CHHS15/115

Canberra Hospital and Health ServicesClinical GuidelinePerinatal Emotional WellbeingAssessment and Management of Perinatal Mental HealthContents

Contents....................................................................................................................................1

Introduction..............................................................................................................................3

Scope........................................................................................................................................ 3

Background............................................................................................................................... 3

Summary of Perinatal Mental Health (PMH)............................................................................5

Section 1 – Perinatal Mental Health Screening.........................................................................6

Who to screen.......................................................................................................................6

When to screen.....................................................................................................................6

Screening tools......................................................................................................................7

How to use EPDS and PPSA screening tool...........................................................................7

Interpret the results/identify risk and protective factors......................................................8

Section 2 – Management Strategies.........................................................................................9

Section 3 – Postpartum Psychosis.............................................................................................9

Background........................................................................................................................... 9

Management.......................................................................................................................10

1. Management of the infant...........................................................................................11

2. Medication and treatment management options........................................................11

3. Non-pharmacological treatments: psycho-socio-cultural considerations....................11

4. Managing the risk of suicide........................................................................................12

5. Follow up......................................................................................................................12

Implementation...................................................................................................................... 13

Related Policies, Procedures, Guidelines and Legislation.......................................................13

References.............................................................................................................................. 14

Definition of Terms................................................................................................................. 15

Search Terms.......................................................................................................................... 15

Attachments............................................................................................................................15

Attachment 1: Edinburgh Postnatal Depression Scale Scoring Guide.................................16

Doc Number Version Issued Review Date Area Responsible PageCHHS15/115 1 01/05/2015 01/05/2019 Division WYC 1 of 22

Do not refer to a paper based copy of this policy document. The most current version can be found on the ACT Health Policy Register

CHHS15/115

Attachment 2: Edinburgh Postnatal Depression Scale Flow Chart......................................18

Attachment 3: Perinatal Mental Health Integrated Care Pathway......................................19

Attachment 4: Referral Reference Guide............................................................................21

Doc Number Version Issued Review Date Area Responsible PageCHHS15/115 1 01/05/2015 01/05/2019 Division WYC 2 of 22

Do not refer to a paper based copy of this policy document. The most current version can be found on the ACT Health Policy Register

CHHS15/115

Introduction

The purpose of this document is to provide early identification, prevention and support to women and their families who are at risk of or have postnatal depression/anxiety or other mood issues. Adjusting to life as a mother is a major life change and for some woman this, or factors associated with the perinatal period, can adversely affect their emotional wellbeing leading to depression, anxiety or other mental health conditions.

Health professionals providing clinical care for women in the perinatal period will routinely screen for emotional wellbeing utilising the following screening tools the Edinburgh Postnatal Depression Scale (EPDS) and the Perinatal PsychoSocial Assessment (PPSA).

The use of evidence-based screening tools will facilitate the identification of early signs and symptoms of maternal anxiety and/or depression in the perinatal period. This practice is supported by the Clinical Practice Guidelines1

Scope

This document applies to: Nurses, Midwives and Maternal and Child Health Nurse (MACH) who are working within

their scope of practice (Refer to Midwifery and Nursing Continuing Competence Policy) Medical staff working within their scope of practice Student working under direct supervision Allied health working within their scope of practice

Back to Table of Contents

Background

Perinatal emotional wellbeing can present in a variety of forms ranging from mild to severe and include:

Baby Blues Usually occurs in the first week after giving birth, feeling emotionally labile which peaks

around the 3rd to 5th day and usually disappears without treatment 25% to 80% of woman experience the baby blues following birth The baby blues are characterised by mild mood swings and are usually transient in

nature. These symptons can manifest as, irritability, periods of crying, exhaustion, feeling overwhelmed and/or experiencing sleep disturbance

However, if these feelings continue for more than 2 weeks, and interfere with daily life, this could mean that the woman may be developing postnatal depression and/or anxiety.

1 Depression and related disorder anxiety, bipolar and puerperal psychosis- in the perinatal period . A guideline for primary health care professionals. February 2011. beyondblue.

