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www.england.nhs.uk Perinatal and Infant Mental Health South West Maternity and Children’s Strategic Clinical Network 27th November 2014 Ann Remmers,
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Www.england.nhs.uk Perinatal and Infant Mental Health South West Maternity and Children’s Strategic Clinical Network 27th November 2014 Ann Remmers, Clinical.

Jan 15, 2016

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NHS England Presentation Template

Perinatal and Infant Mental Health

South West Maternity and Childrens Strategic Clinical Network

27th November 2014Ann Remmers, Clinical Directorwww.england.nhs.ukNetwork priority

www.england.nhs.ukNHS Mandate 2013-15- reduce the incidence and impact of postnatal depression through earlier diagnosis and better intervention and support- Ensuring people have access to the right treatment when they need it, including drugs and treatments recommended by NICE and services for children and adults with mental health problems.- Mental health on a par with physical health parity of esteem (Domain 3)

Priority of the National Clinical Director for Maternity and Womens Health, Dr Catherine Calderwood

National Prioritywww.england.nhs.uk

Depression: the most common major complication of maternitywww.england.nhs.ukSuicide: always in the top 3 causes of maternal deaths up to 12 months

Maternal Death: rates per million maternities, UK 2003-05www.england.nhs.uk5Children depressed at 16 all had mothers who were depressed, mainly during pregnancy No maternal depression No children depressed at 16

Pawlby et al 2009www.england.nhs.uk6Adolescent depression 8% suicide in 10 years, 70% have further episodes of depression weissman et all 1999

Specialist Perinatal Community Carewww.england.nhs.ukWork to dateWorking group set up Group agreement to work with the NSPCC standards (Prevention in Mind) SW-wide event to engage stakeholders in prioritising these standards in order to ensure equitable, consistent and high quality maternal and infant mental healthcare throughout the regionThursday 6th November 2014 Exeter Racecourse PIMH workshop 100+ attended www.england.nhs.ukWork to date (continued)Self-assessment questionnaire based on the standards from the NSPCC distributed across regionAim of gaining a better understanding of the provision of perinatal mental health services across the South West Over 50 responses receivedInitial results shared to help inform local work across the region

www.england.nhs.ukMoving forwardFollowing on from November event and information gained from completed questionnaires, areas of work being identified and initiated with the working group:Sharing the South West vision for the provision of high quality perinatal and infant mental health carePrioritisation of the NSPCC standards to inform the Network work programmeDelivery of the work programme

Questions?www.england.nhs.ukYou can use a maximum of two different types of icon per slideYou can use the same type of icon more than once on a page e.g. as bullet pointsIf you resize an icon, keep the proportions the same

www.england.nhs.ukOur icons - blue

www.england.nhs.ukOur icons - pink

www.england.nhs.ukOur icons - dark blue

www.england.nhs.ukOur icons light blue

www.england.nhs.ukOur icons white

www.england.nhs.ukListNote all graphs replotted in same style, no frame for graph or legend and no grid lineSuggest you leave this 'chart junk' out of your reportFigure 1.1As TableFigure 1.2Figure 1.3See my note on graph- has Gwyneth got corrected data?Figure 1.4I have re-plotted this with axis at bottom. Same graph as 15.2Figure 1.5I have re-plotted this with axis at bottom. Same graph as 11.1 and 15.1Figure 1.6Data from chapter. I have redrawn graph, as annotatedFigure 1.7Data from Nigel. Redrawn without grid linesFigure 1.8Taken from Table 1.20Figure 1.9Strange data extracted from chapter. Not recognised by Nigel or me. Look a bit dodgyFigure 2.1Figure 2.2Used data in Word document and corrected data from reports to replot graphFigure 2.3Used data in Word document and corrected data from reports to replot graph the same way round as Figure 3.2Figure 3.1Figure 4.1Figure 4.2Marion's data in Word document don't look right and Table 4.1 is not consistent with data in Chapter 1Figure 5.1Figure 6.1Figure 6.2Figure 7.1Figure 7.2Figure 8.1Figure 9.1Figure 10.1Figure 11.1Same as Figure 1.5. Typo in title.Figure 11.2Same as Figure 1.6, which I have redrawn with horizontal bars.Typo in title.Figure 12.1Replaced with associated and indirect graphFigure 15.1Same as Figure 1.5. Typo in title.Figure 15.2Same as Figure 1.4 Typo in title.Figure 16.1Data were in word document. I have replotted graph to make it tidier. Do you really use word 'appalling', even if it is true?Figure 20.1Replotted to remove chart junkFigure 21.1Replotted to start at zeroFigure 21.2Replotted to start at zeroFigure 21.3Replotted to remove chart junkFigure 21.4Replotted as area chart in consultation with Tania. Is all women appropriate for CEMDFigure 21.5Shouldn't variable be 'during pregnancy' rather than after, for consistency with title?Figure 22.1Figure 22.2Figure 22.3Figure 22.4See Word document for layoutFigure 22.5Table 22.1Included as it has got a bit mangled in Word

