e h

as s

up

po

rt a

t th

is d

iffi

cult

tim

e.


Co

mp

eten

cyR

egis

tran

tC

ore

Spec

ialis

ed E

nh

ance

d S

kills

Iden

tifi

cati

on

• R

eco

gn

ise

that

th

e ra

ng

e an

d

pre

vale

nce

of

anxi

ety

dis

ord

ers

(in

clu

din

g g

ener

alis

ed a

nxi

ety

dis

ord

er, o

bse

ssiv

e-co

mp

uls

ive

dis

ord

er, p

anic

dis

ord

er, p

ho

bia

s,

po

st-t

rau

mat

ic s

tres

s d

iso

rder

an

d s

oci

al a

nxi

ety

dis

ord

er)

and

d

epre

ssio

n a

re u

nd

er-r

eco

gn

ised

th

rou

gh

ou

t p

reg

nan

cy a

nd

th

e p

ost

nat

al p

erio

d.

• B

e aw

are

of

the

too

ls u

sed

in

mid

wif

ery

pra

ctic

e to

iden

tify

w

om

en a

t ri

sk o

r ex

per

ien

cin

g

men

tal h

ealt

h p

rob

lem

s (W

ho

ole

y q

ues

tio

ns,

GA

D-2

).

• B

e p

roac

tive

at

each

an

ten

atal

vis

it

to a

sk a

bo

ut

a w

om

an’s

men

tal

wel

lbei

ng

.

• B

e aw

are

of

ow

n ju

dg

emen

ts

reg

ard

ing

men

tal i

llnes

s an

d h

ow

th

ey im

pac

t o

n c

are

pro

visi

on

.

• K

no

w h

ow

to

det

ect

per

inat

al

men

tal i

llnes

s in

clu

din

g t

he

reco

gn

itio

n o

f d

eter

iora

tio

n o

f lo

ng

sta

nd

ing

co

nd

itio

ns

thro

ug

h

the

use

of

clin

ical

inte

rvie

w a

nd

co

mp

reh

ensi

ve h

isto

ry t

akin

g.

• B

e co

nfi

den

t in

usi

ng

th

e re

com

men

ded

Wh

oo

ley

and

GA

D-2

q

ues

tio

ns

at b

oo

kin

g a

nd

be

awar

e o

f o

ther

ass

essm

ent

too

ls a

vaila

ble

e.

g. E

PDS,

GA

D-7

, PH

Q9.

• H

ave

an u

p t

o d

ate

kno

wle

dg

e o

n t

he

late

st e

vid

ence

an

d

pra

ctic

e re

gar

din

g id

enti

fica

tio

n o

f m

enta

l hea

lth

pro

ble

ms

in

th

e p

erin

atal

per

iod

.

• B

e aw

are

of

psy

cho

met

ric

theo

ry a

nd

ho

w t

o u

se it

.

• Ev

alu

ate,

use

an

d in

terp

ret

psy

cho

met

ric

test

s; t

his

incl

ud

es

the

sele

ctio

n, a

dm

inis

teri

ng

, sco

rin

g a

nd

inte

rpre

tati

on

o

f p

erfo

rman

ce b

ased

psy

cho

met

ric

test

s in

clu

din

g a

n

un

der

stan

din

g o

f th

eir

flaw

s.

• K

no

wle

dg

e o

f d

iag

no

stic

fra

mew

ork

s su

ch a

s th

e D

SM

and

ICD

, in

clu

din

g a

cri

tica

l un

der

stan

din

g o

f th

e co

nce

pt

o

f d

iag

no

sis.

• D

emo

nst

rate

kn

ow

led

ge

and

un

der

stan

din

g o

f p

sych

otr

op

ic

med

icat

ion

in p

sych

iatr

ic d

iso

rder

s, b

e ab

le t

o d

iscu

ss

com

plia

nce

an

d a

dh

eren

ce a

nd

un

der

stan

d is

sues

wit

h t

his

in

pre

gn

ancy

an

d b

reas

tfee

din

g.

• K

no

w h

ow

to

see

k h

elp

wit

h m

edic

atio

n a

nd

en

suri

ng

ea

ch w

om

an g

ets

bes

t p

oss

ible

ad

vice

.

Stan

dar

d 1

– K

no

wle

dg

e


Co

mp

eten

cyR

egis

tran

tC

ore

Spec

ialis

ed E

nh

ance

d S

kills

Trea

tmen

t•

Kn

ow

wh

o t

o r

efer

to

loca

lly if

a

wo

man

pre

sen

ts w

ith

an

exi

stin

g

men

tal h

ealt

h c

on

dit

ion

or

if a

w

om

an n

eed

s su

pp

ort

.

• B

e aw

are

of

loca

l su

pp

ort

ser

vice

s,

incl

ud

ing

vo

lun

tary

sec

tor.

• B

e vo

cal w

her

e lo

cal s

ervi

ces

do

n

ot

exis

t.

• A

pp

reci

ate

the

imp

act

of

un

trea

ted

p

erin

atal

men

tal i

llnes

s.

• U

nd

erst

and

th

e va

riat

ion

s

in t

he

pre

sen

tati

on

an

d c

ou

rse

in

the

per

inat

al p

erio

d, h

ow

th

ese

vari

atio

ns

affe

ct t

reat

men

t, a

nd

th

e co

nte

xt in

wh

ich

th

ey a

re

asse

ssed

an

d t

reat

ed.

• B

e ab

le t

o d

iscu

ss w

ith

wo

men

p

oss

ible

tre

atm

ent

and

su

pp

ort

o

pti

on

s.

