National Perinatal Mental Health Guideline: 2023 update
Melissa Willoughby, Australian Institute of Family Studies, Australia, April 2024
Resource Summary
This short resource summarises the most recent version of the National Perinatal Mental Health Guideline, which was updated by the Centre of Perinatal Excellence (COPE) in 2023. It outlines what’s included in the Guideline and what’s new from the previous 2017 version.
WHO IS THIS RESOURCE FOR?
This short article is for practitioners who may work with or encounter families in the perinatal period, including those working in generalist services with no experience providing mental health services.
Introduction
Pregnancy and the first year of a child’s life (i.e. the perinatal period) is both a challenging and joyful time for many families. It is also a time when parents can experience increased fears, worries and concerns. For some, these may develop into mental health challenges.
In Australia, 1 in 5 mothers experiences perinatal depression or anxiety (PwC Consulting Australia, 2019). Additionally, 1 in 10 fathers experience depression in the perinatal period (Paulson & Bazemore, 2010), and 1 in 6 fathers experience anxiety in the prenatal period (i.e. from conception to birth) (Leach, Poyser, Cooklin, & Giallo, 2016). Detecting challenges and supporting the mental health of parents is an important part of caring for and working with families in the perinatal period.
The Centre of Perinatal Excellence (COPE) has released a revised version of the National Perinatal Mental Health Guideline. This is an update of the previous version released in 2017. The Guideline provides evidence-based recommendations for screening for mental health symptoms, assessment of psychosocial risk factors, and prevention and treatment of mental health challenges. The Guideline is targeted at health professionals who care for parents and families during the perinatal period and was developed using evidence from the findings of a systematic review, expert opinion and consensus.
This short resource summarises what’s included in the most recent version of the National Perinatal Mental Health Guideline and what’s new from the previous version.
What’s included in the Guideline?
The Guideline is an evidence-based reference for professionals supporting and working with families in the perinatal period. Most of the Guideline relates to women’s1 experiences and mental wellbeing. The Guideline contains:
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- Background information from a literature review on:
- how women’s individual context can impact their perinatal experiences
- the prevalence of mental health challenges during the perinatal period; and
- factors that can impact the best-practice provision of mental health care in the perinatal period.
- Background information from a literature review on:
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- Recommendations for screening (i.e. to detect signs and symptoms of mental health challenges) and psychosocial assessment (i.e. to identify the presence of psychosocial factors associated with mental health challenges) during the perinatal period. These include:
- discussion of factors to consider before conducting the screening or psychosocial assessment
- advice on screening for depressive and anxiety disorders, including recommended screening tools
- advice on assessing psychosocial factors that affect mental health, including recommended tools
- advice on screening and assessing the mental health of non-birthing parents, such as fathers
- considerations and processes for assessing mother-infant interaction and safety of the woman and infant
- advice for implementing routine screening and psychosocial assessment, and post-assessment processes; and
- copies of the recommended tools used for screening and psychosocial assessment.
- Recommendations for screening (i.e. to detect signs and symptoms of mental health challenges) and psychosocial assessment (i.e. to identify the presence of psychosocial factors associated with mental health challenges) during the perinatal period. These include:
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- Recommendations related to prevention and treatment of mental health challenges in the perinatal period, including:
- general principles to promote emotional wellbeing
- specific treatment and prevention advice for depressive and anxiety disorders
- specific treatment and prevention advice for other mental health challenges (i.e. schizophrenia, bipolar disorder and postpartum psychosis); and
- considerations for providing care for women with borderline personality disorder, psychological birth trauma, or who do not respond to treatment.
- Areas for future research.
- Recommendations related to prevention and treatment of mental health challenges in the perinatal period, including:
Detecting challenges and supporting the mental health of parents is an important part of caring for and working with families in the perinatal period.
What’s new to the Guideline?
The updated version of the Guideline includes two new sections relevant to 1) non-birthing parents, and 2) psychological birth trauma.
Non-birthing parents
Chapter six of the Guideline discusses how to screen and assess the mental health of non-birthing parents. The Guideline notes that there is limited evidence in this area, making it difficult to provide recommendations on the best screening and assessment tools.
