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‘Expansive’ perinatal mental health care guidance released
Clinical practice guidelines have been revised to ensure new and expecting parents receive appropriate care and regular screening.
Around 15–20% of Australians are affected by perinatal depression or anxiety.
Mental health care, including targeted assessment and referral, makes up a large portion of the generalist care that GPs provide.
Maternal care also forms a significant part of GPs’ bread and butter, and with evidence identifying increased rates of depression and anxiety during pregnancy, access to timely, appropriate and ongoing support and treatments is essential.
That is according to the Centre of Perinatal Excellence (COPE), which has recently updated its clinical practice guideline on perinatal mental health care in an effort to address existing gaps by providing the latest evidence-based advice for health professionals to support new and expecting parents.
The guideline outlines the importance of prevention, early identification and treatment of perinatal mental health concerns, stating that ‘physical and mental health should be central to every aspect of maternity and postnatal care’.
Dr Nicole Highet, COPE Founder and Executive Director and Chair of the Guideline Expert Working Group, told newsGP the guideline is ‘expansive in its coverage’ of the prevention, detection, and treatment of a range of perinatal mental health disorders.
‘This includes the high prevalence disorders, anxiety and depression, as well as the management of low prevalence disorders – namely puerperal psychosis, bipolar disorder, schizophrenia, and borderline personality disorder in the perinatal period,’ she said.
‘[What is] particularly notable for GPs is the importance of psychoeducation for all parents about emotional and mental health in the perinatal period.
‘The guideline also provides GPs with recommendations regarding the role of psychological and medical treatments, including the safe use of medications in pregnancy and when breastfeeding for the range of disorders.’
According to COPE, 10% of women in Australia experience depression during pregnancy, around 15% experience postnatal depression, and 20% are affected by anxiety in both the antenatal and postnatal periods.
Suicide is also noted as a contributing factor to maternal death, ranked third among the most frequent causes reported in Australia between 2011 and 2020 at 10%, after cardiovascular disease (16%) and thromboembolism (11%).
Because of these statistics, a key focus of the guideline refresh is regular screening to identify those experiencing or at risk of experiencing a mental health condition during the perinatal period to ensure they don’t ‘fall through the cracks’, Dr Highet said.
Routine screening for depression and anxiety should be conducted early in pregnancy and at least once later in pregnancy using the recommended screening tools, the guideline advises, as well as:
- all new mothers screened for depression/anxiety 6–12 weeks after birth and again at least once in the first year after having a baby
- screening to include psychosocial risk factors that affect mental health (such as past history of trauma), and extend to fathers and non-birthing partners.
Dr Highet said the resource outlines best practice guidance for GPs to diagnose and develop a management plan for depressive and anxiety disorders during the perinatal period.
‘[This includes] supporting emotional health and wellbeing of women and their families, assessing mother–infant interaction and the safety of the woman and infant,’ she said.
‘And a new section on care planning for those who have experienced psychological birth trauma.’
For diagnoses of severe mental illnesses during pregnancy and postpartum, care planning requires medical intervention with guidance on the safe use of specific medications detailed in the guideline.
Once a psychiatric diagnosis is established, and where psychological intervention is deemed the best treatment approach, a GP may develop a Mental Health Treatment Plan to allow access to relevant Medicare items for psychological treatment.
In addition, the guideline covers referral and care pathways for women who require further assessment, recommending that all parents be educated about emotional and mental health conditions that may arise in pregnancy and the postnatal period, the available supports, and continue to receive follow-up care.
Follow-up care is an important part of GPs’ role within a multidisciplinary care team, as Chair of RACGP Specific Interests Antenatal and Postnatal Care, Dr Wendy Burton,
recently told newsGP.
‘If I as a GP have concerns and the woman is seeing a midwife for her care, how do I pass that concern along? If an obstetrician has a concern, how can they alert me, the GP?’ she said.
‘It’s making sure you make the next step and make it very clear that you don’t just leave them hanging and expect them to follow up themselves.’
While referral and care pathways vary with location and setting (eg general practice or maternity services), COPE acknowledges that women with pre-existing severe mental illness may already be under the care of a GP and/or psychiatrist. As a result, the guidelines say specific consideration should be given to care planning due to ‘the complexity of these conditions and the substantial challenges for primary care professionals involved in their management’.
COPE also proposes potential areas for future development to support the sustainable and measurable implementation of best practice.
The updated 2023 Perinatal mental health practice guideline is available on the COPE website, and a summary of the recommendations and practice points is due for release in the coming weeks.
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