• K

no

w a

bo

ut

and

be

able

to

ad

vise

on

sel

f-ca

re a

nd

wh

at

wo

men

can

do

to

su

pp

ort

th

eir

ow

n m

enta

l hea

lth

.

• B

e fa

mili

ar w

ith

ap

pro

pri

ate,

ev

iden

ce b

ased

on

line

self

-hel

p

info

rmat

ion

.

• K

no

w t

he

vari

ou

s re

ferr

al

rou

tes

in t

he

loca

lity

for

wo

men

b

ein

g t

reat

ed f

or

men

tal h

ealt

h

con

dit

ion

s.

• U

nd

erst

and

cri

sis

man

agem

ent

an

d w

ho

to

invo

lve

loca

lly.

• U

nd

erst

and

th

e p

rese

nta

tio

n o

f

risk

fo

r d

eter

iora

tin

g p

erin

atal

ill

nes

s (e

.g. s

uic

idal

th

ou

gh

ts;

psy

cho

sis)

, in

clu

din

g w

hen

an

d w

her

e to

mak

e im

med

iate

/

emer

gen

cy r

efer

rals

; ac

kno

wle

dg

ing

saf

egu

ard

ing

p

roce

du

res

for

vuln

erab

le a

du

lts

and

ch

ildre

n.

• B

e aw

are

of

the

vari

ou

s m

edic

atio

ns

wo

men

may

be

taki

ng

in

pre

gn

ancy

fo

r m

enta

l hea

lth

co

nd

itio

ns.

• H

ave

an u

p t

o d

ate

kno

wle

dg

e o

f an

y n

ew t

reat

men

ts,

esp

ecia

lly m

edic

atio

ns,

ava

ilab

le f

or

use

wit

hin

th

e

per

inat

al p

erio

d f

or

wo

men

exp

erie

nci

ng

men

tal h

ealt

h

com

plic

atio

ns.

Th

e u

se o

f N

ICE

gu

idan

ce o

n t

he

‘Bal

anci

ng

ri

sks

and

ben

efits

of

psy

cho

tro

pic

med

icat

ion

’21 is

su

gg

este

d.

• B

e aw

are

of

the

man

agem

ent

of

per

inat

al m

enta

l ill

nes

s u

sin

g e

vid

ence

bas

ed p

sych

olo

gic

al in

terv

enti

on

(C

BT,

no

n-d

irec

tive

co

un

selli

ng

; min

dfu

lnes

s; m

oti

vati

on

al

inte

rvie

win

g; g

uid

ed s

elf-

hel

p; p

rob

lem

so

lvin

g);

hav

ing

aw

aren

ess

of

ow

n li

mit

atio

ns

and

wh

en t

o r

efer

fo

r

spec

ialis

t as

sess

men

t, s

up

po

rt a

nd

tre

atm

ent.


Co

mp

eten

cyR

egis

tran

tC

ore

Spec

ialis

ed E

nh

ance

d S

kills

Imp

act

• u

nd

erst

and

th

e im

po

rtan

ce o

f

the

mo

ther

-in

fan

t d

yad

an

d

go

od

att

ach

men

t.

• u

nd

erst

and

th

e im

pac

t p

oo

r m

enta

l h

ealt

h c

an h

ave

on

th

e m

oth

er-

infa

nt

dya

d a

nd

att

ach

men

t, y

et

also

ap

pre

ciat

e th

at m

ater

nal

m

enta

l illn

ess

or

un

dia

gn

ose

d lo

w

mo

od

/an

xiet

y d

oes

no

t eq

ual

po

or

par

enti

ng

or

po

or

atta

chm

ent.

• A

pp

reci

ate

that

so

me

trea

tmen

ts

pro

vid

ed t

o w

om

en f

or

th

eir

men

tal h

ealt

h m

ay b

e co

ntr

ain

dic

ated

in b

reas

tfee

din

g.

Be

able

to

su

pp

ort

a w

om

an

in w

hat

ever

op

tio

ns

are

op

en

to h

er in

rel

atio

n t

o f

eed

ing

h

er b

aby.

• B

e aw

are

of

app

roac

hes

to

su

pp

ort

th

e d

evel

op

men

t o

f p

osi

tive

m

oth

er-i

nfa

nt

atta

chm

ent

and

tal

k co

nfi

den

tly

wit

h f

amili

es a

bo

ut

po

siti

ve a

pp

roac

hes

.

• U

nd

erst

and

th

e im

po

rtan

ce o

f

the

firs

t 10

01 d

ays

on

th

e h

ealt

h,

soci

al a

nd

em

oti

on

al d

evel

op

men

t o

f th

e ch

ild22

.

• U

nd

erst

and

th

e im

pac

t m

edic

atio

n

can

hav

e o

n b

reas

tfee

din

g a

nd

su

pp

ort

wo

men

acc

ord

ing

ly.

• U

nd

erst

and

th

e im

po

rtan

ce o

f,

and

ap

pro

pri

ate

use

of,

ou

tco

me

mea

sure

s to

mo

nit

or

the

effe

ctiv

enes

s o

f in

terv

enti

on

s u

sed

.

• B

e kn

ow

led

gea

ble

ab

ou

t th

e ev

iden

ce o

f th

e ef

fect

of

mat

ern

al m

edic

atio

n o

n f

etal

dev

elo

pm

ent.

• H

ave

an u

p t

o d

ate

kno

wle

dg

e o

n t

he

imp

act

of

po

or

m

enta

l hea

lth

on

bo

th t

he

mo

ther

an

d in

fan

t an

d

un

der

stan

d h

ow

to

ass

ist

in o

pti

mis

ing

th

e re

lati

on

ship

w

hat

ever

th

e m

enta

l hea

lth

dia

gn

osi

s o

f th

e m

oth

er.