Figure 1.16.13.79.86.13.9105.54.39.86.16.112.256.411.45.37.813.1

Improved case ascertainment by ONSImproved case ascertainment by CEMACHDirectIndirectTotalTrienniumRate per 100,000 maternities

figure 1.1 dataFigure 1.1Rate per 100,000 maternitiesDirectIndirectTotal1985-876.13.79.81988-906.13.910.01991-935.54.39.81994-966.16.112.21997-995.06.411.42000-025.37.813.1Other IndirectCardiacsuicideThromboembolismHaemorrhageHypertensionSepsisEctopic44.62218.5138.5765.5

Fig 1.22.5345.5678.513

Direct deathsCause of deathRate per million maternities

Fig 1.32225109126.56.553.56

IndirectRate per million maternities

direct0305

direct030519.48.58.586.64.72.8

0305direct19.48.58.586.64.72.8

indirect 0522.718117.54.22.12.1

overallrates0522.719.418118.58.586.56.5

Fig 1.2 and 1.3 dataCardiacCNS haemorrhageEpilepsyInfectionsRespiratoryGIOther22126.56.553.56Other IndirectCardiacsuicideThromboembolismHaemorrhageHypertensionSepsisEctopic44.62218.5138.5765.5IndirectCardiac22Suicide/open verdict25Direct deathsSuicide/ open verdict25Misadventure10Misadventure10Drug/alcohol9AFE2.5Drug/alcohol9Anaesthetic3CNS haemorrhage121997472Other direct4Epilepsy6.5Ectopic5.5Infections6.5Sepsis6Respiratory5hypertension7Gastrointestinal3.5Haemorrhage8.5Other Indirect6VTE13for 200305Direct deathsVTE19.4Cardiac22.7Cardiac22.7Sepsis8.5Suicide18VTE19.4Preeclampsia8.5CNS Haemorrhage11Suicide18AFE8Epilepsy7.5CNS Haemorrhage11Haemorrhage6.6GI4.2Sepsis8.5Ectopic4.7Respiratory2.1Preeclampsia8.5Anaesthetic2.8Immununity2.1AFE8Haemorrhage6.5Infections6.5

Fig 15.2, 11.2A and 1.4101101351126620132013103418269102254141661373400

Cases known to CEMACH, up to 42 daysNew cases from linkage, up to 42 daysCases known to CEMACH, more than 42 days after giving birthNew cases from linkage, more than 42 days after giving birthNumbers

figure 15.2,11.2, 1.4 raw dataFigure 15.2 - same as Figure 1.4Cases known to CEMACH, up to 42 daysNew cases from linkage, up to 42 daysCases known to CEMACH, more than 42 days after giving birthNew cases from linkage, more than 42 days after giving birthCardiac disease1011013Cancer511266Infection2013Diseases of blood2013Epilepsy1034Nervous system18269Circulatory system10225Respiratory system41416Gastrointestinal6137Other Indirect3400

