Dissociation in mothers with borderline personality disorder: a possible mechanism for transmission of intergenerational trauma? A scoping review.

BACKGROUND: Dissociation is a feature of Borderline Personality Disorder (BPD), but rarely a focus for research, particularly in the perinatal literature. BPD partly has its aetiology in childhood and is characterised by emotional changes and difficulty with self-coherence that impacts on the processes of caregiving. METHODS: A scoping review was conducted to synthesise current perspectives on the effect of dissociation in caregivers with BPD, particularly regarding the impact of caregiver dissociation on the interactional quality of relationship within parent-child dyads. Studies were included if they explicitly mentioned dissociation in the target population, or if dissociation was implied. A thematic analysis was conducted. RESULTS: 20 studies were included; 10 experimental or quasi-experimental; 2 presenting case material; and 8 non-systematic review articles. 4 studies used the Dissociative Experiences Scale (DES) to measure dissociation, while 2 studies included a 'dissociative behaviour' subscale as part of an observational measure. The remaining studies did not measure dissociation but referenced directly or indirectly a concept of dissociation. CONCLUSIONS: Findings suggested there was some evidence that dissociation plays a unique role in BPD caregivers' interactions with their offspring, however any findings should be interpreted with caution as the concept has been poorly operationalised and defined.

The Management of Perinatal Borderline Personality Disorder.

Borderline personality disorder (BPD) is highly prevalent in clinical perinatal mental health settings, although there are few systematic programmes to identify BPD at this time. Retrospective studies show compromised birth outcomes for women with this condition, and several authors have highlighted a significant range of problem outcomes for offspring identifiable from early infancy through the adult years, including the intergenerational transfer of mental health problems from mother to child. A literature review identifies the varying prevalence rates found in non-clinical and clinical settings and the paucity of published studies on the management of perinatal BPD, in particular focused both on the mother and mother-infant relationships. A case study is presented to show both the potential benefits of inpatient mother-baby unit protocols and of specialised longer-term group therapy. Many knowledge gaps can be identified for further clinical research that could potentially benefit families with perinatal BPD, including systematic identification of perinatal BPD and intensive programmes that not only could perhaps improve birth outcomes but also provide skills to mothers to help with their emotional regulation and potentially improve mother-infant relationships and longer-term offspring developmental pathways.

Reflective functioning and mother-infant relationships among mothers with Borderline Personality Disorder post-therapy.

The stressful nature of parenting infants exacerbates the characteristics of Borderline Personality Disorder (BPD). Consequently, mothers with BPD tend to be emotionally dysregulated, respond impulsively to their infants, and have poorer mother-infant relationships. Few parenting interventions target the specific skill deficits observed in mothers with BPD. This study explored the differences in parental reflective functioning (PRF) and mother-infant relationship quality at baseline and following a 24-week, group parenting intervention for mothers with BPD. PRF and mother-infant relationship quality were assessed from quantitative (N = 23) and qualitative (N = 32) perspectives. Quantitative data (Parental Reflective Functioning Questionnaire) showed a significant improvement in one of the three subscales, Interest and Curiosity, between baseline and post-intervention, and a significant moderate positive association between the subscale Certainty of Mental States and maternal-infant interaction quality post-intervention. Improvements in mother-infant relationship quality were not evident from the observational measure, Nursing Child Assessment Satellite Teaching scale. In contrast, semi-structured interview qualitative data found maternal improvements in parental reflection, coping strategies implemented post-intervention, and quality of mother-infant relationships. Overwhelmingly positive intervention feedback suggested perceived maternal benefits of group format and skills taught. Future studies with larger sample sizes would allow further clarification of such parenting interventions for mothers with BPD.