• B

e ab

le t

o c

on

fid

entl

y su

pp

ort

fam

ilies

wit

h in

form

atio

n

and

gu

idan

ce a

bo

ut

po

siti

ve a

pp

roac

hes

to

bu

ildin

g g

oo

d

atta

chm

ent

rela

tio

nsh

ips.

• B

e ab

le t

o o

bse

rve

and

des

crib

e in

dic

ato

rs o

f m

oth

er-i

nfa

nt

atta

chm

ent

in o

rder

to

iden

tify

an

y d

evel

op

ing

pro

ble

ms.

• B

e ab

le t

o e

mp

loy

valid

ated

ob

serv

atio

n a

nd

ass

essm

ent

too

ls t

o p

rovi

de

feed

bac

k o

n t

he

dev

elo

pin

g m

oth

er-i

nfa

nt

rela

tio

nsh

ip.

Stan

dar

d 1

– K

no

wle

dg

e


Co

mp

eten

cyR

egis

tran

tC

ore

Spec

ialis

ed E

nh

ance

d S

kills

Gen

eral

co

mm

un

icat

ion

• B

e at

ten

tive

an

d s

har

e in

form

atio

n

that

is c

lear

, acc

ura

te a

nd

m

ean

ing

ful i

n w

ord

s w

hic

h w

om

en,

and

her

fam

ily c

an u

nd

erst

and

.

• U

se a

pp

rop

riat

e an

d r

elev

ant

com

mu

nic

atio

n s

kills

to

dea

l w

ith

dif

ficu

lt a

nd

ch

alle

ng

ing

ci

rcu

mst

ance

s in

ind

ivid

ual

s.

• B

e co

nfi

den

t an

d c

om

pet

ent

in

aski

ng

ch

alle

ng

ing

qu

esti

on

s

in r

elat

ion

to

pas

t h

isto

ry e

.g.

abu

se, p

revi

ou

s m

enta

l illn

ess.

• Tr

eat

wo

men

wit

h d

ign

ity

and

re

spec

t th

em a

s in

div

idu

als.

• Pr

ovi

de

care

th

at is

del

iver

ed

in a

war

m, s

ensi

tive

an

d

com

pas

sio

nat

e w

ay.

• B

e aw

are

and

res

pec

tfu

l th

at

wo

men

wit

h p

re-e

xist

ing

men

tal

illn

ess

may

be

con

fid

ent

and

p

rofi

cien

t in

man

agin

g t

hei

r

ow

n c

on

dit

ion

an

d a

re a

war

e o

f ch

ang

es t

o t

hei

r m

enta

l hea

lth

.

• A

ctiv

ely

eng

age

in d

evel

op

ing

/ u

pd

atin

g p

atie

nt

in

form

atio

n m

ater

ials

.

• Pa

rtic

ipat

e in

co

mm

un

ity

eng

agem

ent

even

ts.

List

enin

g•

Be

awar

e o

f an

d u

nd

erst

and

th

e p

rin

cip

les

of

acti

ve li

sten

ing

.•

Wh

ere

app

rop

riat

e u

se t

he

skill

s o

f ac

tive

list

enin

g, q

ues

tio

nin

g,

par

aph

rasi

ng

, an

d r

eflec

tio

n t

o

assi

st in

eff

ecti

ve c

om

mu

nic

atio

n.

• B

e co

nfi

den

t in

op

enin

g a

nd

cl

osi

ng

a c

on

vers

atio

n a

bo

ut

a w

om

an’s

men

tal w

ellb

ein

g.

• H

igh

ly s

kille

d a

nd

co

mp

eten

t in

act

ive

liste

nin

g.

Stan

dar

d 2

– C

om

mu

nic

atio

n


Co

mp

eten

cyR

egis

tran

tC

ore

Spec

ialis

ed E

nh

ance

d S

kills

Invo

lvem

ent

• In

volv

e th

e w

om

an a

nd

, if

she

agre

es, h

er p

artn

er, f

amily

or

care

r, in

all

dec

isio

ns

abo

ut

her

car

e an

d

the

care

of

her

bab

y.

• W

ork

wit

h f

amili

es, c

arer

s an

d

ind

ivid

ual

s d

uri

ng

tim

es o

f re

lap

se

or

cris

is.

• B

e aw

are

of

oth

er s

ervi

ce p

rovi

der

s w

ho

may

be

sup

po

rtin

g w

om

en

wit

h m

enta

l hea

lth

nee

ds.

• U

nd

erst

and

th

e p

roce

ss o

f co

mm

un

icat

ing

eff

ecti

vely

th

rou

gh

inte

rpre

ters

an

d h

avin

g

an a

war

enes

s o

f th

e lim

itat

ion

s th

ereo

f.

• B

e aw

are

of

the

imp

act

of

stig

ma

and

refl

ect

on

ow

n p

ract

ice

to h

elp

re

du

ce s

tig

ma.

• A

sses

s th

e le

vel o

f co

nta

ct a

nd

su

pp

ort

nee

ded

by

wo

men

wit

h

a m

enta

l hea

lth

pro

ble

m (

curr

ent

o

r p

ast)

an

d t

ho

se a

t ri

sk o

f d

evel

op

ing

on

e.

• A

gre

e th

e le

vel o

f co

nta

ct a

nd

su

pp

ort

wit

h e

ach

wo

man

, in

clu

din

g t

ho

se w

ho

are

no

t

hav

ing

tre

atm

ent

for

a m

enta

l h

ealt

h p

rob

lem

.