Fig 1.5 and 15.12Alcohol/drugs28114151Murder/manslaughter25111024Road traffic accident1310Unascertained136

Cases known to CEMACH, up to 42 daysNew cases from linkage, up to 42 daysCases known to CEMACH, more than 42 days after giving birthNew cases from linkage, more than 42 days after giving birthNumber

Fig 11.12Alcohol/drugs28114151Murder/manslaughter25111024Unascertained136

Cases known to CEMACH, up to 42 daysNew cases from linkage, up to 42 daysCases known to CEMACH, more than 42 days after giving birthNew cases from linkage, more than 42 days after giving birthNumber

figure 1.5,11.1,15.1 raw dataFigure 15.1 - same as Figure 1.5Cases known to CEMACH, up to 42 daysNew cases from linkage, up to 42 daysCases known to CEMACH, more than 42 days after giving birthNew cases from linkage, more than 42 days after giving birthAlcohol/drugs228Accident/misadventure11415Murder/manslaughter125Suicide/open verdict111024Road traffic accident1310Unascertained136Up to 42 days42 days+TotalAlcohol/drugs21012Accident/misadventure21921Murder/manslaughter178Suicide/open verdict23436Road traffic accident11314Unascertained1910Figure 11.1, same as Figure 1.5 minus Road Traffic AccidentsCases known to CEMACH, up to 42 daysNew cases from linkage, up to 42 daysCases known to CEMACH, more than 42 days after giving birthNew cases from linkage, more than 42 days after giving birthAlcohol/drugs228Accident/misadventure11415Murder/manslaughter125Suicide/open verdict111024Unascertained136

Figure 1.6PsychiatricPsychiatric25109Cardiac22CardiacCardiacCardiac15EmbolismEmbolismEmbolismEmbolism8.5HaemorrhageHaemorrhageHaemorrhageHaemorrhage7.5Early pregnancyEarly pregnancyEarly pregnancyEarly pregnancy5.5SepsisSepsisSepsisSepsis

DirectIndirectSuicide/open verdictMisadventureDrug/alcoholRate per million maternities

Figure 1.6 dataFigure 1.6Data embedded in chapter - note to be redrawnRates per million maternitiesPsychatricAll other Indirect combinedCardiacEmbolismHaemorrhageEarly pregnancySepsis474522158.57.55.5Suicide/open verdict28Misadventure10Drug/alcohol9Rates per million maternitiesPsychiatricCardiacEmbolismHaemorrhageEarly pregnancySepsisSuicide/open verdict2522158.57.55.5Misadventure10Drug/alcohol9Used this transposed version of data to redraw graphRates per million maternitiesDirectIndirectSuicide/open verdictMisadventureDrug/alcoholPsychiatric25109Cardiac22Embolism15Haemorrhage8.5Early pregnancy7.5Sepsis5.5

Figure 1.712.47469899075.46877007018.450570920610.95583291524.43660601847.167211033413.17684370256.05829124789.11716534315.49489938168.12929911311.378959166615.99016236289.301514565212.3135378553

Upper levelLower levelrateRate per 100,000 live births

figure 1.7 raw dataFigure 1.7QuintileDirect/IndirectrateLower levelUpper levelLeast deprived 18.55.512.527.24.411.039.16.113.2411.48.115.5Most deprived 512.39.316.0Upper levelLower levelrateLeast deprived 112.55.58.5211.04.47.2313.26.19.1415.58.111.4Most deprived 516.09.312.3

Fig 1.88.47.29.411.619.735.5

Rate per 100,000 maternitiesAge of mother, yearsRate per 100,000 maternities

Fig 1.96.84015680829.07636191863.82866871916.38111453184.96814815668.69425927415.99115974216.65684415794.34506011775.0692368045.35689164117.7099188105

DirectIndirectNumber of previous pregnanciesRate per 100,000 maternities

Figs 1.8 and 1.9Data for Figure 1.8 taken from Word documentRedrawndata from Table 1.20Rate per 100,000 maternities