Case study: Obstetric and mental health assessments

Approximately 20% of women will develop a mental health issue during the perinatal period and almost a quarter of maternal deaths between six weeks and one year after pregnancy were related to mental health problems.

To address this worrying trend, Medway Maritime Hospital designed and implemented a new integrated obstetric-perinatal health antenatal service to which patients were referred by the community midwife at booking. Helen Watson, Consultant Obstetrician and Gynaecologist, and Antenatal Lead for Antenatal and Postnatal Mental Health, led the project.

The service provided an obstetric and mental health assessment to women at their initial antenatal appointment. Patients were provided with timely and accurate advice regarding their mental health, medication and signposted to mental health services if required.

This service took the form of the Joint Mental Health Antenatal clinic and was piloted between May and November 2017.

There were four significant outcomes and findings from the pilot:

• A reduction in ‘referral to seen’ times from initial assessment by the community midwife to seeing a mental health professional, with a significant reduction in variation in waiting times. In the final two months of the pilot, no patient waited more than five weeks to be seen.
• A substantial reduction (70%) in referrals to the Mother and Infant Mental Health Service (MIMHS). Of these referrals, a majority (69%) went to MIMHS to ensure continuity of care.
• A downward trend in non-attendance as the new service bedded in. This was initially 23% but fell significantly over the course of the pilot, although additional work is required to further reduce it.
• The majority of referrals were for patients with anxiety and depression. This demonstrated the need to develop robust pathways between community midwives and IAPT (Improved access to psychological therapy).

Patient satisfaction was considerable and was reflected in the patient survey