Appropriate responses to assessments

The following is a useful guide for appropriate responses to assessments, identifying treatments, actions and providers of support/treatment services for women experiencing perinatal depression, anxiety, bipolar disorder and puerperal psychosis.

Treatment	Actions	Who
Risk or symptoms of mental health disorder
Psycho-education	Discuss mental health and offer sign-up to the Ready to COPE Guide.	Ready to COPE - www.readytocope.org.au
Community support	Give details of support groups, early parenting centres etc	Primary or community care professional or services can be found on the e-COPE Directory.
Lifestyle advice	Provide advice on sleep, relaxation and physical activity.
Previous history of mental health disorder including mild to moderate symptoms of depression/anxiety in the perinatal period
Psychosocial support	Assist with accessing support (e.g. family, peer support).	See community support listed services on the e-COPE Directory.
Monitoring and review	Consider possible puerperal psychosis/bipolar disorder and referral to psychiatrist.	Primary or community care professional (see e-COPE Directory).
Monitoring and review	Arrange monitoring if symptoms escalate.
Mild to moderate depression
Psychosocial support	Provide information on self-help strategies.	Encourage sign-up to Ready to COPE.
Non-directive counselling	Take an empathetic and woman-centred approach.	Primary or community care, mental health nurse, psychologist, psychiatrist. Search on the e-COPE Directory.
Psychological therapy	Consider CBT, IPT or psychodynamic therapy.	Search the e-COPE Directory for psychological treatment providers.
Medication	Consider in combination with psychological therapy.
Mother-infant psychotherapy	Refer to perinatal and infant mental health specialist if there are difficulties with mother-infant interaction.	Search the e-COPE Directory for mother-infant treatment providers.
Severe depression
Medication	Consider as a first step and in combination with psychological therapy.
Psychological therapy	Consider CBT and IPT based on the individual's ability to engage in psychological therapy.	Psychiatrist, psychologist, perinatal/infant mental health specialist. See the e-COPE Directory.
Mother-infant psychotherapy	Refer to perinatal and infant mental health specialist if there are difficulties with mother-infant interaction.	Search the e-COPE Directory for mother-infant treatment providers.
Anxiety disorder
Psychological treatment	Mild-moderate - consider CBT or IPT and self-help strategies.	Search the e-COPE Directory for psychological treatment providers.
Medication (see Table 1)	Moderate-severe - consider medication including short-term use of benzodiazepines while awaiting onset of action of SSRI.	Primary or community care, psychologist, mental health nurse, psychiatrist. See e-COPE Directory.
Mother-infant psychotherapy	Refer to perinatal and infant mental health specialist if there are difficulties with mother-infant interaction.	Search the e-COPE Directory for mother-infant treatment providers.
Bipolar disorder/puerperal psychosis
Referral	Refer for urgent specialist mental health assessment and inpatient admission.
Medication	Prescribe medication.	Psychiatrist, psychologist, inpatient care probable.
Psychological therapy	Consider individual or mother-infant therapy as woman recovers.

At all times when mental health problems are identified, consider the potential impact on the mother and infant interaction.

Note: CBT= Cognitive Behaviour Therapy; IPT=Interpersonal Psychotherapy

Ready to COPE

Ready to Cope is an e-guide that provides expectant and new parents with timely, relevant emotional and mental health information throughout their pregnancy and the first year postpartum. The Guide is currently available for expectant and new mothers, fathers and Aboriginal and Torres Strait mothers.

Find out more about the Ready to COPE Guide here or sign-up to receive Ready to COPE.

e-COPE Directory

The e-COPE directory enables consumers and health professionals to identify perinatal mental health practitioners and services. In addition the Directory also provides a listing of community support organisations.