• M

on

ito

r re

gu

larl

y fo

r sy

mp

tom

s th

rou

gh

ou

t p

reg

nan

cy a

nd

th

e p

ost

nat

al p

erio

d, p

arti

cula

rly

in t

he

firs

t fe

w w

eeks

aft

er c

hild

bir

th.

• D

iscu

ss a

nd

pla

n h

ow

sym

pto

ms

w

ill b

e m

on

ito

red

(fo

r ex

amp

le,

by

usi

ng

val

idat

ed s

elf

rep

ort

q

ues

tio

nn

aire

s, s

uch

as

the

Edin

bu

rgh

Po

stn

atal

Dep

ress

ion

Sc

ale

[EPD

S], P

atie

nt

Hea

lth

Q

ues

tio

nn

aire

[PH

Q 9

] o

r th

e

7 it

em G

ener

aliz

ed A

nxi

ety

D

iso

rder

sca

le [

GA

D 7

]).

• En

able

wo

men

wit

h m

enta

l hea

lth

n

eed

s to

ch

oo

se a

nd

par

tici

pat

e in

an

ten

atal

an

d p

ost

nat

al a

ctiv

itie

s th

at a

re m

ean

ing

ful t

o t

hem

, re

cog

nis

ing

th

eir

role

in r

eco

very

.

• Pr

ovi

de

app

rop

riat

e in

terv

enti

on

s al

on

gsi

de

and

in

con

jun

ctio

n w

ith

men

tal h

ealt

h p

rofe

ssio

nal

s.

• U

se a

rec

ove

ry f

ocu

sed

ap

pro

ach

in w

ork

ing

alo

ng

sid

e w

om

en w

ith

men

tal h

ealt

h n

eed

s an

d a

gre

e p

lan

s to

m

eet

thei

r n

eed

s.

• B

e co

mp

eten

t an

d t

arg

eted

wh

en r

efer

rin

g w

om

en w

ith

sp

ecifi

c m

enta

l dis

ord

ers

to a

pp

rop

riat

e sp

ecia

list

serv

ices

fo

r ex

amp

le, p

ost

-tra

um

atic

str

ess,

eat

ing

dis

ord

er o

r su

bst

ance

mis

use

ser

vice

s.

Stan

dar

d 2

– C

om

mu

nic

atio

n


Co

mp

eten

cyR

egis

tran

tC

ore

Spec

ialis

ed E

nh

ance

d S

kills

Co

mm

un

icat

ing

wit

h

oth

er p

rofe

ssio

nal

s•

Dem

on

stra

te c

om

pet

ency

in

app

rop

riat

e re

cord

kee

pin

g

and

rep

ort

wri

tin

g t

o e

nh

ance

co

mm

un

icat

ion

wit

h o

ther

p

ract

itio

ner

s fr

om

th

e sa

me

and

re

late

d fi

eld

s.

• Ef

fect

ivel

y co

mm

un

icat

e cl

inic

al

and

no

n-c

linic

al in

form

atio

n f

rom

a

psy

cho

log

ical

per

spec

tive

in a

st

yle

app

rop

riat

e to

a v

arie

ty o

f d

iffe

ren

t au

die

nce

s fo

r ex

amp

le,

to p

rofe

ssio

nal

co

lleag

ues

, an

d t

o

clie

nt

and

car

ers.

• B

e aw

are

of

ow

n li

mit

atio

ns

and

kn

ow

wh

en a

nd

ho

w t

o e

ng

age

wit

h m

enta

l hea

lth

ser

vice

s an

d o

ther

pra

ctit

ion

ers

wh

ere

app

rop

riat

e.

• En

gag

e p

roac

tive

ly w

ith

oth

er p

rofe

ssio

nal

s an

d v

olu

nta

ry

sect

or

org

anis

atio

ns

to d

evel

op

an

d a

pp

ly a

pp

rop

riat

e ca

re

pla

ns

for

wo

men

an

d t

hei

r fa

mili

es.

• Es

tab

lish

an

d le

ad m

ult

idis

cip

linar

y te

am (

per

inat

al m

enta

l h

ealt

h)

mee

tin

gs

on

mo

nth

ly/q

uar

terl

y b

asis

dep

end

ing

o

n t

he

loca

l nee

d.

• D

evel

op

sys

tem

s, t

oo

ls a

nd

pat

hw

ays

to s

up

po

rt p

osi

tive

in

ter-

pro

fess

ion

al c

om

mu

nic

atio

n, i

nfo

rmat

ion

sh

arin

g a

nd

ca

re p

lan

nin

g.

• B

e p

roac

tive

an

d v

oca

l ab

ou

t th

e n

eed

s o

f p

erin

atal

men

tal

hea

lth

ser

vice

s lo

cally

to

oth

er p

ract

itio

ner

s an

d e

spec

ially

th

ose

wh

o c

om

mis

sio

n s

ervi

ces.


Co

mp

eten

cyR

egis

tran

tC

ore

Spec

ialis

ed E

nh

ance

d S

kills

Trai

nin

g &

Ed

uca

tio

n•

Trai

nin

g is

gai

ned

to

rec

eive

re

gis

tere

d s

tatu

s in

lin

e w

ith

N

MC

reg

ula

tio

ns,

sta

nd

ard

s an

d

com

pet

enci

es.

