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The final day at the Marcé Society International Biennial Conference in Swansea continued to be inspiring. The main lecture theatre was full again for delegates to hear a presentation on ‘The current evidence base for the psychopharmacological treatment of bi-polar disorder’ by Dr. McAllister- Williams. As a non-scientist, I confess that sometimes such talks go way beyond my experience. Possibly a combination of my increased knowledge and his great speaking presence made this talk meaningful and interesting. He described this area of expertise as both a science and an art.  There is a large base of evidence that supports the positive impact of the correct medication for this condition. I especially liked his comment ‘what gets you well keeps you well’. That would be my encouragement for people who feel they should stop medication for a mental health condition when they do feel well.

Have you heard of the Edinburgh Postnatal Depression Scale (EDPS)? If you know anything about postnatal depression I would be surprised if you did not. It has been widely used for many years as an assessment tool. Even if it has drifted in and out of fashion, it remains one of the most global means of measuring this condition. Our next speaker was Professor John Cox, the key author of the EDPS and an internationally acclaimed figure in perinatal mental health amongst other areas of psychiatry. What a wonderfully humble and delightful gentlemen he is. In many areas of professional expertise, the top achievers often develop an ego as big, if not bigger, than their achievements and expect the rest of us to feed that ego. The wonderful aspect of the people in this area is that they are here because of their desire to help others. John was extremely moved before he spoke as the announcement was made that he was the first person to be awarded the ‘John Cox medal for perinatal mental health’. In the years ahead, it will be awarded to others. I am sure I am not the only member of the audience who felt honoured to be in his presence.

John’s presentation was entitled ‘Quality standards for the provision of humanistic health care and of a person-centred medicine in the NHS (England): Perinatal Psychiatry may have the key’. He began by sharing the key achievements of the Marce Society, of which he was a founding member:

1. 35 years since its conception
2. Publication of major historic and contemporary texts
3. Assistance in the birth of a Perinatal Psychiatry Faculty of the Royal College of Psychiatrists
4. The growth of the International dimension
5. Re-engagement of Health Visitors

I also feel that they could add the involvement of people with ‘lived experience’ and charities involved in this subject matter, as we were represented and made up an integral part of this conference. I think that this represents the desire to learn and share knowledge without an elitist attitude.

John also said that the Marce Society is the place where we wish to present our new ideas and research. I trust that he is encouraged in the passion and knowledge in this area by the young psychiatrists and professionals at this conference. I believe that John and his colleagues sowed the seeds that are growing for global improvements in perinatal mental health. I wondered, as I sat in the auditorium, if in years to come a young clinical or researcher would look back at this presentation and say ‘I was there – John inspired me’? I strongly suspect that will be the case. He continued by stating that Perinatal Psychiatry shows the way for a health service that is hungry for new integrative models of care particularly in the light of the Francis report.

He talked around some of the theories around compassion from a philosophical, psychological, theological and sociological perspective. He concluded with some expectations for commissioners to implement four core interpersonal Standards into NHS contracts and into the Centre for Quality Improvements (CQI):

1. State how you will cherish and support all your staff to provide a humanistic Person Centred Medicine and Person Centred Care
2. Indicate how you will provide regular supervision from experienced mentors for all your staff – including general managers
3. Give details of the educational curriculum and teaching methods you will use to train staff in the principles and practice of Person Centred Medicine and Person Centred Care (e.g. Balint Groups, Listening Skills and Compassion focussed courses)
4. Identify how you will identify role models for the provision of Compassionate healthcare and how you will implement a culture of Intelligent Kindness.

Let’s make this happen!

John received a long standing ovation from us all – very well deserved.

