Mother and Baby Unit (MBU) and Outreach Service and Perinatal Mental Health Inpatient Services

Scope

Jasmine Lodge Mother and Baby Unit (MBU) in Exeter is a relatively new mental health inpatient unit (opened 20 May 2019). There are 8 beds for mothers and their babies/infants. Mothers can be admitted if detained under the Mental Health Act. The MBU is an NHS England Specialised Commissioning service. The beds are for mothers living in Cornwall, Devon and Somerset though the unit will accept out of area admissions if a nearer unit does not have capacity and Jasmine Lodge has vacant beds.

The unit adhere to admission criteria offered by all 19 MBU's across England to ensure a standardised approach to accepting admissions. The admission criteria can be found below in the Referral Criteria section.

Out of Scope

Exclusion criteria as set by NHS England:

  • For sole purpose of a parenting assessment
  • Women with severe personality disorder, learning disability or substance misuse unless they are also suffering from, or there is suspected, serious mental illness
  • If there is evidence that the mother will not be capable of independent functioning in caring for her infant in the community with reasonable support
  • If there is evidence of serious violence/aggressive behaviour that might pose a risk of harm or injury to her own or other babies on MBU
  • Under 16 years of age
  • Women less than 32 weeks into their pregnancy or women over 10 months postnatal, in this situation a referral would need to be made to the local Crisis Team if an inpatient bed is being sought

Assessment

Signs and Symptoms

  • Severe postnatal depression
  • Relapse of pre-existing mental illness
  • Postnatal psychosis
  • Poor attachment with their unborn (from 32 weeks into pregnancy) or new baby/infant
  • Mental health history
  • Risk to self, others and the baby/infant

History and Examination

  • Mental health review in the perinatal period. Mood. Anxiety. Psychosis
  • Exclude mis-attributed physical health conditions

Red Flags

Confidential Enquiry into Maternal Deaths (MBRRACE) red flags (Mental Health section, pages 42-60).

  • Recent significant change in mental state or emergence of new symptoms
  • New thoughts or acts of violent self-harm
  • New and persistent expressions of incompetency as a mother or estrangement from the baby/infant
  • Disengagement from care by women with a known significant psychiatric disorder should be regarded as a potential indicator of worsening mental state. All professionals involved should be informed of non-attendances and assertive follow-up arranged where there is already concern regarding mental state or prior evidence of risk

Investigations

Consider misattribution of symptoms; mental and physical health.

Management

If a mother does not meet the above criteria consider a referral to the local Community Perinatal Mental Health Team or TALKWORKS (Improved Access to Psychological Therapy Service).

Referral

Referral Criteria

The Mother and Baby Unit provides admission for mothers from 32 weeks in pregnancy up to 12 months postnatally. We have a cut-off point for admission at around 10 months postnatally which allows us to offer up an to 8 weeks admission episode. This brings us up to the 12 months period. Admission would be appropriate for vulnerable women presenting with one or more of the following:

  • Postpartum Psychosis or previous history of
  • Diagnosis of Bipolar Affective Disorder, Schizo-affective disorder or other psychoses
  • Moderate or severe antenatal/postnatal depression or anxiety disorders including previous severe depressive episode/post natal depression-requiring treatment in hospital/secondary care
  • Referrals for mothers with these conditions aged 16 - 18 years are accepted if there is a significant perinatal mental illness and they are likely to be the infant's principal carer. Inpatient Mother and Baby Units are suitable for the admission of a young mother but the admission will be managed in collaboration with Child and Adolescent Mental Health Services (CAMHS) and Social Services
  • Women in the antenatal period over 32 weeks gestation

Referral Instructions

Professionals who can refer include, Mental Health Professionals (Recovery Care Co-ordinators, Psychiatrists, Liaison Psychiatry Teams, Crisis Teams), GP's or Approved Mental Health Practitioners (AMHP's), Midwives or Health Visitors.

To refer:

Telephone the Mother and Baby Unit on 01392 539100 – Monday to Friday 10:00-16:00 ask to speak with the Duty Outreach Practitioner, outside of these hours it's the Nurse in Charge on the unit on the same number.

The service do not accept emailed referrals owing to the high risk/severity of mothers usually referred.

Referral Form Completion: Monday to Friday 10:00-16:00 the Outreach Practitioner will complete the referral form with the referrer, outside of these times the referrer will be asked to complete the form electronically and email to dpt.mbuexeter@nhs.net a telephone call must take place before referring with the form.

Pathway Information

This guideline has been signed off on behalf of the NHS Devon Clinical Commissioning Group

Publication date: February 2020

 

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