Doc Number Version Issued Review Date Area Responsible PageCHHS15/115 1 01/05/2015 01/05/2019 Division WYC 3 of 22

Do not refer to a paper based copy of this policy document. The most current version can be found on the ACT Health Policy Register

CHHS15/115

Perinatal Anxiety Feeling uncertain in pregnancy and worrying about adapting to parenthood are normal An anxiety disorder may be diagnosed if these feelings interfere with everyday

functioning, activities and, the ability to enjoy pregnancy and parenthood There are several types of anxiety disorders including Generalized Anxiety Disorder

(GAD), Posttraumatic Stress Disorder (PTSD), Tocophobia (fear of birth) and Obsessive-Compulsive Disorder (OCD)

Maternal symptoms can include:o overwhelming worry o panic or fear that is difficult to control o feeling irritable, restless or on edge o unrealistic fearso muscle tension, tightness in the chest, breathlessness

Antenatal Depression 6-16% of women meet the diagnostic criteria for major depression during their

pregnancy Common experiences of pregnancy can mimic those of depression or anxiety, such as,

changes in eating and sleeping patterns and loss of libido and energy Some medical conditions occurring in pregnancy also need to be considered as they can

also mimic a depressive illness, such as anaemia, gestational diabetes and thyroid dysfunction

Postnatal Depression (PND) PND affects 5-20% of women occurring at any time in the first year postpartum Correct diagnosis and appropriate interventions can be delayed as women frequently

present to health care workers with other presenting issues, such as, relationship issues, sleep disturbance or over-concerns for their baby rather than low mood

At times fatigue, distress and normal adjustment issues are misdiagnosed as depression

Postpartum Psychosis (refer to Section 2 page 8 for more detailed information including management strategies). It is a rare severe mental illness that occurs in 1 to 2 mothers in every 1000 after they

give birth Onset is within hours or up to weeks following birth It is characterised by a significant change/shift in ‘usual’ behaviour. Signs and symptoms

can include: o euphoriao decreased sleep requiremento rapid and pressured speech o irritabilityo paranoiao delusionso severe depression with delusions and auditory hallucinations

Doc Number Version Issued Review Date Area Responsible PageCHHS15/115 1 01/05/2015 01/05/2019 Division WYC 4 of 22

Do not refer to a paper based copy of this policy document. The most current version can be found on the ACT Health Policy Register

CHHS15/115

Alert: This is a psychiatric emergency. You need to refer the woman to psychiatric/psychological services immediately.

Back to Table of Contents

Summary of Perinatal Mental Health (PMH)

Factors associated with perinatal mental health conditions personal or family history of mental health problem/s current personal mental health disorder/s current alcohol and/or drug problems current or past history of abuse (e.g. Physical, sexual, psychological) negative or stressful life events (e.g. previous loss of baby, stillbirth, loss of job,

relationship issues, moving house)

Outlined below is an overall summary of Perinatal Mental Health conditions and management plan.

Doc Number Version Issued Review Date Area Responsible PageCHHS15/115 1 01/05/2015 01/05/2019 Division WYC 5 of 22

Do not refer to a paper based copy of this policy document. The most current version can be found on the ACT Health Policy Register

CHHS15/115

Back to Table of Contents

Section 1 – Perinatal Mental Health Screening

Who to screenScreening for both the Perinatal PsychoSocial Assessment (PPSA) and the Edinburgh Postnatal Depression Scale (EPDS) should be offered to all antenatal and postnatal women at the first contact with a health professional either at a home or clinic visit.

When to screen Health professionals will use the following screening schedule to apply the screening tools to help indentify mother and families vulnerability factors that may influence maternal emotional wellbeing:

Doc Number Version Issued Review Date Area Responsible PageCHHS15/115 1 01/05/2015 01/05/2019 Division WYC 6 of 22

Do not refer to a paper based copy of this policy document. The most current version can be found on the ACT Health Policy Register

Anxiety

Features:*overwhelming worry *panic or fear that is difficult to control *feeling irritable, restless or on edge *unrealistic fears*tense muscles, a tight chest, breathlessness

Management*complete the EPDS* refer to the EPDS management flowchart*utlise referral reference guide * refer to the Intergrated Care Pathway

Depression

Features:*sleep disturbance *over-concerns for their baby * persistent sad or low mood* negative thougths* lack of confidence*irritable*tearfull*loss of appetite

Management*complete EPDS*refer to the EPDS management flowchart* utlise referral reference guide* refer to the Intergrated Care Pathway

Perinatal Psychosis

Features* Schizophrenia* Bipolar mood discorders* drug induced psychoses

Management Women with postpartum psychosis can be at risk of harming themselves or others.

