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The
process for
a woman
who needs
psychological
therapy support
to access
it:
Funding which was
made available to each Health
Board in 2015 has been
utilized to develop specialist community based teams
within each Health
Board in order to provide support to women,
their infants and families. The
challenge faced by
these new teams,
is the provision of care and treatment required for
women with moderate to
severe perinatal mental health problems, whilst liaising with and
providing training for staff in
primary care.
The Health Board
has successfully
developed a
Perinatal
Mental Health
Service and has recruited
a multidisciplinary
team which
includes a Perinatal Consultant Psychiatrist
(O.3wte), Perinatal Specialist Lead
Nurse
(1.0wte), Occupational Therapist
(O.5wte), Psychology Assistant
(O.5wte), Perinatal
CPN (1
.4wte) and a
Clinical Psychologist
(O.2wte).
All women within the
Health Board area, upon the receipt of their All Wales Handheld
Antenatal notes, will also be provided with a Health Board
Perinatal leaflet clearly outlining the purpose of the service. The
leaflet contains details of any relevant contact numbers and useful
websites. The leaflet also aims to normalise Perinatal Mental
Health problems by its
use of language and discussion on how every woman has
the propensity to be
affected by the increase in
hormone levels during the perinatal period. It also clearly
outlines what is offered by the service and how this
is achieved.
There is a clear pathway for
accessing Psychological Therapy within the Health Board. The
Integrated Perinatal Service is fully functioning in Pembrokeshire
and will be fully operational in
September 2017 across Carmarthenshire and Ceredigion.
Specialist Perinatal interventions are offered within Primary Care,
with priority given to all Perinatal clients, in order that they
may receive intervention in a timely manner.
Within the Health Board's Therapeutic Day Service, the
'Emotional Coping Skills'
module from Dialectical Behaviour Therapy (DBT) has been
specifically adapted, with assistance from Midwifery and Health
Visiting, to offer a pertinent range
of coping skills during the perinatal period for women who
experience emotional dysregulation. Within the local Primary Mental
Health Support Service, a specialist antenatal template for group
work to utilising the
principles of Cognitive Behaviour Therapy (CBT) has been
created. The
purpose of this group is to alleviate antenatal anxiety.
Work is currently
progressing to create a group for Perinatal post natal problems and
the team plans to initiate
a specialist group, the focus being to enhance the
'first attachment
relationship' between mother and infant.
Women with a diagnosis of a serious mental illness (SMI), can be
offered an assessment by the Perinatal Clinical Psychologist, the
resulting formulation, (a theoretically-based explanation of the
information obtained from a clinical assessment),
is then shared with the
psychology team in each Community Mental Health Service
(CMHS). All young
women under
18 years of age, if they meet
the criteria of a mental health disorder which may require
intervention, medication
or both, and are assessed to be in need of Perinatal Service
assistance alongside S-CAMHS intervention and support, will receive
Care Coordination in S-CAMHS.
The
Primary Care Service within the Health Board provides the
majority of the Perinatal Service's psychological interventions,
which have been created in collaboration with the
Health Board Midwifery and
Health Visiting services. All Perinatal women are given priority to
ensure timely intervention
in order to help prevent problems occurring or reduce
further deterioration.
Where Psychological
assessment is
needed following
an initial
psychological intervention
at a low intensity level (Matrix
Cymru 2017), a referral
will be made to the Integrated
Psychological Therapy
Service (lPTS). The IPTS
includes a
range of psychological
modalities such as Cognitive Behavior Therapy,
Psychodynamic Psychotherapy, Systemic Psychotherapy or
Integrative Psychotherapy. These
therapies are usually
delivered as a high intensity
intervention for complex
presentations.
Waiting times for
access to psychological
therapy services
Within the
Perinatal Mental Health Service there
is access
to a Specialist
Perinatal Clinical Psychologist (0.2wte) and a
Psychology Assistant (2.5wte). There is no
waiting list for
assessment and intervention within the
Perinatal Mental Health
Service. The
Perinatal Service
works in
collaboration with Local
Primary Mental Health Services and the Integrated Psychological
Therapy Service for the
provision of Psychological Therapy, as due to
the limited
clinical resource, the
Clinical Psychologist prioritises assessment and
support to
the multidisciplinary team.
Referrals for
Psychological interventions
are directed to Primary Mental Health
Services and the Integrated Psychological Therapy Service
for more complex
presentations, where a specific intervention
such as CBT or Systemic Psychotherapy is
required.
Within the Integrated
Psychological Therapy Service (lPTS),
waiting times vary according to
the therapy modality. The
waiting time
for psychodynamic therapy is 18 months; however The Health
Board has recently appointed three CBT therapists in addition to
Integrative Therapists to the team which will lead to a reduction
in this waiting time.
The
number of
individual and
group Perinatal clinical
psychological sessions provided by
your Heath
Board weekly
The
following individual
and group Perinatal clinical psychological sessions are
offered within the Health
Board:
· Individual Perinatal Clinical Psychology sessions, 2 sessions per week offered.
· Individual sessions by Psychology Assistant, 5 sessions per week offered.
· Baby in Mind CBT Group Sessions, 22 patients have been referred referred, there isno waiting list for this.
· Emotional Coping Skills -Low Intensity Group, 18 people have been referred, there is currently no waiting list.
In addition to the Specialist Perinatal Psychologist and Psychology Assistant, the Adult Psychology Service also provides psychological interventions where there is co morbidity and or complex presentation.
A breakdown of the proportion of time spent by each of your psychologists on providing:
a. 1-to-1,
In the Health Board the proportion of time spent by the Clinical Psychologist in the provision of one to one treatment is 25%, and the Assistant Psychologist is 25%.
b. Group, psychological therapy sessions for women requiring Perinatal support.
In the Health Board the proportion of time spent by the Clinical Psychologist in the provision of group psychological therapy sessions for women requiring Perinatal support is 25%, and the Assistant Psychologist: 25%.
Additional Comment
Three members of the Health Board Perinatal team have received training in the Introduction to Video Interactive Guidance (VIG); however VIG cannot be delivered until the clinicians have completed Levels 1 and 2, and specialist supervision is in place. This, therefore, would seem to be a key priority for the Committee to support, in respect of increasing access to further training and supervision on a national level.
I hope that this information on the provision and waiting times for services in the Health Board is sufficient for your inquiry.