The Perinatal Parent Infant Mental Health Service (PPIMHS)

The PPIMHS teams are made up of perinatal psychiatrists, community mental health practitioners and psychotherapists/psychologists and they accept referrals from Health Visitors, GPs, midwives, Children’s Centres workers or other health professionals and self-referrals.  Click here for their referral form.  They may signpost elsewhere after the initial consultation if appropriate or they will offer the parent/carer and infant/child 9-12 sessions to work on the parent-infant relationship and/or psychiatric support as required.

Groups particularly at risk of having problems with bonding include families with ex-premature babies who have spent a significant amount of time on the Special Care Baby Unit, those where the baby has feeding issues or is difficult to soothe, those where breastfeeding failed to establish and those where there was a traumatic birth or difficult conception and/or pregnancy.  Many of the parents on their case load have a personal history of disturbed attachments and are keen not to let history repeat itself.  A recent audit showed that 41% of their mothers had some sort of mental health diagnosis which means that 59% did not.  Click here for an information leaflet about their service that you might like to give to your patients.

Mums with postnatal depression or post-partum psychosis should be referred directly to PPIMHS.  Parents struggling with a crying baby or fussy toddler but with no bonding issues should be referred to their health visitor.  The PPIMHS team is a tier 3 (specialised) service concentrating primarily on the parent-infant relationship and perinatal mental health.

Symptoms in the baby that might suggest a bonding problem:

extreme clingy behaviours, fussy, difficult to soothe, abnormal self-soothing behaviours (eg. head-banging, hair-pulling, scratching), excessive sleep problems, extreme feeding problems, lack of verbal and non-verbal communication, stiff or floppy posture, extreme fearfulness or watchfulness, lack of interest in the world, no comfort sought from parents, avoids eye contact with parents, smiles very little.

Symptoms in the parent:

high anxiety and panic about the baby, excessive A and E or GP presentations, feeling frightened of harming the baby, lack of separation between parent and baby, baby never put down, excessive sterilising of bottles and toys, detached feelings about the baby, no pride in their development, anger about baby as if baby intends to upset the parent, feelings of failure as a parent, inability to cope.

There is some evidence around this issue and around maternal stress during pregnancy and the effect of high maternal cortisol levels on the foetus’ developing brain.  I have asked the Waltham Forest PPIMHS psychologists to write a bit about that and correct anything I have written about their service!

3 thoughts on “The Perinatal Parent Infant Mental Health Service (PPIMHS)


    Referrals should be made directly to the Service for all antenatal women who either have mental health problems or are having difficulty bonding with their unborn baby.

    For Postnatal women is experiencing mental health problems she should be referred to the Borough based Access and Assessment Team who will do an initial assessment and refer onto PPIMHS if she has moderate to severe mental health problems. However if the woman is experiencing bonding and attachment difficulties she can be referred directly to PPIMHS.

    The contact details for the the Borough based Access and Assessment Teams are :

    – Waltham Forest 0300 555 1242

    – Redbridge 0300 555 1088

    – Barking & Dagenham 0300 555 1038

    – Havering 0300 555 1092

    So in PPIMHS there are two halves to the Service ; the Psychiatric half of the Service works with women who have mental health problems when they become pregnant; and women who develop mental health problems either during pregnancy or up to a year after having a baby. Clinicians have an Adult Mental health background. The Psychological half of the Service works with women and their partners where there are bonding and attachment difficulties and the Therapists have a child psychology and child psychotherapy background. We work in therapy with children up to the age of 3, but typically wouldn’t accept a referral for a child who was older than 18 months.

  2. Hello,
    I am currently working with a family whose child has just turned 2 years. The child was very premature born at 24 weeks and spent a considerable amount of time in hospital and is still on oxygen at home although this is becoming less frequent. I am quite concerned with the child’s development which I would consider to have regressed significantly. I feel there could be some attachment disorder between Mum and the child. Would this be an appropriate referral to your service? Or if not where could I refer the family to?

    Thanks for your help

    Cheryl Morrison, Early Support Team – Waltham Forest

    1. It does indeed sound like an appropriate referral to PPIMHS although they may not accept a child over 18 months as a new referral. WF phone number is 0300 555 1242. If you have developmental concerns then you will need to refer the child to Wood Street community paediatric service if they are not already under them. I hope this helps.

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