This is a psychiatric emergency.

CHHS15/115

1. Edinburgh Postnatal Depression Scale (EPDS)The EPDS screening tool is administered routinely to mothers once in pregnancy at pre-admission clinic and at their 6-8 week postnatal check or when appropriate. The EPDS scoring template is used to score the tool. Repeat EPDS can be conducted at any time during pregnancy, postnatal period or when clinically indicated.

2. Perinatal PsychoSocial Assessments (PPSA)The PPSA screening tool is administered routinely to all mothers once in pregnancy and postnatally at the first initial contact either at home or clinic visit.

Note: If time is insufficient to completion screening at the first visit then screening assessments can be offered at the next visit.

Screening toolsScreening Tool Resources/ ToolsEdinburgh Postnatal Depression Scale (EPDS)

Edinburgh Postnatal Depression Scale EPDS Scoring Template (Attachment 1) EPDS Management Response Flowchart

(Attachment 2) Resources link www.beyondblue.org.au

Perinatal Psychosocial Assessments (PPSA)

Perinatal PsychoSocial Assessment (PPSA) screening tool

Perinatal Mental Health Integrated Care Pathway (Attachment 3)

Referral Reference Guide (Attachment 4)

How to use EPDS and PPSA screening tool Complete the e-learning package on capabiliti – here

1. Administering the EPDSIntroduce the EPDS screening tool using supportive and reflective listening skills and open communication strategies such as, “as you are about to or have recently had a baby, how you are feeling is important”.

Avoid saying, ‘I need your permission to administer the EPDS’ or ‘You don’t have to do this if you don’t want to’. These statements may create a negative or fearful reaction in the women.

Note: Remember that the EPDS asks about their mood in the past seven days.

Important considerations: 1. Have the correct form/s ready2. The EPDS screening tool is to be completed in the presence of the health professional

Doc Number Version Issued Review Date Area Responsible PageCHHS15/115 1 01/05/2015 01/05/2019 Division WYC 7 of 22

Do not refer to a paper based copy of this policy document. The most current version can be found on the ACT Health Policy Register

CHHS15/115

3. Briefly explain the EPDS, providing clear instruction about the screening tool to the woman, answer any questions they have making no assumptions about their literacy or ability to complete the form on their own

4. If the woman wants you to go through the EPDS with them, work through the 10 questions. Do not change or reword the questions

5. Score the questionnaire using the EPDS scoring template6. In discussing and communicating the outcome of the tool try to keep any discussion

until after the woman has finished the screening tool.7. Inform the woman of the score and discuss any issues the screening tool has highlighted

for the woman. In discussion with the mother suggest that the results indicate that they may be experiencing some depressive/anxious symptoms and further investigation of these symptoms may be of benefit.

8. The woman’s overall score of the EPDS may be below the cut-off point indicative of significant difficulties, but some issues may still be important to the respondent.

ALERT: EPDS QUESTION 10If a woman scores 1, 2 or 3 the health professional must gather further information in order to ensure the woman’s safety. This information should include whether she has a current plan of self-harm, she can ensure her safety in the immediate future, she has attempted self-harm before or if she has the resources to carry out the plan.

2. Administering the Perinatal PsychoSocial Assessments (PPSA)Follow the same procedure as for the EPDS, including introducing the PPSA screening tool to the woman. Use supportive and reflective listening skills and open communication strategies such as, “this is a routine questionnaire that helps us look at what may impact you as a new parent ensuring the best outcomes are achieved for you, your baby and family”.

