Medical Independent: The second anniversary of specialist perinatal mental health services model of care

In an article for the Medical Independent, June Shannon looks at the implementation of Ireland’s first specialist perinatal mental health services model of care on the second anniversary of its publication.

You can read the full Medical Independent article, published on 19/09/19, here.

‘Prior to [the] new model, the perinatal mental health service was solely concentrated in Dublin and consisted of just three part-time perinatal psychiatrists in the three Dublin maternity hospitals, while liaison psychiatrists in other parts of the country did their best to meet the mental health needs of  the women and babies in their care.

The model of care employs a ‘hub-and-spoke’ model, where within each of the six Hospital Groups, the maternity hospital with the greatest number of births acts as the ‘hub’ for the rest of the maternity units, or ‘spokes’.

‘Under the model of care, the teams should comprise a full-time consultant perinatal psychiatrist; an NCHD (preferably senior registrar); two mental health nurses (clinical nurse specialist grade); one senior psychologist; one senior occupational therapist; one senior social worker; and one administrator.

The model of care also involves the further development and implementation of mental health midwives, a relatively new position in Ireland.

‘According to the model of care, “women should be referred to the perinatal mental health services if they are suspected of having a mental illness or have any history of mental illness. Women with milder problems would be seen by a mental health midwife, and those with severer problems by the specialist perinatal mental health team.”

“The milder problems will be dealt with by the mental health midwife and then the moderate-to-severe in the hubs will be responded to by the perinatal mental health service or in the spokes, by the liaison psychiatry service,” Dr Wrigley said.’

Limerick became the first service outside of Dublin to come on board, with the University Maternity Hospital Limerick serving as the hub with an average of 5,000 births per year and the sole provider of obstetrical, midwifery and neonatal intensive care to the mid-west region.

The first two hubs to get off the starting blocks were the National Maternity Hospital, with the full-time appointment of consultant perinatal psychiatrist Prof Anthony McCarthy and University Maternity Hospital Limerick (UMHL), with the appointment of Consultant Perinatal Psychiatrist Dr Mas Mahady Mohamad.

However, delays in Galway have meant that the model of care has not yet been fully adopted across the island.

‘Dr Wrigley explained that there is currently a fully-trained consultant perinatal psychiatrist ready to take up the post in Galway University Hospital. However, to date, formal written approval has not been received to recruit the consultant and the members of the specialist multidisciplinary team.

“Given it is so hard to recruit consultants, it is very disappointing not to be able to proceed.  We are continuing to advocate strongly for these posts to be given the formal go- ahead,” she said.

In a statement, the HSE said: “There is not a recruitment ban in place in the HSE. There is ongoing capacity to recruit new funded posts and also to replace critical clinical posts within front-line services. There are, however, controls in place to ensure that the HSE is demonstrating that it is living within the available resources provided to it by Government… Regarding the recruitment of a consultant perinatal psychiatrist in Galway, the recruitment process is currently ongoing.”’