Community Perinatal Mental Health Services: briefing paper for boards

Guidance on regional leadership and clinical roles

Guidance on regional leadership roles (level 1)

The funding already allocated for regional roles is intended to allow those specialists in senior leadership roles to have additional time for education and training of other specialist and non-specialist staff both locally and regionally, working in collaboration with NES, and to provide clinical leadership for the regional network of services in north, west and east of Scotland. For all boards in each region (North, East, West), these posts (lead psychiatrist, lead clinical psychologist, lead parent-infant therapist, nurse consultant) should provide:

• clinical leadership in education and training
• clinical leadership for regional network and regional care pathway development
• informal clinical advice, support and guidance to local staff
• exceptionally, joint clinical assessment for complex cases in support of the local team. It is anticipated that such requests would occur no more frequently than once or twice per year within a region and would largely be restricted to supporting complex decision making on suitability for Mother and Baby Unit admission

Guidance on regional clinical roles (level 2)

Some of the boards have very low birth numbers without stand-alone/dispersed provision (primarily the island boards but potentially extending to other boards adopting a regional model of service provision as shown in table two). For these boards it is recommended that regional nurse consultants provide a regional service to include (where required):

• clinical support and supervision to local staff
• joint clinical assessment for complex cases to support local team decision making, e.g., decisions on need for admission, evaluation of perinatal risk, complex treatment planning (such as management of lithium in pregnancy), evaluation of need for complex psychological interventions, or supporting the assessment of complex mother-infant relationship difficulties in the context of maternal mental disorder.

Professional support and supervision may be required for a small number of nursing staff with specific perinatal roles in local services. This support/supervision may be best provided in a group setting to allow for mutual learning. It is anticipated that this need could be met through monthly online or in person supervision groups, with the possibility for individual supervision on a temporary basis if required.

Joint clinical assessment (with the local team) would be provided on a second opinion basis and overall clinical responsibility for patients would remain with the local service. Such provision may use video conferencing technology/remote working arrangements. The nurse consultant, or other professionals with regional responsibility, would not be in a position to take on clinical responsibility for patients outwith their local board area. It is anticipated that such requests would occur no more frequently than 2.5-5.0 per 1,000 deliveries/year.

It is envisaged that, at most, 0.1-0.2 WTE nurse consultant time would be required to meet the need for clinical support, supervision and assessment. Table two shows that this additional role would only be required for those boards/areas who cannot establish a comprehensive local community perinatal mental health service due to small size / low birth numbers. The majority of boards across Scotland have already established comprehensive community provision. It is anticipated that regional clinical leadership roles would be reflected in Nurse Consultant job plan.