La naturaleza estresante de criar infantes agudiza las características del Trastorno Límite de la Personalidad (BPD). Por tanto, madres con BPD tienden a estar emocionalmente no reguladas, responder impulsivamente a sus infantes y tener relaciones madre-infante de menor calidad. Pocas intervenciones de crianza se centran en los específicos déficits de habilidades observados en madres con BPD. El presente estudio exploró diferencias en el funcionamiento con reflexión del progenitor y la calidad de la relación madre-infante al punto inicial y al del seguimiento a 24 semanas de la intervención de crianza en grupo para madres con BPD. Se evaluó el funcionamiento con reflexión del progenitor y la relación madre-infante desde la perspectiva cuantitativa (N=23) y cualitativa (N=32). Datos cuantitativos (Cuestionario del Funcionamiento con Reflexión del Progenitor) mostraron un significativo adelanto en una de tres subescalas, Interés y Curiosidad, entre el punto inicial y posterior a la intervención, y una significativa moderada asociación positiva entre la subescala Certeza de Estados Mentales y la calidad de la interacción materno-infantil al momento posterior a la intervención. Las mejoras en la calidad de la relación madre-infante no fueron evidentes con la medida de observación, la escala de la Enseñanza Satélite de Evaluación del Niño Lactante. En contraste, datos cualitativos de entrevista semiestructurada encontraron mejoras maternas en la reflexión del progenitor, estrategias de cómo arreglárselas puestas en práctica después de la intervención, y en la calidad de las relaciones madre-infante. La abrumadoramente positiva información sobre la intervención sugirió que había una percepción materna de beneficios del formato de grupo y las habilidades que se enseñaban. Estudios futuros con grupos mayores permitirán clarificaciones adicionales de tales intervenciones de crianza para madres con BPD.

La nature stressante du parentage des nourrissons exacerbe les caractéristiques du Trouble de la Personnalité Limite (TPL). Par conséquent les mères avec un TPL ont tendance à être émotionnellement dérégulées, réagissant de manière impulsive à leurs bébés et ont des relations mère-bébé moins bonnes. Peu d'interventions de parentage visent les déficits de compétence spécifiques qui sont observés chez les mères avec un TPL. Cette étude a exploré les différences qu'on trouve dans le fonctionnement de réflexion parental et la qualité de la relation mère-bébé au départ et après une intervention de groupe de parentage pour des mères avec un TPL, de 24 semaines. Le fonctionnement parental de réflexion et la qualité de la relation mère-bébé ont été évalués à partir de perspectives quantitatives (N=23) et qualitatives (N=32). Les données quantitatives (Questionnaire de Fonctionnement de Réflexion parental ont montré une amélioration importante dans l'une des trois sous-échelles, Intérêt et Curiosité, entre le départ de l'intervention et la post-intervention, ainsi qu'un lien positive modéré important entre la sous-échelles Certitude des Etats Mentaux et la qualité de l'interaction maternelle-bébé après l'intervention. On n'a pas trouvé d'améliorations de la qualité de la relation mère-bébé à partir de la mesure d'observation échelle d'Formation Satellite de l'Evaluation du Nourrisson. Par contre les données qualitatives de l'entretien semi-structuré a révélé des améliorations maternelles dans la réflexion parentale, dans des stratégies d'adaptation mises en place après l'intervention et dans la qualité des relations mère-bébé. Les retours de l'intervention extrêmement positifs ont suggéré que des bénéfices maternels perçus du format de groupe et des compétences enseignées. Des études avec des échantillons plus grands permettraient une clarification plus poussée sur de telles interventions avec des mères avec un TPL.

Mothers with borderline personality disorders' experiences of mother-infant dialectical behavior therapy.

BACKGROUND: Borderline personality disorder (BPD) is increasingly diagnosed in perinatal and infant settings, and research suggests that as well as an escalation of BPD symptoms in this period, these symptoms may also be detrimental to infant development. Providing tailored treatments during the postnatal period may help women and prevent an intergenerational cycle of emotional and interpersonal symptoms in infants. Mother-infant dialectical behavior therapy (MI-DBT) has produced promising, yet inconsistent, improvements on quantitative scales of maternal mental health and the mother-infant relationship. The qualitative evaluation may provide complementary information. AIMS: This study aimed to explore the subjective experiences of women who had completed MI-DBT. MATERIAL AND METHODS: Thematic analysis of semistructured interviews conducted on 13 women undertaking MI-DBT before, post, and 12 months after MI-DBT were analyzed for themes. RESULTS: Five major themes were identified. Overall, the women expressed that their emotional literacy and regulation improved after MI-DBT, subsequently addressing key risks and challenges such as uncertainty around their child's cues, and low self-esteem, and potentially improving the women's mentalization capability. DISCUSSION AND CONCLUSIONS: This study consolidates previous research on maternal BPD, and provides qualitative evidence of the benefits of MI-DBT for mothers as both individuals and as parents with likely flow-on effects for infants. Lived experience input for future adaptations was a valuable gain.

"A service we know was missing": bridging the gap between referral to admission for women with moderate-severe perinatal mental health disorders at an Australian psychiatric mother-baby unit.