The PPSA screening tool is given to the woman to complete in the presence of the health professional with explanatory comments and support as required

The PPSA provides a good way to start a conversation focusing on the key issues concerning the woman. This allows the women the opportunity to recognise her readiness to seek further support

Interpret the results/identify risk and protective factorsThe health professional is to utilise their clinical judgement concerning additional support and/or referral, in conjunction with the woman. The referral is to include responses to the PPSA, as appropriate, the score derived from the EPDS, as well as other medical or social relevant history that may impact the women’s emotional wellbeing. This promotes continuity of care as women may see a number of health professionals during pregnancy and early parenthood.

NOTE: It is important to remember the PPSA and the EPDS are screening tools and not used for diagnosis. They will help identify vulnerability factors for women at risk of perinatal mental health issues.

Doc Number Version Issued Review Date Area Responsible PageCHHS15/115 1 01/05/2015 01/05/2019 Division WYC 8 of 22

Do not refer to a paper based copy of this policy document. The most current version can be found on the ACT Health Policy Register

CHHS15/115

Section 2 – Management Strategies

The score obtained from screening using the EPDS or PPSA will guide which management strategies is most suitable. For example: ‘Watchful waiting’: a woman with mild distress, anxiety or depression may need extra

practical support regarding normalizing adjusting to parenting. Utilize the support documents for current best practice referral pathway ie:

o EPDS Management Response Flowchart o Perinatal Mental Health Integrated Care Pathways o Referral Reference Guide for referral options

Provide the woman with information regarding possible support services e. g. GP, Post and Ante Natal Depression Support and Information (PANDSI), New Parent Groups, Social Worker, Access to Allied Psychological Services (ATAPS) program – Medicare Local or private psychologists

Refer the woman to the beyondblue booklet ‘Emotional Health During Pregnancy and Early Parenthood’

If referral is required ensure the woman is aware of the service being referred to and has given her consent for referral

Document consent for referral in the woman’s relevant clinical notes.

For further professional support and guidance speak to your CMC/CNC Further comprehensive assessment and management plans may be required by General Practitioners or mental health professionals.

URGENT referral: Mental Health Crisis and Assessment Team (CATT) - 1800 629 354

NON-URGENT referral: Fax or email Perinatal Mental Health Referral Form2 to Perinatal Mental Health Consultation Service ph: 6205 2627 email: perinatalmhcs@act.gov.au and/or refer clients to their General Practitioner.

Section 3 – Postpartum Psychosis

BackgroundPostpartum psychosis is indicated by changes in a woman's usual behaviour. These changes usually start within 48 hours to two weeks after giving birth, but may develop up to 12 weeks after the birth. They can be extremely distressing for both the woman and her family.

Early changes in usual behaviour include: finding it hard to sleep feeling full of energy or restless and irritable feeling strong, powerful, unbeatable

2 Perinatal Mental Health Referral Form – ACT Health intranet Perinatal Mental Health Consultation service

Doc Number Version Issued Review Date Area Responsible PageCHHS15/115 1 01/05/2015 01/05/2019 Division WYC 9 of 22

Do not refer to a paper based copy of this policy document. The most current version can be found on the ACT Health Policy Register

CHHS15/115

having strange beliefs (e.g. people are trying to harm the baby) seeing, hearing, smelling, tasting or feeling something that doesn’t exist

This may be followed by a combination of manic or depressive symptoms including: manic symptoms (e.g. high energy, hearing voices or seeing things that aren't there

(hallucinations), believing things that are not based on reality (delusions), talking quickly)

depressed symptoms (e.g. low energy, not sleeping or eating, having thoughts of harming herself or the baby, feeling hopeless or helpless as a mother).

Note: The hallucinations are not just associated with the manic symptoms (can be manic without psychosis and can be psychotic / hallucinating while depressed)*

The woman may seem confused and forgetful, she may experience rapid fluctuation in mood and have difficulty concentrating. Women who experience the symptoms of postpartum psychosis can become very confused and disconnected from reality, thus may be at risk of harming themselves or others (including their baby).

ManagementUrgent mental health assessment, ensuring an appropriate understanding of and attention to safety issues for mother and infant but also others in the immediate environment, and level of symptoms is required urgently.