• Tr

ain

ing

is e

xpec

ted

to

be

gat

her

ed

thro

ug

h a

dd

itio

nal

CPD

mo

du

les,

st

ud

y d

ays,

e-l

earn

ing

, co

urs

es

and

an

nu

al m

and

ato

ry t

rain

ing

o

n e

lem

ents

of

per

inat

al m

enta

l h

ealt

h t

o s

up

po

rt t

he

com

pet

enci

es

req

uir

ed o

f al

l pra

ctic

ing

mid

wiv

es.

• Pe

rso

nal

tra

inin

g a

nd

dev

elo

pm

ent

sho

uld

be

gat

her

ed

at p

ost

gra

du

ate

leve

l – c

erti

fica

te, d

iplo

ma,

mas

ters

or

Ph

D le

vels

to

en

han

ce a

nd

su

pp

ort

pra

ctic

e.

• B

e ab

le t

o f

urt

her

en

han

ce t

he

role

by

acq

uir

ing

oth

er

qu

alifi

cati

on

s in

are

as s

uch

as

cou

nse

llin

g, i

nfa

nt

men

tal

hea

lth

, CB

T, p

har

mac

olo

gy.

Th

is t

rain

ing

sh

ou

ld b

e

reco

gn

ised

at

a lo

cal l

evel

wit

hin

ro

le g

rad

ing

.

• O

ng

oin

g le

arn

ing

sh

ou

ld in

volv

e le

ctu

res,

gro

up

wo

rk,

on

line

mat

eria

ls a

nd

cas

e b

ased

dis

cuss

ion

s.

• O

ng

oin

g t

rain

ing

sh

ou

ld in

clu

de

sim

ula

tio

n b

ased

te

ach

ing

, att

end

ing

Mo

ther

an

d B

aby

Un

it w

ard

ro

un

ds

an

d jo

int

clin

ic p

lace

men

ts.

• H

ave

un

der

take

n s

tru

ctu

red

man

agem

ent

trai

nin

g o

n

serv

ice

dev

elo

pm

ent.

• M

anag

emen

t tr

ain

ing

sh

ou

ld in

clu

de

atte

nd

ance

on

m

anag

emen

t co

urs

es o

r sh

ort

pla

cem

ents

wit

h C

CG

/

Reg

ion

al n

etw

ork

s.

• Ta

ke a

lead

ro

le in

loca

l mat

ern

ity

team

CPD

an

d p

re-

reg

istr

atio

n e

du

cati

on

on

mat

ern

al m

enta

l hea

lth

by

coo

rdin

atin

g a

nd

del

iver

ing

ed

uca

tio

n t

o b

uild

co

nfi

den

ce,

kno

wle

dg

e an

d s

kills

of

loca

l tea

m.

• Ta

ke a

n a

ctiv

e ro

le lo

cally

in t

he

trai

nin

g o

f o

ther

hea

lth

p

rofe

ssio

nal

s, v

olu

nta

ry s

ecto

r st

aff,

so

cial

car

e an

d s

up

po

rt

staf

f o

n m

ater

nal

men

tal h

ealt

h.

• W

ork

wit

h t

he

mid

wif

ery

team

to

iden

tify

gap

s in

kn

ow

led

ge

and

th

e re

leva

nt

trai

nin

g n

eed

s o

f st

aff

at a

ll le

vels

.

Stan

dar

d 3

– T

rain

ing

, Ed

uca

tio

n a

nd

Su

per

visi

on


Co

mp

eten

cyR

egis

tran

tC

ore

Spec

ialis

ed E

nh

ance

d S

kills

Sup

ervi

sio

n•

Wo

rk w

ith

in o

wn

ran

ge

of

com

pet

ence

an

d c

on

fid

ence

, se

ek s

up

po

rt a

nd

su

per

visi

on

w

hen

ever

req

uir

ed.

• Se

ek s

up

ervi

sio

n f

rom

lead

m

idw

ife

or

wh

ere

no

t p

rese

nt,

fr

om

wid

er p

erin

atal

men

tal h

ealt

h

or

adu

lt m

enta

l hea

lth

co

lleag

ues

.

• R

ole

sh

ou

ld h

ave

reg

ula

r su

per

visi

on

fro

m a

men

tal h

ealt

h

colle

agu

e.

• Pr

ovi

de

sup

ervi

sio

n f

or

mid

wiv

es w

ith

in t

he

team

on

m

ater

nal

men

tal h

ealt

h is

sues

.

• B

e th

e ke

y p

oin

t o

f co

nta

ct f

or

oth

er m

idw

ives

fo

r is

sues

re

lati

ng

to

mat

ern

al m

enta

l hea

lth

.

Res

earc

h•

Hav

e aw

aren

ess

of

key

rese

arch

in

the

area

of

per

inat

al m

enta

l hea

lth

.•

Iden

tify

are

as f

or

rese

arch

, au

dit

an

d d

evel

op

men

t re

leva

nt

to

per

inat

al a

nd

infa

nt

men

tal h

ealt

h w

ith

in t

he

loca

lity.

In

itia

te a

nd

par

tici

pat

e in

res

earc

h a

nd

clin

ical

au

dit

p

rog

ram

mes

wh

ere

app

rop

riat

e.

• C

reat

e an

d m

ain

tain

loca

l dat

abas

e fo

r fo

llow

up

, au

dit

an

d r

esea

rch

pu

rpo

ses.


Co

mp

eten

cyR

egis

tran

tC

ore

Spec

ialis

ed E

nh

ance

d S

kills

Mu

ltid

isci

plin

ary

wo

rkin

g•

Be

awar

e th

at a

wid

er t

eam

may

be

sup

po

rtin

g a

wo

man

in t

hei

r ca

re.