OBJECTIVES: Service demand at Australian psychiatric mother-baby units is high. This project aimed to test a model of care providing step up/step down support to women with moderate-severe perinatal mental health disorders awaiting hospital admission. METHOD: A multi-disciplinary team was convened to provide pre-admission assessment and support to women waiting for admission, as well as post-discharge support as needed. RESULTS: 108 referrals were managed between April - November 2021. With appropriate assessment and/or support in place, half of the women referred (n = 54/108) were removed from the waitlist and avoided hospital admission. Service capacity indicators suggest a positive impact on referral numbers managed each week, as well as admissions per month. CONCLUSION: The tested model of care appears to have successfully improved service capacity; however longer term data is recommended to determine the sustainability of the trend towards increased capacity, and the acceptability of the model of care from a consumer perspective.

Seeing it clearly: How to use graphics to guide collaborative consultation in pregnancy.

OBJECTIVE: This study aims to examine the use of decision aids which may improve shared decision making through an exploration of risk apprehension and modes of collaborative communication. CONCLUSIONS: Decision aids such as graphics have a key role in facilitating shared treatment decision making, perhaps particularly in perinatal mental health care. They are most useful within a trusting, two-way conversation.

Holistic community-based group parenting programs for mothers with maternal mental health issues help address a growing public health need for a diversity of vulnerable mothers, children and families: Findings from an action research study.

Background: Maternal mental illness is a major growing global concern which can affect parenting with serious negative implications for offspring. Group-based parenting programs for mothers which both enhance the parent-child relationship and address mental health symptoms in a supportive social setting may optimise better outcomes for mothers and children. The Acorn program in South Australia draws on attachment theory to integrate dance play, reflective diary keeping and therapeutic letters in a holistic program for a diversity of vulnerable mothers and children aged 1-36 months. The program seeks to nurture and enhance parental wellbeing and the quality of the parent-child relationship for mothers experiencing identified mental health illnesses that impinge upon their parenting. This study presents the evaluation of the program and its effectiveness. Methods: Action research approach for continuous monitoring and program improvement engaging Acorn program staff in evaluation data collection and interpretation of pre and post self-completion measures and standardized observations. Additional data was collected through a telephone interview of attending mothers 6-8 months after program completion to address sustainable impacts on parenting and wellbeing. Results: The program engaged 353 diverse vulnerable mothers with their children. Many had profound overlapping mental health issues including borderline personality disorder (BPD) and depression. The quality of the parent-child interaction, parental confidence, competence and enjoyment were enhanced; mothers' wellbeing, ability to cope and lasting social supports were augmented. This occurred for a number of "most vulnerable" subgroups including single mothers, mothers with BPD, mothers from non-English speaking households and those with lower levels of education or household income. Mothers reported sustained improvements in their wellbeing, parenting, social and family lives, and feeling closer to their child as a result of participating in the program. Conclusions: Given the high prevalence of maternal mental health issues and substantial potential negative consequences for mothers and offspring, the Acorn parenting program offers an effective means of addressing this pressing public health issue potentially helping large numbers of vulnerable mothers and their children. This has additional gravitas in the shadow of COVID-19 due to expanded numbers of those experiencing greater parental stress, isolation and mental illness.

The interrater reliability of a routine outcome measure for infants and pre-schoolers aged under 48 months: Health of the Nation Outcome Scales for Infants.

BACKGROUND: A review of Australian mental health services identified a gap in routine outcome measures addressing social, emotional and behavioural domains for pre-schoolers and infants. The Child and Adolescent Mental Health Information Development Expert Advisory Panel Working Group developed the Health of the Nation Outcome Scales for Infants (HoNOSI), a clinician-reported routine outcome measure for use with those aged under 4 years. Prior psychometric testing showed that the HoNOSI was considered to show face validity, and that it met the standards for concurrent validity and internal consistency. AIMS: We aimed to investigate the interrater reliability of the HoNOSI. METHOD: Forty-five infant mental health clinicians completed HoNOSI ratings on a set of five case vignettes. RESULTS: Quadratic weighted kappa interrater reliability estimates showed the HoNOSI to have Almost Perfect interrater reliability for the HoNOSI total score. Of the 15 scales, one had Moderate, seven had Substantial and seven had Almost Perfect interrater reliability. Ten of the fifteen scales and the total score exceeded the COnsensus-based Standards for the Selection of Health Measurement INstruments criteria for interrater reliability (κw ≥ 0.7). CONCLUSIONS: There has been a clear need for a routine outcome measure for use with infants and pre-schoolers. This study provides evidence of interrater reliability. The current findings, combined with the face and concurrent validity studies, support further examination of HoNOSI in real-world settings.

