What criteria should I use to determine whether to refer a patient with postpartum psychosis to specialist mental health services?

Criteria for referral of a patient with postpartum psychosis to specialist mental health services include:

• Presence of a severe mental health problem within 12 months of childbirth, indicating the need for specialist assessment and treatment, preferably in a specialist mother and baby unit unless contraindicated.
• Rapid onset of psychotic symptoms or severe affective symptoms such as mania, mixed affective states, or catatonia that may require urgent specialist intervention including consideration of treatments like electroconvulsive therapy (ECT).
• Need for inpatient care that is specifically designed for mothers and babies, staffed by specialist perinatal mental health professionals, and integrated with community mental health services to ensure continuity of care.
• Requirement for specialist advice on psychotropic medication use during pregnancy and breastfeeding, including risk-benefit assessment and dose adjustments.
• Any indication that the woman’s mental health problem is severe enough to impair her ability to care for her baby safely, or where there is a risk to the physical health of the mother or infant.
• Situations where there is a history or current presentation of severe mental illness, necessitating close monitoring and possibly preconception counselling or early referral during pregnancy and postpartum.

Referral pathways should be clearly defined and accessible to all healthcare professionals involved in perinatal care, ensuring timely specialist assessment and treatment planning.

Overall, referral to specialist perinatal mental health services is indicated for women with postpartum psychosis due to the severity, complexity, and potential risks associated with the condition, requiring multidisciplinary specialist input and often inpatient care in a mother and baby unit ¹.