Intended for healthcare professionals

Rapid response to:

Practice Pregnancy Plus

Depression during pregnancy

BMJ 2007; 334 doi: https://doi.org/10.1136/bmj.39189.662581.55 (Published 10 May 2007) Cite this as: BMJ 2007;334:1003

Rapid Response:

Re: The NICE Guidlelines: a Travesty of Mother-Infant Psychiatry

Bravo, Professor Brockington!

The integration of 'mental illness' experience with experience of the
consequences for 'child abuse and neglect' is the key future challenge for
maternal and infant health services.[1]

Just before the National Institute for Social Work disappeared into
history, this was the problem they were beginning to address. [2] As well
as problems with the early 'mother-infant relationship' that may underpin
'rejection' and especially long-term emotional abuse of that child, the
same household may generate domestic violence or parental breakup, viewed
with terror by small, dependent children. The approximate successor to
NISW is the Social Care Institute for Excellence, whose 2003 'Report 2'
was also on working with families where parents had mental disorders. It
seems to be difficult for many generic professionals to accept that some
mothers do 'detest' their infants so specialist skills are essential for
the child's life chances, and perhaps even survival.[1] The UK's latest
Government strategy recognises that 'accountability for families can fall
between services'.[3] This urges us to Think Family in an 'integrated'
strategy. It remains to be seen whether this is compatible with the
Parenting Orders and other externally imposed measures proposed in the
same Review....

[1] Brockington IF. The NICE guidelines: a travesty of mother-infant
psychiatry. BMJ Rapid Response 21 June 2007.

[2] Kearney P, Levin E, Rosen G. Alcohol, Drug and Mental Health
Problems: Working with Families. London: NISW, 2000.

[3] Social Exclusion Task Force. Reaching Out: Think Family. Analysis
and themes from the Families At Risk Review. London: Cabinet Office, 2007.

Competing interests:
Unsuccessful attempts to give advice to NICE in the past.

Competing interests: No competing interests

25 June 2007
Woody Caan
Professor of public health
Anglia Ruskin University, Cambridge CB1 1PT, UK.