Job Speciality trainee in Perinatal Psychiatry
Trainer Dr Paula Brownsett, Derby
Job description
This is a full-time perinatal psychiatry post based at the Radbourne Unit, Royal Derby hospital, Derby.
Dr Paula Brownsett is the lead consultant for this post and will be responsible for clinical supervision; specialist
supervision in psychological therapies is available from the consultant psychologist in the team.
Service description
The main sites for clinical activity will be the Beeches Mother and baby unit which has 6 beds for women in
late pregnancy or with their infants in the first postnatal year. The unit is a tertiary unit admitting women from
both within and outside the East Midlands. The unit is part of the perinatal quality network being peerreviewed annually. The service as a whole is also part of the east Midlands managed care network which
ensures standards are uniform across units. There is a community team based on the same site which trainees
work closely with in managing patients who are at risk of developing mental illness following delivery.
Outpatients are seen either at the Radbourne unit or the resource centre, London Road Community Hospital
(formerly the DRI).
In Derbyshire, 10,000 women are delivered annually, 6,000 at the Royal Derby Hospital, where there are
specialist midwives in mental health and substance misuse, trainees will have an opportunity to work with
both and visit other services providing care to pregnant and post natal women.
Staff in the community team comprises 2WTE CPNs, 1 WTE occupational therapist and 1WTE psychologist, in
addition there is a specialist midwife who also works closely with the team. For those trainees interested,
supervision in psychological therapies is available from the psychology staff.
Clinical opportunities
Experience will be gained in assessing women in different settings and at different times in pregnancy and
postpartum. Assessments may be in a crisis situation or routine. Close working with the crisis team is at times
necessary and encouraged where appropriate.
There will be experience in liaising with many different agencies both statutory and non-statutory.
Trainees will have a maximum of 2 clinics per week which will run alongside the consultant and CT trainee
clinics. IN addition, the trainees will assist in providing liaison services to the maternity services as needed.
Referral meetings screen all referrals and it is expected the trainee will take an active role in this alongside the
community team. There is one fixed ward review each week which the trainee will attend.
As the activity in the service can be variable, trainees will also be encouraged to visit other services,
particularly the pregnant substance user’s clinic.
A journal club and case presentation takes place on the Thursday; currently at lunchtime though this may
change senior trainees are encouraged to take an active role in this. Trainees will have opportunity to teach
medical students and to support core trainees in preparing for their examinations.
The trainee will take part in the senior on-call rota, a maximum of 1 night in 7, providing supervision and
support to junior trainees and other staff members as required, and providing emergency assessments as
needed, which may include section 136 assessments at the Radbourne Unit or as appropriate in the
community. When on call you will be supervised by a substantive consultant psychiatrist.
Trainees will be expected to work to the professional standards set out in Good Psychiatric Practice, and as
defined by the GMC.
2.
Weekly Timetable for the trainee and Clinical Supervisor which should show
a.
b.
c.
d.
e.
f.
An overlapping pattern of clinical work.
Two sessions for research/special interest (preferably on the same day).
Details of clinical supervision.
Opportunities for attendance at journal clubs/ case conferences.
Attendance at an appropriate academic programme.
Details of on-call work (including nature of duties and arrangements for clinical
supervision.
2.1
Trainee Timetable
Please complete the proposed timetable for the trainee. This timetable must indicate the arrangements for
Clinical Supervision (1 hour per week).
Monday
Tuesday
Wednesday
am
supervision
Community team
referral meeting
supervision
pm
Ward review
Outpatient clinic
Outpatient clinic
Thursday
Friday
12- 2pmAcademic
meeting
The trainee supervision time will be finalised with the individual trainee to allow for their special interest
sessions.
2.2
Trainer timetable
Please complete the timetable for each clinical supervisor/ trainer. This should show:
a.
regular scheduled consultant supervision of one hour per week.
b.
a substantial overlap with that of the trainee.
am
Monday
Tuesday
Administration,
ward meetings as
needed
community team
referral meeting
Wednesday
Admin
Ward review
Friday
Management
meetings
Ward review
ST supervision
ST supervision
pm
Thursday
12-2
academic
meeting
Outpatient clinic
Outpatient clinic
CT supervision
Admin
Intended learning outcomes
Outcome 1
The trainee develop experience in recognising both the normal changes in women’s psychological state during
pregnancy and post postnatally, and be able to recognise the distinctive changes associated with mental illness
in the Perinatal period. This will be achieved through assessing women in the outpatient clinics, obstetric
liaison and reviews of women on the mother and baby unit. This will include disorders affecting adults of all
ages as well as relapse of pre-existing mental illness, particularly affective disorders, OCD and schizophrenia
and new disorders which may be arising for the first time particularly puerperal psychosis.
Alongside assessing the mother’s mental health, trainees will begin to develop an understanding of how this
may impact upon their ability to care for their child/ren.
In deciding upon a management plan trainees will learn to consider the risk and benefits of treatment
particularly medication in pregnancy and breastfeeding with an individualised plan considering the risks to the
fetus and/or neonate.
Outcome 2
The trainee will develop skills in liaising with and working alongside many different agencies. There will be
opportunity to work with general adult psychiatrists, primary care, maternity services, health visiting and
children and young people’s social services. There will also be opportunity to liaise with services in North
Derbyshire where there is no specialist perinatal service. The trainee will work with the multidisciplinary team
in assessing and prioritising referrals.