Changing intergenerational patterns of emotional dysregulation in families with perinatal borderline personality disorder.

A pilot study with women with borderline personality disorder (BPD) and their infants showed promising results. This clinical research program sought to discover whether ongoing implementation confirmed preliminary results in relation to maternal mental health and, in addition, whether parenting and the mother-infant relationship showed sufficient improvement. Women with BPD and their infants were referred to a 25-week group program of Mother-Infant Dialectical Behavior Therapy (MI-DBT). During groups, infants were provided care by childcare workers while mothers took part in a skills training session. Mothers and infants then reunited and took part in an activity together that incorporated skills taught in the teaching session. Sixty-nine of 98 women commencing MI-DBT completed the program, demonstrating a 71% completion rate. Women showed improvement on all measures of mental health including depression, anxiety, and BPD symptoms. While women reported improvement in parenting confidence, an objective measure of the mother-infant relationship showed continuation of concerning relationships in a significant percentage. MI-DBT was found to be effective at improving mothers' mental health, both at the initial site and in community settings, with different clinicians and with different childcare options. While there were some improvements found in measures of the mother's perception of the infant-parent relationship, there were no significant improvements in currently used observational measures of the interaction or the infant's social-emotional development, suggesting that additional intervention such as infant-parent therapy may be needed to augment the benefits of MI-DBT to improve outcomes in these areas.

Impact of infant crying on mothers with a diagnosis of borderline personality disorder: A qualitative study.

Mothers with borderline personality disorder (BPD) and their infants often have compromised relationships. To further understand the complexities, this study explored (a) the experiences of mothers with BPD in response to infant crying and (b) how these parenting responses impact on mothers' interpersonal functioning with significant others. Six mothers with clinical BPD were recruited from a mother-baby psychiatric unit and interviewed using an interpretative phenomenological analysis (IPA) approach. Transcripts of the semistructured interviews were coded for themes and subthemes. Dominant themes revealed that mothers with BPD entered motherhood in a psychologically fragile state, hypersensitive to experiencing intense physiological-emotional pain and cognitive chaos in response to infant crying. Automatic maladaptive flight-fright responses including suicide attempts were common. A novel theme revealed some mothers' split identity, and only the "mother" part could attend to infant crying. Finally, the data provided an understanding of the detrimental domino effect on close family. Mothers also highlighted gaps in accessibility of current mental health services and parenting programs, and their desire to prevent the intergenerational transmission of attachment problems and BPD symptoms to offspring. Clinical implications include antenatal BPD screening, psychoeducation about infant crying, and greater access for programs supporting the whole family to improve outcomes.

Las madres con el Trastorno Limítrofe de la Personalidad (TLP) y sus infantes a menudo presentan relaciones puestas en peligro. Para comprender más las complejidades, este estudio exploró: I) las experiencias de madres con TLP en respuesta al llanto del infante; y II) cómo estas respuestas de crianza tienen impacto sobre el funcionamiento interpersonal de las madres con sus parejas. Se reclutaron seis madres con TLP clínico en una unidad siquiátrica de mamá-bebé y se les entrevistó usando el acercamiento del Análisis Fenomenológico Interpretativo (IPA). Las transcripciones de las semiestructuradas entrevistas fueron codificadas por temas y sub-temas. Los temas dominantes revelaron que las madres con TLP entraron a la maternidad en un estado sicológicamente frágil, hipersensibles a experimentar intenso dolor fisiológico-emocional y caos cognitivo como respuesta al llanto del infante. Fueron comunes las respuestas automáticas inapropiadas de defensa o escape, incluyendo el intento de suicidio. Un tema nuevo reveló la dividida identidad de algunas madres, y sólo la parte de 'madre' pudo atender el llanto del infante. Finalmente, la información suministró una comprensión del perjudicial efecto dominó sobre la familia cercana. Las madres también subrayaron vacíos en la accesibilidad a actuales servicios de salud mental y programas de crianza, así como su deseo de prevenir la transmisión intergeneracional de problemas de afectividad y síntomas de TLP a su niño. Entre las implicaciones clínicas se incluyen el examen antenatal para detectar la presencia de TLP, la educación sicológica sobre el llanto del infante, así como el mayor acceso a programas que apoyan a toda la familia para mejorar los resultados.