• K

no

w w

ho

to

ref

er t

o a

nd

wh

o

to c

on

sult

wit

h lo

cally

an

d f

urt

her

afi

eld

if n

eces

sary

wh

en lo

oki

ng

af

ter

a w

om

an w

ith

men

tal

hea

lth

nee

ds.

• En

sure

ro

bu

st in

form

atio

n s

har

ing

b

etw

een

su

bse

qu

ent

care

rs in

th

e p

erin

atal

pat

hw

ay e

.g. h

ealt

h

visi

tors

, GP,

men

tal h

ealt

h t

eam

, so

cial

or

fam

ily s

ervi

ces

etc.

• W

ork

co

llab

ora

tive

ly a

nd

in

par

tner

ship

wit

h o

ther

co

lleag

ues

w

ith

in p

rim

ary

and

sec

on

dar

y

care

to

su

pp

ort

a w

om

an’s

car

e in

th

e p

erin

atal

per

iod

.

• Fo

llow

up

on

an

y re

ferr

als

to o

ther

se

rvic

es a

nd

en

sure

ap

pro

pri

ate

reco

rd k

eep

ing

du

rin

g t

he

wo

man

’s

per

inat

al jo

urn

ey.

• Le

ad in

th

e co

ord

inat

ion

of

mid

wif

ery

serv

ices

fo

r w

om

en

wit

h m

ild-m

od

erat

e m

enta

l h

ealt

h p

rob

lem

s.

• B

e in

volv

ed in

th

e d

evel

op

men

t o

f co

mp

reh

ensi

ve c

are

pat

hw

ays

for

wo

men

an

d f

amili

es a

ffec

ted

by

mild

, m

od

erat

e an

d s

ever

e m

ater

nal

men

tal h

ealt

h p

rob

lem

s in

ac

tive

co

llab

ora

tio

n w

ith

co

lleag

ues

, sp

ecia

list

men

tal h

ealt

h

serv

ices

an

d o

ther

pro

vid

ers

of

men

tal h

ealt

h s

ervi

ces

(e.g

. G

Ps, h

ealt

h v

isit

ors

, IA

PT s

ervi

ces,

th

ird

sec

tor

org

anis

atio

ns)

.

• Es

tab

lish

an

d le

ad m

ult

idis

cip

linar

y (p

erin

atal

men

tal

hea

lth

) m

eeti

ng

s o

n m

on

thly

/ q

uat

erly

bas

is d

epen

din

g

on

th

e lo

cal n

eed

.

• B

e th

e le

ad c

oo

rdin

ato

r o

f m

idw

ifer

y se

rvic

es f

or

wo

men

w

ith

sev

ere

men

tal h

ealt

h p

rob

lem

s.

• Fo

rmu

late

man

agem

ent

pla

ns

in p

reg

nan

cy f

or

wo

men

at

hig

h r

isk

of

recu

rren

ce o

r re

lap

se.

• B

e p

art

of

and

rec

og

nis

ed a

s th

e m

idw

ifer

y ex

per

t w

ith

in

any

loca

l mu

ltid

isci

plin

ary

team

fo

r w

om

en w

ho

hav

e

exis

tin

g o

r n

ewly

iden

tifi

ed m

enta

l hea

lth

pro

ble

ms.

Th

e m

ult

idis

cip

linar

y te

am s

ho

uld

als

o in

clu

de

an o

bst

etri

cian

p

lus

the

wid

er p

artn

er o

rgan

isat

ion

s su

ch a

s h

ealt

h v

isit

ing

, co

mm

un

ity

men

tal h

ealt

h t

eam

s, a

nd

sp

ecia

list

per

inat

al

men

tal h

ealt

h t

eam

s w

her

e av

aila

ble

.

• B

e p

roac

tive

in m

akin

g c

on

tact

an

d b

ein

g c

on

vers

ant

w

ith

th

e lo

cal w

ider

tea

m w

ith

in t

he

mat

ern

ity

net

wo

rk

to f

acili

tate

eas

y co

ord

inat

ion

of

care

an

d r

efer

rals

fo

r w

om

en. T

his

may

incl

ud

e G

Ps, h

ealt

h v

isit

ors

, ch

ildre

n’s

se

rvic

es, m

enta

l hea

lth

pra

ctit

ion

ers,

IAPT

, dru

g a

nd

al

coh

ol s

ervi

ces

etc.

• R

epre

sen

t th

e m

ater

nit

y u

nit

to

th

e R

egio

nal

Net

wo

rk

on

a r

egu

lar

bas

is a

nd

sh

are

go

od

pra

ctic

e.

• C

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1. Howard L.M, Molyneaux E, Dennis C et al (2014). Non-Psychotic mental disorders in the perinatal period. Lancet 384 (9956): 1775-88.

2. NICE (2014) Antenatal and postnatal mental health: clinical management and service guidance. Available from: https://www.nice.org.uk/guidance/cg192. [Accessed: 2nd November 2015].

3. Knight. M, et al (Eds.) on behalf of MBRRACE-UK. (2014) Saving Lives, Improving Mothers’ Care - Lessons learned to inform future maternity care from the UK and Ireland Confidential Enquiries into Maternal Deaths and Morbidity 2009-2012. Oxford: National Perinatal Epidemiology Unit, University of Oxford..

4. Sutter-Dallay, A. et al. (2011) A prospective longitudinal study of the impact of early postnatal vs. chronic maternal depressive symptoms on child development. European Psychiatry, Vol 26 (8): 484-9, pp. 484-9.

5. Bauer A., Parsonage M., Knapp M., Lemmi V., & Adelaja B., (2014). The costs of perinatal mental health problems. Available from: http://ow.ly/U8Pt3. [Accessed: 2nd November 2015].

