Severe mental illness

Women with a history of severe mental illness, such as bipolar disorder, schizophrenia, schizoaffective disorder or severe depression will need specialist care, preferably by a specialist perinatal psychiatrist during their pregnancy and postnatal period.

Women with Bipolar Affective Disorder (1-2% of the population) have a risk of developing postpartum psychosis of around one in four which increases to one in two, if they have had a previous episode of postpartum psychosis.

Joint working between midwifery and obstetric teams, perinatal psychiatrist and GP is recommended in order to make a plan for the woman’s postnatal care, when she is at highest risk of relapse.

Postpartum psychosis is a psychiatric emergency and a woman should be assessed and treated by a psychiatrist, preferably a specialist perinatal psychiatrist, within 4 hours.


At a woman’s first contact with services in pregnancy and the postnatal period, ask about:

  • any past or present severe mental illness

  • past or present treatment by a specialist mental health service, including inpatient care

  • any severe perinatal mental illness in a first-degree relative (mother, sister or daughter).

If a woman has any past or present severe mental illness or there is a family history of severe perinatal mental illness in a first-degree relative, she may present as high risk of developing postpartum psychosis in the initial weeks after childbirth.


Refer to a secondary mental health service (preferably a specialist perinatal mental health service) for assessment and treatment, all women who:

  • have or are suspected to have severe mental illness

  • have any history of severe mental illness (during a pregnancy or the postnatal period or at any other time).

Ensure that the woman’s GP is aware of the referral.


Jones et al Lancet series on Perinatal Mental Illness (2014) Bipolar disorder, affective psychosis, and schizophrenia in pregnancy and the post-partum period.

NICE Guidance CG192 Antenatal and postnatal mental health: clinical management and service guidance

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