Les mères ayant un Trouble de la personnalité limite (TBL) et leurs nourrissons ont souvent des relations compromises. Afin de mieux comprendre toutes les complexités se présentant, cette étude a exploré : (1) les expériences des mères ayant un TBL par rapport aux pleurs du nourrisson ; et II) comment ces réactions de parentage impact le fonctionnement interpersonnel des mères avec leurs partenaires ou proches. Six mères ayant un TBL clinique ont été recrutées dans une unité psychiatrique mère-bébé et interviewées en utilisant une approche d'Analyse Interprétative Phénoménologique (AIP). Les retranscriptions des entretiens semi-structurés ont été codés pour les thèmes et les sous-thèmes. Les thèmes dominants ont révélé que les mères avec le TBL entraient dans la maternité avec un état psychologique fragile, hypersensible à l'expérience de la douleur physiologique-émotionnelle intense et au chaos cognitif en réaction aux pleurs du bébé. Des réactions automatiques de peur inadaptée, y compris des tentatives de suicide, ont été communes. Un nouveau thème a révélé l'identité éclatée de certaines mères et seule la partie « mère ¼ pouvait prendre soin du nourrisson pleurant. Enfin, les données ont offert une compréhension de l'effet domino néfaste de la famille proche. Les mères ont aussi mis en évidence les fossés dans l'accessibilité aux services de santé mentale en place et aux programmes de parentage, et leur désir de prévenir la transmission intergénérationnelle de problèmes d'attachement et de symptômes de TBL à leurs enfants. Les implications cliniques incluent un dépistage de TBL avant la naissance, une psychoéducation sur les pleurs du nourrisson, et un accès plus grand aux programmes soutenant toute la famille afin d'améliorer les résultats.

Treatment of postpartum psychosis in a mother-baby unit: do both mother and baby benefit?

OBJECTIVES: To describe characteristics and treatments of mother-baby dyads affected by postpartum psychosis admitted to a specialist mother-baby inpatient psychiatric unit in Australia. METHODS: A retrospective review of medical records for all mothers with postpartum psychosis and their babies admitted to a mother-baby unit over a 5-year period was conducted. RESULTS: A total of 25 dyads met the study criteria. Affected women were found to be severely ill with a high rate of involuntary status (64%). They waited an average 4.7 days for a bed in the mother-baby unit. All received an atypical antipsychotic, with 16% receiving lithium augmentation. Infants were found to have generally normative growth and development, with relationship concerns noted in 5. A total of 36% of the cohort maintained some breastfeeding, and all had their infants in their care at discharge. CONCLUSIONS: The mother-baby unit enabled severely ill women to remain with their infants during treatment. While a minority of infants showed developmental concerns, appropriate development was noted in most. Future efforts should focus on determining the most effective treatments and further defining the risks and benefits for infants in mother-baby units.

A New Therapeutic Group To Help Women With Borderline Personality Disorder and Their Infants.

OBJECTIVES: Few treatments have been described to treat the population of women with borderline personality structure who present in a dysregulated state with their infants. Therefore, a new treatment program was developed for this target group. METHODS: A total of 45 women, who were identified clinically as meeting full or partial diagnostic criteria for borderline personality disorder (BPD) and having an infant younger than 3 years of age, were offered entry with their infant(s) into specialized dialectical behavior therapy groups, adapted to focus on parenting and the mother-infant relationship. Outcomes measured included maternal mood and anxiety, BPD functioning, parenting sense of competence, parental reflective functioning, and caregiver-infant interaction (CARE Index). Infants received high-quality child care while mothers attended each group, with dyadic reunions a further therapeutic focus each week. RESULTS: A total of 29 women who met clinical or self-report measures for BPD and were offered group therapy began the program, 21 (72%) of whom completed the 24-week group program, with complete premeasures and postmeasures available for 20 dyads. Of the 20 women, 15 met full diagnostic criteria for BPD and 5 met partial criteria. Significant improvements were noted in maternal mood, with positive changes on 2 subscales of the Parental Reflective Function Questionnaire (prementalizing and increased curiosity in mental states); significant reductions in anxiety and BPD symptomatology were also observed. Only a medium effect size was found for parenting sense of competence, and in smaller numbers of participants as this scale was introduced later. It should particularly be noted that 15 dyads showed substantial change on the CARE Index, indicating improvement in dyadic relationships. CONCLUSIONS: This innovative adaptation of mother-infant dialectical behavior therapy showed promising improvements in maternal BPD symptoms and caregiver-infant relationships. Given that the feasibility and safety of this method have been demonstrated, a more methodologically rigorous trial with further refinements appears warranted to help this troubled cohort of patients.