Outcome 3
The trainee will begin to develop management plans for women, using a biopsychosocial model, considering
risks to the mother, and her fetus or neonate as well as other children where necessary. Where needed the
trainee will advise on or use the Mental Health Act or Mental Capacity Act.
Outcome 4
The trainee will develop skills in prescribing in pregnancy and breastfeeding, considering the risks to fetus and
infant, they will be able to discuss this with women in a way which assists them in making informed choices.
Consideration may also be given to effects of medication on a woman’s ability to safely care for her child/ren.
The trainee will also learn how the physiological changes of pregnancy may affect the pharmacokinetic and
pharmacodynamics of a drug and how to adjust doses accordingly.
Trainees will also assess women who have longstanding mental health conditions particularly bipolar disorder
who wish to become pregnant, they will learn to discuss risks of treatment and formulate a plan of care.
In women with a previous history of perinatal mental illness particularly puerperal psychosis trainees will learn
to develop care plans taking their wishes into consideration in order to reduce their risk of relapse in the
postnatal period.
Trainees will also gain skills in discussing contraception with women and their partners.
Outcome 5
Trainees will learn to assess risk both to the mother and others and whether this is arising from mental illness
or not. The trainee will use standardised risk assessment forms when seeing any patient and utilise the many
sources of information available to assist in the assessment. The risk of suicide is a significant driver in the
development of perinatal services, and the trainee will gain knowledge of the key documents which give
guidelines for service provision.
The trainee will work with relevant agencies and liaise with them as appropriate regarding a woman’s risk of
suicide or self harm and how to manage this.
Through liaison and crisis referrals the trainee will gain experience of emergency situations, they will continue
to develop skills in managing acute behavioural disturbance. They will also gain experience of assessing the risk
to women of harm either from themselves or others and those at risk of exploitation. With all women the
assessment risk posed by women to their children born or unborn is an important part of any assessment,
trainees will be expected to consider this in all cases and will gain experience in liaising with other services and
outlining the risks clearly so that the relevant action may be taken. During the post trainees will gain
experience of working with colleagues in social care, attending case conferences and writing reports under
supervision where appropriate.
Outcome 6
Trainees will gain experience in use of psychological therapies with women. Supervision is available from the
consultant psychologist in the service. Psychotherapy supervision is also available via the psychotherapy
service.
Outcome 7
Being in post for a year allows trainees to develop longer therapeutic relationships with women than are
usually possible. The trainee will be able to build a develop a rapport, with a woman and her family many of
who are anxious at this time in their lives. They will develop skills in instilling optimism to women at risk and in
some cases work to try and prevent a relapse of illness or a recurrence of a previous puerperal psychosis.
Emergency assessments particularly in the maternity unit where staff may have limited knowledge of mental
illness will give a senior trainee opportunity to develop their skills in communicating risk clearly and effectively
to various professionals.
Outcome 8
Trainees will have opportunity to help women in dealing with their fears in relation to their illness and the
consequences of seeking help, particularly in relation to social services. Where appropriate they will also have
opportunity to educate the wider public and other professionals about the impact mental illness may have
upon a family and its functioning and dispel stigma in relation to mental illness and parenting.
Outcome 9
The trainee will work with many disciplines including maternity staff, obstetrics and gynaecology, health
visiting, primary care, children’s workers and social services. The trainee will gain experience in writing reports
for case conferences and attendance at them where they will have the opportunity to educate staff with no
training on mental health about the effects of illness upon a mother and her children, often trying to dispel
some of the misconceptions that arise.
Outcome 10
The trainee will gain opportunity to experience the work of the Perinatal Quality Network and assist in the
development of relevant documentation and tools to assist in improving the quality of care offered to women
and their children. Where possible the trainee will attend regional meetings of the managed care network,
gaining experience in development of standards of care. Attendance at regional meetings will also afford
trainees an opportunity to understand changes in the wider NHS particularly in relation to commissioning of
specialist services.
Audit is encouraged as part of the managed care network and trainees will be supported in this. There will be
opportunity to meet with staff from the Nottingham Perinatal Service through joint audit and case review
meetings.
Outcome 11
Trainees will be supported in improving and building upon skills in written communication, in the form of
letters to many different agencies, and where appropriate with supervision the preparation of reports for
tribunals, case conferences and legal reports when requested under the Children Act.
Outcome 12
Trainees will develop skills in audit, either participating in ongoing audit or their own topic. They will also take
part in the peer review process as part of the quality network.
Outcome 13
Trainees will be guided in their own learning and sharing their knowledge with members of the perinatal team.
They will be encouraged to work with the medical school to participate in the student teaching programme
locally, particularly through patient centred teaching clinics. They will be encouraged where possible to assist
with the teaching programmes for midwives, health visitors and trainees in obstetrics and gynaecology.
Outcome 14
The team is currently involved in working with the Bipolar Disorder Research Network (BDRN) in recruiting
patients for the molecular genetics investigation and will be participating in a further study involving pregnant
women with bipolar disorder with the BDRN. Trainees will be encouraged to participate in these studies and to
attend meetings with the research team.
Outcome 15
Trainees will have the opportunity to further their understanding of the limit of confidentiality, when
confidential information needs to be shared with other agencies and how this may be discussed sensitively
with women and their families.
Paula M Brownsett/ Andrew J Cairns Jan 2011