Reforming mental health services for pregnant women 'unfinished business' — psychiatrists

Perinatal psychiatrist Dr Catherine Hinds said 'the other big lack in perinatal services is having a bespoke specialist inpatient unit'. Picture: Moya Nolan

Reforming mental health services for pregnant women is “unfinished business”, with women in some regions still missing out on services available in cities, leading psychiatrists have warned.

Ireland also still does not have a psychiatric unit to admit new mothers and babies together.

Dr Mas Mahady Mohamad, psychiatrist with the Specialist Perinatal Mental Health Team at the University Maternity Hospital Limerick, said this team was the first to open outside of Dublin under 2018 reforms.

“Last year we received almost 1,000 referrals which is quite significant for a maternity hospital with around only 4,000 new births per year,” he said.

Limerick is one of six hub sites with smaller maternity units operating as spoke sites.

The Midwest has seen a rise in referrals and more complex cases since the pandemic began, with Dr Mahady saying he believed the "increase is quite standard across all the hubs."

Dr Mahady, a member of the Perinatal Psychiatry Special Interest Group at the College of Psychiatrists of Ireland (CPI), said women attending the hubs receive more supports.

“We need to look at equal services across the country. At the moment the smaller hospitals are mainly staffed by a mental health midwife, with the support of the liaison psychiatry or general adult psychiatry.

"But they don’t have the same level of access to a specialist perinatal psychiatrist or they don’t have access to a specialist clinical psychologist or occupational therapist.” This is particularly key, he said, for women with more severe mental illnesses.

“I think looking at enhancing what is provided in the spokes is one of the key pieces (remaining) so that someone who lives in Dingle or Wexford or Donegal would get the same level of services as someone who lives in Dublin or Limerick,” he said.

At the National Maternity Hospital in Dublin, perinatal psychiatrist Dr Catherine Hinds, echoed these concerns.

“The other big lack in perinatal services is having a bespoke specialist inpatient unit,” she said.

At the moment, she said, new mothers are admitted to a psychiatric hospital and looked after by a general adult psychiatrist.

“That’s a mismatch of expertise,” she said.

"We want specialist teams looking after those women, but the most important thing is in a mother and baby unit the mums can be admitted with their babies.” Separating them, she said will “prolong their recovery and make their mental health worse” as well as impacting babies.

“In the vast majority of perinatal inpatients, it is preferable to have them cared for with their baby, and that’s the gold standard of care,” she said.

“The model of care (2018) was designed with inpatient provision, but unfortunately all the outpatient services have been established – they’ve been a great success – but the mother and baby units haven’t been built.”

Based on the Irish birth-rate, “according to the UK estimates, you’d need 22 in-patient beds in Ireland”, Dr Hinds, who is CPI Perinatal Psychiatry Special Interest Group chair, said.

A spokesman on perinatal psychiatry for the CPI said it is encouraging to see the increase in numbers of perinatal psychiatrists in recent years.

“Yet it is clear that much more needs to be done in order to offer patients the optimal care they need,” he said.

“It is critically important that the perinatal specialty receives sustained and significant investment for both research purposes and for effective resourcing at a national level in order to meet demand in a way that benefits all patients.”