Infants of emotionally dysregulated or borderline personality disordered mothers: Issues and management in primary care

BACKGROUND: Knowledge has increased regarding the developmental needs and capabilities of infants, and parental behaviours that support optimum infant development. Despite a better understanding of the emotional dysregulation in borderline personality disorder (BPD) and its effects on infants, general practitioners have had few guidelines for how to recognise and help emotionally dysregulated mother-infant dyads. OBJECTIVE: This article focuses on the behaviours and needs of infants whose mothers have BPD, including knowledge and skills for primary care practitioners to help these troubled families. DISCUSSION: Understanding the adequacy of parenting and troubling infant signs, such as hypervigilance, can potentially lead to either more intervention in primary care, including support, reassurance, guidance regarding development and interaction, and enhanced family support or else specialist referral for enhanced infant care. Infants’ needs are urgent, and timely intervention can begin a better life trajectory for infant and mother.

Helping mothers with the emotional dysregulation of borderline personality disorder and their infants in primary care settings.

BACKGROUND: Six per cent of patients who present to primary care have borderline personality disorder (BPD). Mothers with full or partial features of BPD, often undiagnosed and perhaps previously functioning adequately enough on the surface, may rapidly be-come emotionally dysregulated by the normal needs of an infant. Family and maternal functioning can rapidly destabilise. Management of patients with BPD in primary care may be challenging. OBJECTIVE: The objectives of this article are to provide primary care practitioners with relevant information on current knowledge of BPD and its management when mothers with BPD are caregivers to an infant. DISCUSSION: Useful guidelines for general practitioners that can help women who are emotionally dysregulated with infants include: keeping the diagnosis in mind openly discussing BPD diagnosis where relevant providing psychoeducational material and ongoing support to the woman and her familyreferring to specialised services for BPD referring to standard maternal-child health services and specialised .infant mental health services ongoing communication with other services and supervision for the practitioner.

Perinatal and infant mental health in Australia: moving forward towards REAL prevention and early intervention - can we do it?

OBJECTIVES: Australia has been at the forefront of appropriate early intervention. Prevention of mental illness in infants by early identification and intervention in the mental health of their mothers has stalled since the cessation of funding through the National Perinatal Depression Initiative (NPDI, 2009-2015). Whilst screening for maternal mental illness has been widely implemented throughout Australia during the last two decades, services are now diminishing and great opportunities to ride the crest of a wave for appropriate mental illness intervention are receding. Reviews of history and interventions internationally may help guide future directions. CONCLUSIONS: Advocacy through across-agency and across-political-party support has been markedly successful for perinatal and infant mental health in the United Kingdom. A solid foundation exists in Australia. Australian psychiatrists have the ability to continue to change the face of prevention and early intervention.

Managing Life, Motherhood and Mental Health After Discharge from a Mother-Baby Unit: An Interpretive Phenomenological Analysis.

Women who are admitted to a mother-baby psychiatric unit during the postnatal period often experience ongoing difficulties after discharge and require support in the community. This study explored the experiences of women following discharge from a mother-baby unit and their use of services and supports in the community. Semi-structured interviews were conducted with eight women who had been discharged from a mother-baby unit. To gain a comprehensive understanding of the lived experiences of these women, Interpretive Phenomenological Analysis was used to examine the transcripts. The themes identified focused on the transition home from the mother-baby unit as a significant event, the experience of life in the community, and the complex decision-making process involved in community service use. This study provides greater insight into women's experiences of managing life, motherhood, and mental health in the community and their use of recommended services. Results can inform future post-discharge and transition planning within mother-baby units and inpatient psychiatric facilities.

Primary care mental health consultation-liaison: a connecting system for private psychiatrists and general practitioners.

OBJECTIVE: The aim of this study was to describe and evaluate a service that provides a single point-of-entry for general practitioners (GPs) wishing to refer their patients for one-off psychiatric consultations, using a new Medicare Item, number 291. METHOD: Statistics of all referrals made through a single access point used by GPs for referral to psychiatrists were collated, as well as data regarding psychiatrists' provision of appointments. GPs using the service were surveyed after 28 months of operation. RESULTS: Both GP and psychiatrist user groups were predominantly positive about their experience of a system that provided ease of access for GPs and appropriate use of psychiatric expertise. Use of the service rose from six referrals per week to 10 per week during the survey period. Fifty-five percent of psychiatrists who joined the service continued to provide appointments on a regular basis. CONCLUSION: A single access point for GPs to access patient appointments to private psychiatric consultants is a simple and acceptable mode of increasing access for many patients to expert assessment and management plans.