Male non-birthing parents may manifest distress differently to women, which should be taken into consideration when screening. They are more likely to show distress through fatigue, irritability or anger; by withdrawing socially; or by using avoidant/escapist activities. In some circumstances, commonly used screening tools such as the Edinburgh Postnatal Depression Scale, the Kessler Psychological Distress Scale (K10), Antenatal Risk Questionnaire (ANRQ), and Postnatal Risk Questionnaire (PNRQ) may still be appropriate tools for screening non-birthing parents (see Guideline for details).
Psychological birth trauma
Chapter 14 of the Guideline outlines considerations for working with women who have experienced psychological birth trauma. The Guideline notes that little research has been conducted into understanding, preventing and responding to psychological birth trauma.
Many factors can contribute to experiencing a birth as traumatic; for example, previous experience of trauma, unplanned intervention, or giving birth to a preterm or stillborn baby. The Guideline provides preventative measures to reduce the risk of birth trauma, such as providing trauma-informed care, screening for vulnerabilities, maximising the woman’s control in labour, and gaining consent for procedures. Some psychosocial and psychological interventions are available to help improve trauma symptoms related to the birth (see Guideline for details).
Summary
COPE has released a revised version of the National Perinatal Mental Health Guideline. The Guideline provides evidence-based recommendations for professionals who work with families to support and assess their mental health during the perinatal period. New sections for this version include advice on screening and assessment for non-birthing parents, and guidance for women who experience psychological birth trauma.
Further resources
The following resources may be useful for practitioners working with families in the perinatal period:
- COPE has various resources for practitioners on supporting the mental health of families in the perinatal period, including free training on basic skills in perinatal mental health.
- The short article, What is pregnancy-related anxiety and how can I identify someone experiencing it?, describes symptoms and intervention strategies for pregnancy-related anxiety.
- The practice paper, Post-natal care: Making the most of your first session with parents, provides practical strategies for making the most of the first session with parents after the birth of their child.
- The podcast, How holistic pregnancy care promotes infant mental health, discusses the importance of examining parents’ psychosocial context and providing them with choices in pregnancy.
- The webinar, Supporting fathers’ mental health during the perinatal period, brings together research, practice and lived experience knowledge to discuss father’s experiences, mental health and support needs during the perinatal period.
- These resources for working with Aboriginal and Torres Strait Islander families:
- The Kimberley Aboriginal Medical Service (KAMS)’s online module on the Kimberley Mum’s Mood Scale helps practitioners develop the necessary skills to identify and support Aboriginal and Torres Strait Islander women at risk of experiencing a mental health condition during the perinatal period.
- Chapter 16 of Working Together: Aboriginal and Torres Strait Islander Mental Health and Wellbeing Principles and Practice explores the protective and risk factors for perinatal mental health in Aboriginal and Torres Strait Islander communities.
- Perinatal Anxiety & Depression Australia (PANDA) has a range of resources for practitioners working with families who may be experiencing mental health challenges, including:
- an online course on developing skills to support parents’ perinatal mental health
- tips for making referrals
- tips for facilitating groups to support the wellbeing of new and expectant parents
- mental health checklists for expecting and new parents; and
- information on emotional and mental wellbeing for LGBTIQA+ parents.
- The Guideline uses terms such as ‘woman’ or ‘mother’ and ‘breastfeeding’, but the authors of the Guideline advise that these should be interpreted as also including people who are pregnant or have given birth but do not identify as a woman.
References
Leach, L. S., Poyser, C., Cooklin, A. R., & Giallo, R. (2016). Prevalence and course of anxiety disorders (and symptom levels) in men across the perinatal period: A systematic review. Journal of Affective Disorders, 190, 675-686.
Paulson, J. F., & Bazemore, S. D. (2010). Prenatal and postpartum depression in fathers and its association with maternal depression: A meta-analysis. Jama, 303(19), 1961-1969.
PwC Consulting Australia. (2019). The cost of perinatal depression and anxiety in Australia [Report]. Australia: Gidget Foundation.