Admission to a specialized psychiatric facility that has some capacity for rooming in for babies less than 6months, such as at Calvary Hospital is generally appropriate, however at times mothers may be treated within the community. Wherever safety considerations permit, it is very important to try to keep the mother and infant together to help establish good attachment relationships and breastfeeding. . Some medications may be contraindicated in breastfeeding, thus lactation support may be considered in conjunction with the medical team.

For an inpatient the O&G Registrar is required to contact the Psychiatric Services Register from the Psychiatric Consultation Liaison ph: 6244 3204.

For the community contact the Crisis Assessment Team (CATT (SOP: Crisis Assessment and Treatment Team – Mental Health Services Triage) also GP or Perinatal Mental Health Consultation Services (PMHCS.)

Safety/risk considerations for mother and infant must be considered as some psychotic illnesses at this time are florid, with delusions and hallucinations producing unpredictable behaviours

The highest risk time for occurrence/recurrence of a postpartum psychosis is in the first 28 days postpartum.

The woman’s health care team is recommended to involve:

Doc Number Version Issued Review Date Area Responsible PageCHHS15/115 1 01/05/2015 01/05/2019 Division WYC 10 of 22

Do not refer to a paper based copy of this policy document. The most current version can be found on the ACT Health Policy Register

CHHS15/115

General Practitioner Obstetrician Midwife- continuity of care Perinatal mental health, or preferred psychiatrist Maternal and Child Health nurse (MACH) Psychiatric Consultation Liaison (while an inpatient) Social Worker

1. Management of the infant While the mother remains acutely unwell, she may find complete care of her infant very difficult as her ability to concentrate may make it difficult for her to complete tasks such as feeding her baby. Continuing to breastfeed may be manageable but can sometimes be difficult and consultation with a lactation consultant and with her treating psychiatric team regarding medication is advisable.

Keeping the infant separate, or observed at all times, when with their mother, may be necessary until safety can be assured.

2. Medication and treatment management optionsPreventative measures, including anti depressants, mood stabilizers, antipsychotics and benzodiazepines for sedation can be introduced immediately if labour is concluded. Some women may prefer to take the (unknown) risks of using medication in late pregnancy. Type of medication and doses will vary depending on the woman’s obstetric presentation, previous history, responsiveness to treatment and risk of relapse and women should be advised to seek the guidance of a medical professional prior to making any changes to their medication.

3. Non-pharmacological treatments: psycho-socio-cultural considerations Good management of all psychotic illnesses in pregnancy, and ideally pre-pregnancy planning if the woman has a history of PND or bipolar, and postpartum will include: Psycho-education, with provision of both written and verbal information to the woman

and her immediate family Counselling support Practical support for other children in the family Information providing a low stimulus environment through restricted visiting, single

room accommodation, accommodation provided for partner or significant other to support in care of woman and newborn baby

Extended hospital stay if indicated is recommended. Comprehensive discharge planning across a number of agencies including mental health

and MACH services Specific Cognitive Behavioural Therapy intervention once the acute symptoms have

subsidedAll management plans should be undertaken in consultation with the woman or significant other and they are provided with all the relevant contact support numbers.

Doc Number Version Issued Review Date Area Responsible PageCHHS15/115 1 01/05/2015 01/05/2019 Division WYC 11 of 22

Do not refer to a paper based copy of this policy document. The most current version can be found on the ACT Health Policy Register

CHHS15/115

Safety/risk considerations for mother and infant can be paramount initially as some psychotic illnesses at this time are florid, with delusions producing unpredictable behaviours and Care and Protection involvement should be considered. 4. Managing the risk of suicideEvidence has shown that the first weeks following discharge from psychiatric in-patient care is a most critical time in terms of suicide risk, particularly for people initially admitted following a suicide attempt; suicidal ideation; and/or depression. The increased contact that health professionals have with clients during this time provides an opportunity for closer monitoring of suicidality.

