Perinatal and Infant Psychiatry

The management of patients with severe postnatal psychiatric problems is complex. Staff stability in a parent-infant unit over 20 years has allowed the development of assessment methods, parent-infant therapy skills, a teaching faculty and policies which determine care.

Objectives: To share the methods whereby both maternal and infant issues are assessed and managed whilst inpatients in Helen Mayo House, a publicly funded 6 bed-inpatient perinatal and infant unit based in Adelaide, with a view to:

• Describing the case load

• Describing management plans

• Describing transition to community care from inpatient status

• Showing the complexities of the work using videotaped therapy sessions

• Discussing the many problems and gaps which have not been solved

Key messages:

• A biopsychosocial approach is appropriate for management of maternal illness. Expertise must be maintained in medication use, psychological strategies and broad sociocultural issues

• Complexities change over time with increase of dual diagnosis and child protection issues. Challenges abound

• Attachment theory combined with systems theory provides theoretical underpinning of the management of mother and infant and also partner and extended family

• Community care arrangements with an understanding of community resources is necessary for continuing care

Conclusions:

• Whilst management protocols will guide care, constant challenges are thrown up with increasing complexity of cases

• Up to date knowledge in many areas, including neurodeve-lopmental, psychopharmacological, and therapeutic change must be maintained

• Country-wide sharing of modes of management is essential to ensure best practice.