SOME CONSIDERATIONS IN PATERNAL PARENTAL ADJUSTMENT

Sara Weeks, Manaaki House Community Mental Health Centre, Auckland, New Zealand

Men as well as women have to traverse the major and irreversible life change of becoming a father to a baby. Their psychological needs and difficulties, however, have been largely ignored unless problems come to light, and even then, the focus is often on the mother or baby. This theoretical paper will introduce some areas which men in particular have trouble negotiating in adjusting to fatherhood. It will focus upon the father who is in a relationship with the mother, and in a situation where there are no major obstetric or psychological problems although some aspects of their impact will be briefly addressed.

A DESCRIPTION OF THE MATERNAL MENTAL HEALTH SERVICE AT WAITEMATA HEALTH, AUCKLAND

Jacky Lornie, Maternal Mental Health, Waitemata Health, Auckland, New Zealand

A description of the Maternal Mental Health Service at Waitemata health in Auckland will be given. This will include:

1. Composition of the team
2. Method of referral
3. Numbers of women seen
4. Diagnostic categories
5. Intervention, including support required
6. Decision making around medication used
7. Length of time women are seen in the service
8. Deficiencies in the service and improvements for the future will also be discussed.

WOMEN EXPERIENCING POSTNATAL DEPRESSION: WHO ARE THEIR PARENTS?

Doreen Westley, Faculty of Education, Monash University, Melbourne, VIC

As part of a larger study looking at the long term effects of postpartum depression I also investigated the mothers' perceptions of their own parents. The scale, Egna Minnen av Barndoms Uppfostram (Ross et al, 1983), designed in Sweden and adapted for Australia, was used to measure parental recollection of their own childhood history. The scale has 81 items and a 4-point adjective scoring. There are 14 subscales measuring the following characteristics: abusive, depriving, punitive, shaming, rejecting, overprotective, overinvolved, tolerant, affectionate, performance oriented, guilt-engendering, stimulating, favoured siblings and favoured subject. The subscales have an intercorrelation mean of 0.88. In regard to the depressed and nondepressed groups, there were differences as shown on the EMBU. The depressed group perceived their mothers as more punitive (F=10.25, p<.01), as well as their fathers (F=4.48, p<.05). The depressed mothers saw their own mothers as depriving (F=11.8, p<.01) and their fathers (F=5.03, p<.05). In addition, the depressed mothers saw their mothers (F=11.22, p<.01) and their fathers (F=5.23, p<.05) as shaming them. The depressed mothers also saw their mothers as rejecting (F=7.45, p<.01) them but not their fathers. Furthermore, the depressed mothers believed their mothers (F=14.37, p<.01) and their fathers (F=23.47, p<.01) were not affectionate to them. As well, the depressed mothers perceived their mothers as not stimulating (F=13.63, p<.01) and their fathers (F=23.87, p<.01). Moreover the depressed mothers did not perceive their mothers as tolerant (F=4.22, p<.05). The depressed mothers believed their mothers favours the other siblings (F=10.08, p<.01) as they felt their fathers did (F=4.01, p<.05). The depressed mothers perceived their mothers (F=16.01, p<.01) and their fathers (F=4.95, p<.05) as guilt engendering them.

EARLY INTERVENTION: THE KEY TO MENTAL HEALTH

Maureen Speedy, Waikato Family Centre, Hamilton, New Zealand

The Waikato Family Centre provides professional assessment/observation services primarily on referral. The emphasis is on understanding, prevention and treatment of mental illness related to childbearing and rearing. The free service provides immediate access to families with children under five years to:

• identify babies or children at risk of physical or mental abuse
• identify mothers at risk of postnatal distress through to psychotic illness
• assess need for further intervention
• assist/develop mothercraft/parenting skills
• provide access to other health providers

The centre has close linkages with general practitioners and other health providers and provides an orientation and teaching facility for paediatricians, nurses and midwives at local hospitals as well as community based nurses and nurses in training. 220 mothers in crisis (and their children) have been seen since August 1996. Seven of these mothers had been clinically diagnosed with postnatal depression by a general practitioner before they presented at the Centre. After collecting 6 months (to date) of statistical data there is a clear demonstration that early intervention reduces the risk of the development of postnatal depression in the maternal population, as many of the 213 other mothers first presented with symptoms of postnatal stress.