6. Russell, S., Lang, B., Clinton, J. & Adams, C. (2013) Perinatal mental health: experiences of women and health professionals. London: The Boots Family Trust.

7. Khan, L (2015). Falling through the gaps: perinatal mental health and general practice. London: Centre for Mental Health.

8. Maternal Mental Health Alliance Everyone’s Business Campaign. Available from: http://everyonesbusiness.org.uk/ [Accessed: 2nd November 2015].

9. Scottish Intercollegiate Guidelines Network (2012) Sign 127: Managment of Perinatal Mood Disorders. A national Clinical Guideline. Edinburgh: Scottish Intercollegiate Guidelines Network.

10. Maternal Mental Health Alliance (2013). Specialist mental health midwives. What they do and why do they matter. Available from: http://ow.ly/U3bmR. [Accessed: 2nd November 2015].

11. Department of Health (2014). Closing the gap: priorities for essential change in mental health. Available from: http://ow.ly/U3dAj. [Accessed: 2nd November 2015].

12. Department of Health (2013). Delivering high quality, effective, compassionate care: developing the right people

with the right skills and the right values. A mandate from the Government to Health Education England: April 2013 to March 2015. http://ow.ly/U3diu. [Accessed: 2nd November 2015].

13. Hogg, S. (2013) Prevention in mind. London: NSPCC. http://ow.ly/U3deg. [Accessed: 2nd November 2015].

14. NSPCC (2013) All babies count; spotlight on perinatal mental health. Available from: http://ow.ly/U8xWR. [Accessed: 2nd November 2015].

15. Royal College of Midwives (2014). Report on a survey of Heads of Midwifery on specialist maternal mental health midwives. Available from: http://ow.ly/U8QVC. [Accessed: 2nd November 2015].

16. Nursing and Midwifery Council (2011). Standards of Competence for Registered Midwives. http://ow.ly/U3bZz. [Accessed: 2nd November 2015].

17. NHS Education for Scotland (2006). Perinatal Mental Health Curricular Framework. http://ow.ly/U3bBQ. [Accessed: 2nd November 2015].

18. NHS Skills for Health (2010). http://ow.ly/U3bw0. [Accessed: 2nd November 2015].

19. Nursing and Midwifery Council (2015). The Code Professional standards of practice and behaviour for nurses and midwives. http://ow.ly/U3brO. [Accessed: 2nd November 2015].

20. Joint Commissioning Panel for Mental Health (2012) Guidance for commissioners of perinatal mental health services. Available at: http://ow.ly/U3aOV. [Accessed: 2nd November 2015].

21. NICE (2015). Balancing risks and benefits of psychotropic medication. Available at: http://ow.ly/U8VYO. [Accessed: 2nd November 2015].

22. All Party Parliamentary Group for Conception to Age 2 – the first 1001 days (2015). Building Great Britons. www.1001criticaldays.co.uk/buildinggreatbritonsreport.pdf. [Accessed: 2nd November 2015].

Department of Health (2014). Early Years High Impact Area 2 – Maternal (Perinatal) Mental Health (What and why including context). Available from: http://ow.ly/U3aJq. [Accessed: 2nd November 2015].

Royal College of Midwives (2014). Maternal Mental Health improving emotional health in postnatal care. Available from: http://ow.ly/U3aDQ. [Accessed: 2nd November 2015].

Appendix 1.

References and Resources


Royal College of Midwives

Gail Johnson, Education and professional development advisor

Janet Fyle, Professional Policy Advisor

Louise Silverton CBE, Director of Midwifery

Carmel Lloyd, Head of Education and Learning

RCM/MMHA Project Leads

Janet Fyle, Professional Policy Advisor, Royal College Midwives

Beckie Lang, Tommy’s the baby charity

Maternal Mental Health Midwives

Judith Barac, Guys and St Thomas’ NHS Trust

Katrina Ashton, Medway Foundation Trust

Jill Demilew, Kings College NHS Trust

Jessica Doherty, Southampton University Hospital NHS Trust

Consultant Perinatal Psychiatrist

Liz McDonald, Chair of the Perinatal Faculty, Royal College of Psychiatrists, Chair of the Pan-London Perinatal Mental Health Clinical Network

Dr Alain Gregoire, Consultant and Honorary Senior Lecturer in Perinatal Psychiatry, Chair Maternal Mental Health Alliance

Consultant Perinatal Psychologist

Brenda McLackland, British Psychological Society Perinatal Faculty

Consultant Obstetrician

Raja Gangopadhyay, Perinatal Mental Health Lead, West Hertfordshire Hospitals NHS Trust

Health Visiting

Obi Amadi, Lead Professional Officer CPHVA/UNITE

Nursing

Carmel Bagness, Professional Lead Midwifery and Women’s Health, Royal College of Nursing

General Practice

Judy Shakespeare, Royal College of General Practitioners

NHS England

Jacquie Dunkley-Bent, Interim Head of Maternity

NHS Education Scotland

Mary Ross Davie, Education Projects Manager, Maternal and Child Health

Patient/Public Involvement

Jenny Burns, Two in Mind Perinatal Mental Health Project Manager, Mind Cymru

Acknowledgements

Appendix 2.

