Paul Lelliott

1
MOTHERS DESERVE THE BEST Setting standards for
perinatal mental health services Peter Thompson
Programme Manager Royal College of
Psychiatrists Centre for Quality Improvement
2
Overview

• The CCQI
• Guiding principles of a quality network
• Quality Network for Perinatal Mental Health
  Services
• Methods
• The review day
• Results of the pilot and comments from mothers
• Progress to date and plans for the future

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College Centre for Quality Improvement

• The college has been involved in quality
  improvement work for 10 years
• The CCQI was launched in 2006 and brought
  together the various QI initiatives
• Member led networks aimed at frontline clinical
  staff nationally and internationally

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College Centre for Quality Improvement

• More than 90 of mental health services in the UK
  participate in one or more of these initiatives
• Work with NHS and independent services
• All networks are voluntary and most are funded by
  members subscriptions

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CCQI Projects

• Quality Networks for
• Inpatient CAMHS
• Multi-agency CAMHS
• Therapeutic communities
• Forensic mental health services
• Adult acute inpatient wards
• ECT clinics
• Also National Audit of Violence, ACP 360, Better
  Services for People who Self Harm and POMH-UK
• www.rcpsych.ac.uk/ccqi

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Quality Network for Perinatal Mental Health
Services

• Following the Confidential Enquiries, RCPsych
  made a commitment to promote perinatal mental
  health
• Funding provided to establish a Quality Network
  for Perinatal Mental Health Services
• Initially starting with Mother and Baby units
• Network launched in summer 2007

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Guiding principles

• EMPOWER AND ENABLE front-line staff
• PATIENT FOCUSED - Standards to focus on what
  really makes a difference to a patients care
• SUPPORTIVE AND NOT JUDGEMENTAL
• HONEST AND CHALLENGING of poor performance

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Guiding principles

• CREDIBLE AND AUTHORITATIVE good standards
• PERSIST until changes sustained
• INCLUSIVE - recruit marginal services otherwise
  preaching to converted

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Standards

• Standards developed with multi-disciplinary
  perinatal professionals and service users
• Access and Admission
• Environment and Facilities
• Staffing
• Care and Treatment
• Information and Confidentiality
• Rights and Consent
• Audit and Policy
• Discharge
• Also review of existing standards, guidelines
  etc.

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Clinical Audit Cycle
Revise Standards

• Data Collection
• Self-review
• External peer-review

Annual Forum
Aggregated annual report compiled - benchmarking
Local reports compiled
Action planning follow up Implement changes
throughout the year
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Timetable
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Benefits of being part of a network

• Can use report to help argue for funding
• Sharing best practice with colleagues
• Common problems its not just us!
• Can identify national trends useful for
  lobbying
• Standards allow frontline staff to say what they
  think the priorities are
• Work of CCQI recognised by Healthcare Commission,
  DoH etc.

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The pilot year

• 7 units participated from- Nottingham-
  Cardiff- Stafford- Morpeth- Glasgow- East
  London- Winchester
• These are the preliminary findings from the data
  collected annual report will be published in
  the autumn

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Results

• There are insufficient units in the country so
  mothers are often not accessing appropriate
  services
• The majority of units are without social work and
  psychology input
• Several units dont have strong
  community/outreach teams working with them to
  manage mothers

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Results

• The status of the baby within the hospital
  remains an area of debate for units
• Families from remote areas struggle
• Mothers reported that theyd like more activities
  more structure
• Very specialised area therefore difficult to
  find experienced staff and to also access
  training

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Mothers comments - concerns

• I was admitted to a different hospital and
  separated from my baby for 4 days before someone
  realised there was a mother and baby unit
• There are no nursery nurses at the weekend. I
  would have liked there to be as if I had a
  problem e.g. with feeding then I would have to
  wait until Monday
• There are no nursery nurses at the weekend. I
  would have liked there to be as if I had a
  problem e.g. with feeding then I would have to
  wait until Monday

17
Mothers comments - concerns

• I would have liked some structure to the day
• There are no private or quiet areas

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Mothers comments - praise

• Staff are there all the time to help you care for
  your baby
• I was involved in my care plan and agreed and
  signed it
• I was referred by my GP to the crisis team who
  carried out an assessment and admitted me the
  same day
• The staff have been fantastic answering my
  partners concerns

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Mothers comments - praise

• Staff normalised things for me, I was afraid of
  the stigma of mental health problems and the
  staff reassured me
• The staff have taught me a lot of things about
  caring for my baby - I feel I have had an
  advantage over other new mums who have to learn
  how to care for their baby on their own
• Staying here has helped me

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Progress to date and plans for future

• 4 new services already members for Year 2
• Annual forum planned for Autumn 2008 along with
  annual report
• Look to include other perinatal services in
  future cycles community teams?

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Contact Us

• Peter Thompson Programme Manager
  pthompson_at_cru.rcpsych.ac.uk
• Jane Solomon Quality Improvement Worker
  perinatal_at_cru.rcpsych.ac.uk
• Tel [phone]
• Web www.rcpsych.ac.uk/perinatal-network