MANAGEMENT ISSUES

Virginia Davies, Postnatal Support Group, Canberra, ACT

For many years I have been closely associated with postnatal depression - initially as a sufferer 22 years ago and more recently 161/2 years ago. Following the second episode I was motivated to do something about it and co-founded a support group in Canberra which has been running since 1981. For the first ten years we were referred all women with postnatal depression by those general practitioners, community nurses and families who had heard of our existence. We had no funding and little energy to apply for it as we were too busy helping those women and their families who were affected by postnatal depression. Another role of the group was to provide information and education for those health professionals who were gradually becoming more aware of the condition and so talks were given to pupil midwives, community nurses, college students, Nursing Mothers' groups and other interested groups and individuals. We also put together an extensive information package and purchased all up to date books, papers and videos on the topic. These were very scarce in the early years. With the boon in interest in postnatal depression in the early 1990s more people from all fields wanted to 'own' this illness and management pathways are currently being devised and initiated. Some of these are a great improvement on what previously existed but others I have great concern about - particularly if they are strictly enforced. Although team approach and primary, secondary and tertiary levels of care are the catch phrases of the 90s, those of us working with these women know how rapidly many of them can change in the severity of their illness. The current referral pathways in the ACT recommend strongly that women progress via a referral system from one level of care to the next but often (a) an advocate is required to state clearly how unwell the mother is and (b) this advocate is not necessarily a health professional, as women often are more comfortable speaking honestly to another person who has suffered the same overwhelming experience. If our management pathways are too rigid women will no longer be encouraged to self refer and their families will also have problems accessing the available services. Knowledge and choices are what the management of postnatal depression is all about.

STRATEGIC PLANNING IN PERINATAL MENTAL HEALTH

Lesley Barclay, Kate Barclay, Marie-Paul Austin

This paper presents a case study of the beginning of a movement to improve the perinatal mental health of families in the South Eastern Sydney Area Health Service. The original impetus was to facilitate cooperation and avoid duplication of service when two Area Health Services merged in mid-1995. The focal point for our first efforts was to put forward an argument for residential care of severely ill women and their babies. the case study demonstrates a model by which practitioners who feel they have no power over policy can work toward influencing policy.

The key theme that has emerged from our work is that perinatal mental health (as distinct from 'mental illness') is an issue with many disparate effects and its maintenance requires a combined effort from many different people. Interventions should, therefore, be characterised by collaboration and communication between disparate groups of professionals and community structures. Health professionals tend toward sectoral thinking so the first step toward collaborative efforts is one of changing the way we think about perinatal mental health services. Although improvements to service delivery are at planning stage, strategies that may be useful for workers in perinatal mental health have already emerged. Through these strategies we hope to produce creative solutions for overlaps and gaps in services and strengthening services already provided.

THE ANTENATAL NEEDS OF WOMEN WITH SERIOUS MENTAL ILLNESS

Jo Barkla, J McGrath, L Glozier, J Hearle, K Plant
Queensland Centre for Schizophrenia Research, Wolston Park Hospital, QLD

There is evidence from the international literature that women with pre-existing serious mental illnesses are an "at risk" group during the antenatal period. They have an increased likelihood of being without social support, having poor interpersonal relationships and not being able to parent their infant. They are also at risk of having an unplanned pregnancy, receiving suboptimal antenatal care and are more vulnerable to pregnancy and birth complications. These factors may contribute towards increased maternal and infant morbidity and expose the developing foetus to additional risk factors for neurodevelopmental deviance. The aim of the study is to gather representative Australian data describing the characteristics and needs of women with serious mental illness so that services can be developed which can facilitate improved antenatal care.

This presentation will describe a study which has recently commenced, that identifies women with serious mental illness who are attending any of three Brisbane antenatal services (approximately 20,000 women will be screened over a two year period). These women will be assessed prospectively and compared with women without a history of serous mental illness on a range of variables including utilisation of services, social supports, own experiences of being parented, antenatal emotional attachment and symptomatology. The implications for service development will be discussed.

Acknowledgments: Qld Health Promotion Council, Royal Women's Hospital, Logan Hospital, Mater Mother's Hospital

EVOLUTION OF A MODEL OF COMMUNITY BASED SERVICE FOR WOMEN AND FAMILIES EXPERIENCING ANTE- AND POSTNATAL DEPRESSION, DEMONSTRATING COMMITMENT AND COOPERATION FROM GOVERNMENT AND NON-GOVERNMENT AGENCIES

Gally McKenzie, V Yeo, C Kirby
Rockingham Women's Health & Information Centre, Rockingham, WA

Summary: 1995-1997 Development of a model of service, with cooperation and integration of agencies. These include: Rockingham Women's Health and Information Centre, Rockingham Kwinana Community Psychiatric Service, Rockingham Kwinana Maternal and Child Health Team, and the Rockingham Division of General Practice.

This poster aims to demonstrate the stages in development from pilot project to established service. Joint commitment from the above agencies has enabled a district-wide screening program with the EPDS and referral to a central team at Rockingham Women's Health and Information Centre. This service provides a counselling and therapeutic group program to women and their partners experiencing ante- and postnatal depression and distress. Rockingham and Kwinana are outer suburban areas of the Perth Metropolitan Region with a population of 90,000 and approximately 1,000 live births per year.