The next speaker certainly had a difficult act to follow! She was Professor Marie-Paule Austin from Sydney. Her presentation was ‘Psychosocial assessment and depression screening in the perinatal period – the debate continues’.  She stressed the potential for early intervention as expectant/new parents are often highly motivated to seek help for the sake of their child. This made me smile as during pregnancy I devoured every bit of literature I could on pregnancy and birth! She showed a funny clip of a doctor screening a new mother who clearly was very well – the implication was that you need to be assessed even if you are completely well. She outlined some key ‘screening program’ components such as referral mechanisms and effective treatments. Marie-Paule concluded by sharing the Marce society position statement:

‘Not undertaking assessment because of possible complexity or lack of resources, overlooks the critical role of psychosocial wellbeing in maternal and infant outcomes’.

‘Such assessment holds intrinsic value in terms of educating women and families and ‘starting the conversation’ about psychosocial and mental health issues.’

The full details of this statement is here

After the break I joined a symposia on Perinatal Depression in mothers and fathers: combinations and possible pathways to effect on the child. Yet again it was an interesting and inspiring series of research.  This area is covered by the Perinatal Psychopathology and Offspring Development Research Group,

The main conclusion is that depression in fathers in the postnatal period, like depression in mothers, is associated with an increased risk of adverse child outcomes, though the pattern of risk may be different.

Our last picnic lunch was eaten outside on the grass in the sunshine, with friends old and new. My only regret was having to leave then as I needed to be back home that evening.

I spent the last 30 minutes at the book-signing table and spoke to Lynne Murray (as described in part 2). I also had a brief chat with the next President of the Marce Society, Jeanette Milgrom.  Earlier this summer I had lunch with Rosie Smith, from New Zealand whom I had met originally at the Meeting in Sydney in 2008 where I spoke. She was in the UK for a holiday and we met up to share our professional and personal news. Rosie had mentioned that she knew Jeanette so I said hello on her behalf! I did say that perhaps I would make it to the next international meeting in Melbourne in September 2016 and be signing my next book there.

During the conference I also had the pleasure of meeting Elly Taylor, a perinatal relationship researcher and author of ‘Becoming us – 8 steps to grow a family that thrives’. This will get a mention in my next one as the relationship between mother and father is so important.

I also chatted to another author, Professor Philip Boyce from the University of Sydney. He told me about a carers guide to puerperal psychosis written by the husband of a sufferer.

I drove back to Cheshire via some stunning Welsh scenery as opposed to M5/M6 on a Friday afternoon. As I did so I reflected on the past four days.

As a speaker I was delighted to have the opportunity to learn from those who have a global reputation. I found that the key ingredients of the most impactful presentations were those that had a balanced speed/pace; appropriate humour; good and interesting tone. Also the number and quality of the slides made a difference – too many with too much information were ‘lost’. One big difference I did notice was the number of delegates (me included) who used their phones to take pictures of the slides. Who needs a pen?

I reflected on my role at the conference. It was below par because I felt unwell yet I was determined to take the full benefit from it – I felt I did. I also hope that I listened far more than I spoke. I know that in the past I have had the reputation of ‘why use a sentence when a paragraph will do’ and people have regretted asking me a question because 15 minutes later I haven’t paused for breath! I do now make a conscious effort to be brief and then ask about other people.

I felt that the whole conference had included far more on antenatal conditions and anxiety, not just depression. The study of the effect on the fathers was also much greater. The wider range of attendees was very good and there was such a lovely atmosphere of learning and sharing good practice. I feel that we have a wealth of established clinicians and researchers in this area and some amazing youngsters who will be the ‘leaders’ in this field in the future.

Yes, we can moan and complain that resources are limited and that we are unable to move forward to help others because of this. In the same way, should we all stop living our lives until we ‘win the lottery’ and miss present opportunities whilst waiting for monetary heaven? Or do we take the knowledge, passion and desire to help young families with what we already know and have?

The International Marcé Society meeting in Swansea certainly encouraged the latter.

My sincere thanks to everyone who made it so informative and enjoyable. Looking forward to the next one already! Melbourne 2016 – now how can I make that happen?

I am now taking a break to relax and recuperate fully before my book writing starts again next week with renewed passion, enthusiasm and knowledge!

Elaine 🙂