Risk factors for suicide include: A personal or family history of suicide or self harm Plan, intent and access to means Previous suicide attempt Hopelessness about the future Relationship issues Drug or alcohol abuse or misuse Gambling Trouble with family or friends Financial stress Trouble with the law Inability to cope with the current stresses, crisis or loss Poor physical health Untreated mental illness or recent discharge from an inpatient psychiatric admission Current or previous experience of domestic violence, family violence or abuse

The presence of children or a pregnancy is not necessarily a protective factor.

5. Follow up Long term mental health/parenting support follow up is likely to be appropriate and referral to the most relevant adult mental health community team should be facilitated.

A multidisciplinary approach for long term care is generally necessary. This could include family and professional support from a wide range of practitioners. Eg: Maternal & Child Health Child and Family Health Centres General Practitioner Perinatal Mental Health Consultation Service Psychologist Social worker IMPACT program PANDSI

Implementation

Doc Number Version Issued Review Date Area Responsible PageCHHS15/115 1 01/05/2015 01/05/2019 Division WYC 12 of 22

Do not refer to a paper based copy of this policy document. The most current version can be found on the ACT Health Policy Register

CHHS15/115

Implemented professional development education sessions Incorporated with the PMH e-learning education package for ACT Health Presented at team, Maternity Leaders, MACH Leaders Meeting Tabled at Senior Division Women, Youth and Children (WYC) Management Meetings Tier 3 WYC Divisional Quality and Safety Meeting Divisional Tier 3 Risk Meeting Policy Register ACT Health

Back to Table of Contents

Related Policies, Procedures, Guidelines and Legislation

LegislationMental Health Act 2015http://www.legislation.act.gov.au/a/1994-44/default.asp

Clinical Practice GuidelinesDepression and related disorder anxiety, bipolar and puerperal psychosis- in the perinatal period. A guideline for primary health care professionals February 2011, beyondblueClinical Practice Guidelines

PoliciesACT Mental Health, Justice Health and Alcohol and Drug Services Policy: MHACT Triage Category of Responsehttp://health.act.gov.au/c/health?a=dldivpoldoc&document=150ACT Mental Health, Justice Health and Alcohol and Drug Services Policy: Suicidal Behaviour: Treatment and Care of Consumers with Suicidal Behaviourhttp://health.act.gov.au/c/health?a=dldivpoldoc&document=1951ACT Mental Health, Justice Health and Alcohol and Drug Services: Clinical Processes and Documentation Resource Package- 3rd Editionhttp://health.act.gov.au/c/health?a=dldivpoldoc&document=81

Standards Mental Health Justice Health Alcohol and Drug Services (MHJHADS), Standard Operating Procedure: Crisis Assessment and Treatment Team – Mental Health Services Triage

Related Documents Edinburgh Postnatal Depression (EPDS) Screening Tool EPDS Scoring template MACH Nurses Management Response Flow Chart Perinatal Mental Health Integrated Care Pathway Reference referral guide Perinatal PsychoSocial Assessment (PPSA) Perinatal Mental Health Referral Form

Doc Number Version Issued Review Date Area Responsible PageCHHS15/115 1 01/05/2015 01/05/2019 Division WYC 13 of 22

Do not refer to a paper based copy of this policy document. The most current version can be found on the ACT Health Policy Register

CHHS15/115

National Perinatal Depression Initiative (NPDI) Steering Committee includes: Perinatal Mental Health Consultation Service GP liaison MACH Managers and representative Maternity Manager and representative Medicare local Community and Hospital Social worker QE11 Calvary Maternity Services Calvary John James Maternity Unit NPDI Project Officer

Back to Table of Contents

References

Clinical Practice Guidelines Depression and related disorder anxiety, bipolar and puerperal psychosis- in the perinatal period. A guideline for primary health care professionals February 2011, beyondblue

Centre for Mental Health Research. (2001). Mental Health First Aid, A Participants Manual. Australian National University, Canberra.

Cox, J.L., Holden, J.M. & Sagosvsky, R.(1987). Detection of postnatal depression development of the 10item Edinburgh Postnatal Depression Scale. British Journal of Psychiatry, 150, 782-786

Hickey, A.R., Boyce, P.M., Ellwood, D., Morris - Yates, A. (1997). Early Discharge and Risk for Postnatal Depression. MJA, 167: 244-247.

