Perinatal Mental Health Team Experience?

[AiRoo]

Hi all,

I was wondering if anyone had any positive experiences with a perinatal mental health team?

im just over 9 weeks pregnant after two previous losses. This is my first biological child. My wife carried our 18 month old son.

I have/had a long standing MH history and worked so so hard to get myself to a mentally healthy place before conceiving. I gave up a good intelligence analyst job to focus on therapy and have been medication free for nearly 2 years after being on them for 25!

however, my mood is crashing further and further on the daily. I’m having thoughts that I thought were long gone. In all honesty I’m worrying as I don’t want to ever get to the place I have been in before.

I am considering asking for a referral from my GP tomorrow to the perinatal MH team, but I’m hesitant due to my history.

I have had a few psychiatric inpatient stays so I don’t want eagle eyes on me and be judged on the old me. Wondering if I should just focus on the ethos of “this too shall pass” and keep quiet?

has anyone had any good experiences where the team is supportive not judgemental and overreactive to a relatively severe risk level in previous years?

TIA x

Hi, I have a long term mental health condition. I was under the perinatal team from the third trimester with my daughter until she turned 1. I was assessed and accepted by them in my first trimester but my mental health was stable so I didn't need their input until later into the pregnancy.

I saw a cc every other week and had phone calls in the alternative weeks if necessary. I developed severe depression and psychosis after my daughter was born and they were very proactive in trying to find solutions for me in the community. I did end up needing an admission to a mother and baby unit when she was 10 months old but it was first discussed at 10 weeks. In the intervening time they tried quite a few different medications, cft therapy and regular support. It was only when I became treatment resistant and needed to have more regular psychiatric input that I needed the admission. At this point the 6 weekly reviews with the psychiatrist just weren't going to make the difference I needed before my maternity leave ended at 12 months and my transfer back to the cmht.

I'm pregnant with my second now and have my assessment with the perinatal team next week, I'm 27 weeks. I had two miscarriages last year so I asked for referrals not to be put in until after my dating scans as I had to cancel the assessment after the first miscarriage. So far I've been stable although my mood is starting to drop. I'm under the Obstetrician that specialises in mental health and I have the contact details for the two mental health midwives

Hi @Superscientist thank you for your comprehensive reply.

sorry to hear you’ve been through so much, it sounds like you have had a lot of successful and supportive input.

I wish you luck for your assessment next week, I hope your mood doesn’t continue to drop too low. It’s so hard and conflicting isn’t it? A time that should be happy just doesn’t feel it.

I know I’m very early and a lot can go wrong still but if I’m feeling this way now and things do go well then it’s going to be a long 7 months.

I would probably see what the GP can do now, potentially restarting meds. There's plenty that are safe to take in pregnancy and see what they recommended regarding the perinatal team

Have you had your booking appointment yet? I'd also look at what support you can get through the midwives and obstetrics.

They were amazing after my eldest was born and I was referred back to the same CC just in case when I was pregnant with my second. With the second while my mood did drop at times it wasn't anywhere near as bad as the first and was so reassuring to have someone to talk to who just got it. In terms of meds they are obviously much better informed of options to safely take while pregnant/bf than the gp will be.

I think you should ask to be referred to the perinatal team. I wasn’t referred until DD2 was a month old, and they put me on the waiting list for therapy but basically told me that I’d be out of their remit before I got to the top of the list (basically DD would turn 1 and I wouldn’t be under their team any more before I got anywhere with treatment)

Yes it was last week. She asked if I smoked I said “not any more, but did for 20 years” and she said “I’ll put never”
then asked about previous meds, I said I was last on aripiprazole and venlafaxine but haven’t taken them for 18 months. Again she said “I’ll put never”
so don’t know how to feel about that!!

Did they go through previous mental health? That would be the section I think that would trigger the potential extra support.
From a pregnancy perspective they just need to know what medication you've been on in the 6 months prior to conception but it's the reason for the medication in this instance that potentially could trigger needing extra support. Certain conditions put you at very high risk of relapse post partum. I'm bipolar and there's a 50% chance of severe depression and psychosis in the post partum period. I think previous episodes of psychosis have a similar risk.

A chat with the GP would probably be a good idea. Even if the perinatal team can't take you on right now, there can be quite a high barrier to getting on their books, they should be able to give you GP advice on medication in pregnancy. My GP approached the perinatal team for advice on medication before I stop contraception to ensure it was safe for pregnancy

@Superscientist no. My booking apt was relatively short, bloods, height, weight. Explanation of genetic tests etc.

my midwife is coming to the house on the 7th July so maybe it’ll be discussed then.

I will discuss with the gp tomorrow then. Thank you for your advice and guidance

They should also go through your medical and family history to identify anything that might add complications in pregnancy and that might be made worse by pregnancy.
Usually you would have your booking appointment and then not have your second appointment until 16 weeks so I would guess that they have split he booking appointment into two and will cover medical history when they come on the 7th

I found them useful however they drop you like a stone at 1st birthday time so please make sure you have the next support in place in readiness. Fortunately I had great support from Aberlour in tandem with PNMHT who supported me until I went back to work when DD was 18 months and dip in and out of PANDAS support as well. My feedback to PNMHT was ‘MH doesn’t suddenly improve when your child hits 365 days’

@FNDandme thank you for your reply and advice. Your feedback is very correct and I hope they took that onboard.

I have had a similar experience with my last treatment programme, the mentality was “end of treatment, you should be fixed, bye bye, don’t contact us or anyone in the trust again”

i will bear your comments in mind. Thank you.

I was kept under the perinatal team for an extra 2 weeks as I couldn't be discharged until I had a care coordinator lined up with the cmht.

Unfortunately the cmht was hopeless and I saw this care coordinator once before he left without replacement for months. Replacements came twice before leaving with another several month gap before a replacement was found who saw me once a month and only asked me 3 questions - my diagnosis, if I was suicidal and if I psychotic.

I did a CFT group therapy course whilst under the perinatal team and out of the 8 of us I was the only one not well enough to be discharged back to GP care. So it is possible that the support from the team will get you back into a place when you can cope without the specialist services.

I've been in and out of treatment for 20 years and broadly have found specialist services are so much better than the cmht and you can get gaps in care post transition but also that the specialist services can give you many skills to allow you to cope on your own.

Another angle for support once baby is here is the HV. I have qualified for extended care. The first HV arranged for me to have 1 on 1 baby massage course to help with bonding at home - during the pandemic no less! Saw me every other week to check in with me and did a referral to the infant parenting service who provided me with 18 months of therapy to help with bonding. I moved when my daughter was 2 and saw a different HV when she was 3.5 for counselling to help me cope with parenting alongside my health and my daughters as she has a few health issues. I know HV can be quite varied though!