Peer moms should be familiar with the specific clinical and risk profiles associated with the perinatal period, for example, the red flags for suicide risk, and amber flags for relapse of existing mental health conditions.

Red flags may indicate suicide risk and their presence should prompt urgent specialist review/input:

• Recent significant change in mental state or emergence of new symptoms

• New thoughts or acts of violent self-harm

• New or persistent expressions of incompetency as a mother or estrangement from the infant.

What causes perinatal mental health problems? previous experience of mental health problems. biological causes. lack of support. difficult childhood experiences. experience of abuse. low self-esteem. stressful living conditions. major life events.

Amber flags indicating risk for recurrence of major perinatal mental illness, particularly in early postpartum:

• Previous history of psychosis gives a 25% chance of recurrence in a subsequent pregnancy

• Women with a family history of bipolar disorder or postpartum psychosis who themselves have mood disorder or change in mental state

• Person and family patterns of occurrence and recurrence can inform risk management strategies. Peer moms should be aware that mental health difficulties can be exacerbated by pregnancy and/or childbirth, or present for the first time during the perinatal period.