NHMRC. (1999). Informational Paper Postnatal Depression - A systematic review of published scientific literature to 1999. Pp 82 - 86. National Health and Medical Research Council. Commonwealth of Australia.

Back to Table of Contents

Doc Number Version Issued Review Date Area Responsible PageCHHS15/115 1 01/05/2015 01/05/2019 Division WYC 14 of 22

Do not refer to a paper based copy of this policy document. The most current version can be found on the ACT Health Policy Register

CHHS15/115

Definition of Terms

Perinatal period - the period covering pregnancy and the following year. (Clinical Practice Guidelines: beyondblue 2011)Psychosocial – refers to the various psychological and social factors that may have an impact on the health and wellbeing in the perinatal period. (Clinical Practice Guidelines; beyondblue 2011)Health professional – refers to nurses, midwives, MACH nurses, medical staff and allied health professionals

Search Terms

Perinatal Mental HealthEdinburghPostnatalDepressionAnxietyBabybluesPsychosisScreening toolsPsychosocial Antenatalbeyondblue

Attachments

Attachment 1: Edinburgh Postnatal Depression Scale Scoring GuideAttachment 1: Edinburgh Postnatal Depression Scale Flow ChartAttachment 3: Perinatal Mental Health Integrated Care PathwayAttachment 4: Referral Reference Guide

Disclaimer: This document has been developed by Health Directorate, Canberra Hospital and Health Services specifically for its own use. Use of this document and any reliance on the information contained therein by any third party is at his or her own risk and Health Directorate assumes no responsibility whatsoever.

Date Amended Section Amended Approved ByEg: 17 August 2014 Section 1 ED/CHHSPC Chair

Doc Number Version Issued Review Date Area Responsible PageCHHS15/115 1 01/05/2015 01/05/2019 Division WYC 15 of 22

Do not refer to a paper based copy of this policy document. The most current version can be found on the ACT Health Policy Register

CHHS15/115

Attachment 1: Edinburgh Postnatal Depression Scale Scoring Guide

Doc Number Version Issued Review Date Area Responsible PageCHHS15/115 1 01/05/2015 01/05/2019 Division WYC 16 of 22

Do not refer to a paper based copy of this policy document. The most current version can be found on the ACT Health Policy Register

CHHS15/115

Doc Number Version Issued Review Date Area Responsible PageCHHS15/115 1 01/05/2015 01/05/2019 Division WYC 17 of 22

Do not refer to a paper based copy of this policy document. The most current version can be found on the ACT Health Policy Register

CHHS15/115

Attachment 2: Edinburgh Postnatal Depression Scale Flow Chart

Doc Number Version Issued Review Date Area Responsible PageCHHS15/115 1 01/05/2015 01/05/2019 Division WYC 18 of 22

Do not refer to a paper based copy of this policy document. The most current version can be found on the ACT Health Policy Register

CHHS15/115

Attachment 3: Perinatal Mental Health Integrated Care Pathway

Doc Number Version Issued Review Date Area Responsible PageCHHS15/115 1 01/05/2015 01/05/2019 Division WYC 19 of 22

Do not refer to a paper based copy of this policy document. The most current version can be found on the ACT Health Policy Register

CHHS15/115

Doc Number Version Issued Review Date Area Responsible PageCHHS15/115 1 01/05/2015 01/05/2019 Division WYC 20 of 22

Do not refer to a paper based copy of this policy document. The most current version can be found on the ACT Health Policy Register

CHHS15/115

Attachment 4: Referral Reference Guide

Doc Number Version Issued Review Date Area Responsible PageCHHS15/115 1 01/05/2015 01/05/2019 Division WYC 21 of 22

Do not refer to a paper based copy of this policy document. The most current version can be found on the ACT Health Policy Register

CHHS15/115

Doc Number Version Issued Review Date Area Responsible PageCHHS15/115 1 01/05/2015 01/05/2019 Division WYC 22 of 22

Do not refer to a paper based copy of this policy document. The most current version can be found on the ACT Health Policy Register