Standards development advisory group members

Dr Louise Harding

Emily Slater, MMHA

Claire Rees, PIPUK

Professor Cathy Warwick CBE, RCM Chief Executive

Jacquie Gerrard, Royal College of Midwives

Jo Luckie, London Perinatal Mental Health Network

Nishma Badiani, Royal College of Midwives

Angela Yates, Midwife, St James’ University hospital Leeds Infirmary

Emily Slater, Campaign Manager Maternal Mental Health – Everyone’s Business

Edited by Dr Beckie Lang, Dr Liz McDonald, Janet Fyle

Cover photograph Freiya Fyle and Charlotte Olësen-Fyle


Blank competence sheet to produce own evidence for caring for women with mental health problems: a competence framework for midwifery

Name: Role: Trust:

Standard Competence Evidence

Has the competency been achieved Yes No

Please make comments and if any further planning required:

Midwife signature: Assessor signature:

DATE:


Getting staffing right Enabling knowledge, skills and attitudes that are required to develop person centred care.

Positive staff experience Improving knowledge and skills to develop quality care, teaching other members of the MDT within maternity care, primary care, secondary care and as a professional standard to which to aspire.

Strengthening leadership Working to support midwifery leadership to integrate better pathways between primary and secondary care.

Improving patient experience The specialist maternal mental health midwife and their wider midwifery team have knowledge and understanding of perinatal mental health and are able to offer more information to help women to understand their choices.

Measuring levels of patient care By improving midwifery knowledge this should have a positive impact on patient care.

Helping people to stay independent Better working partnerships between primary and secondary care enabling working towards earlier identification and treatment planning.

Specialist mental health midwife in Kent

At Medway NHSFT the specialist midwife role has both operational and strategic elements. The day to day work is in providing assessment of mental health needs to support women and their families in enhancing their emotional wellbeing. The specialist midwife is a resource for families and her colleagues by helping them to better understand contemporary issues in perinatal mental health. This often involves making people aware of what help is available and what best suits their psychological problems. The SMHM is often involved with families where there are concerns about the safeguarding of either adults or children. Her role being to support women during this difficult period and in partnership with women to recommend appropriate maternity care in relation to enhancement of emotional wellbeing.

The SMHM is a key partner in the planning and commissioning of services for both maternity and mental health with regard to women and the family’s mental health needs.

All this work means that the SMHM must be knowledgeable in contemporary perinatal mental health. She must have a good understanding of social care and the developing needs of the family.

She needs to have good communicative networking skills and an analytical mind to help with the strategic work.

Most importantly the SMHM must have an empathic understanding of what it might be like to be affected by psychosocial problems, having a positive and hopeful attitude to this very complex work.

The six Cs and how they fit into “Caring for Women with Mental Health Problems: Standards and Competency Framework for Specialist Maternal Mental Health Midwives”

Case Studies


Tocophobia clinic at Guys and St Thomas’ (GSTT), London

This clinic is primarily for nulliparous women with low risk pregnancy who are requesting elective caesarean section (ELCS) where there is no medical indication.

Women who have had previous CS attend the VBAC clinic. For women requesting ELCS where there is no obvious psychological indication or women who had poor outcome or sub-optimal experience of vaginal birth these women would be seen in the first instance by the consultant midwife for normal birth.

GSTT do not offer ELCS for maternal request alone where there is neither obstetric, medical nor psychological reason. Women who request ELCS due to anxiety about vaginal birth are offered appointments within the tocophobia clinic in order to have a place to think about their reasons for this anxiety.

The clinic has three one hour sessions per week and is held by a midwife and a psychotherapist. These sessions are to facilitate thinking and planning around the birth. The final decision for mode of delivery is with consultant obstetrician and the woman. Women can be seen in the clinic for up to four sessions in the antenatal period. At this time there is no capacity for women to be seen postnatally in this clinic but they are encouraged to contact the clinic or the birth reflections service if they need to discuss any issues further.

An example Case Study.

35 year old Caucasian UK female. Requested ELCS at booking. Responded positively to Whooley Questions at this time. Referred to clinic and seen at 14/40 gestation.

Patient had been about to commence IVF treatment when she became pregnant. She had been with same partner for more than ten years and had covertly been avoiding pregnancy by various methods which her partner was unaware of. A history of anxiety and depression was noted from teenage years and she was currently taking an SSRI.

Since becoming pregnant she had become increasingly anxious with ruminating thoughts, panic attacks, nightmares, nausea and palpations. She was unable to think about pregnancy, birth or breastfeeding without extreme feelings of revulsion and fear.

She was unaware of what may have triggered this extreme reaction but remembered as a child looking at a heavily pregnant cousin and finding the image of a baby inside causing this huge bump revolting.

As her symptoms were so extreme it seemed unlikely that such a strongly held belief could be shifted before delivery.

It felt impossible to do any meaningful planning as her levels of anxiety made it impossible for her to think.

It was clear that she needed some support to help her manage those symptoms - not to change her mind.

SMHM referred her to IAPT (improving access to psychological therapy) for CBT (cognitive behavioural therapy) with the aim of managing her symptoms of anxiety. It was clear from her initial assessment that she needed a highly specialised psychologist so she was referred onto CADAT (Centre for anxiety disorders and trauma) at the Maudsley Hospital.

She is now engaged with treatment there and there has been some reduction in her anxiety levels.

In this case there is a clear psychological indication for ELCS and her obstetrician has offered to perform ELCS at 39/40 in line with NICE guidance.

SMHMW has arranged for her to have care with caseload midwives so she is familiar with them and they are familiar with her.

We have spent some of the sessions thinking about how much she is able to tolerate in terms of exposure to pregnancy and birth and education around it, and familiarisation with the clinical area.

Her partner has been able to attend so he is aware of the plan and is also familiar with the clinical area.

We await the outcome.

www.rcm.org.uk

November 2015

Caring for Women with Mental Health Problems...midwifery and maternity care for women whose pregnancy, birth and postnatal experience may be complicated by mental health problems.

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