What’s the idea?
Specialist perinatal mental health services need to be aware of and build strong working relationships with other local services supporting families during the perinatal period.
Where families are receiving care from multiple services, appropriate information needs to be communicated well between services to ensure safety and continuity of care. Referrals between services may be needed.
Partnership working may include the following local services:
- universal services including GPs, maternity services and health visiting
- specialist maternity services such as bereavement midwives, ‘Birth Choices’ and ‘Birth Afterthoughts’ clinics, maternity outreach clinics
- specialist baby health services including neonatal intensive care units (NICU) and special care baby units (SCBU)
- gynaecology departments
- adult mental health services such as Improving Access to Psychological Therapy (IAPT) services and Community Mental Health Services, and specialist inpatient provision
- parent-infant services
- children and young people’s mental health services (including under-5s provision and Child and Adolescent Mental Health Services)
- support services for young carers
- local authority services such as children’s centres, Early Help and children’s social care
- third sector organisations including bereavement charities.
It is important for specialist perinatal mental health services to hold in mind the needs of the partner and other family members at times of transition between services.
Key transition points may include:
- planned or emergency admission to inpatient acute or MBU care
- discharge from inpatient to a community perinatal team
- staff changes within inpatient or community teams
- discharge from community perinatal care to universal services
- involvement of social care
- involvement or onward referrals to other mental health services or third-sector organisations
- (e.g. IAPT, parent-infant services).
Why implement it?
- Transitions are not only periods of vulnerability for mothers but also threaten the extent to which partners and other family members are considered in the next steps of the care plan.
- Partnership working is at the core of providing appropriate and effective care to families where mothers are experiencing perinatal mental health disorders.
- Partnership working can facilitate shared knowledge and continuity of care between services, reducing risks to the wider family and promoting the ‘Perinatal Frame of Mind’ across services and organisations.
- Some mothers and families may experience heightened levels of stress and distress during the perinatal period, but do not meet criteria for perinatal mental health services. These families may include, for example, those affected by neonatal intensive care admissions, assisted conception, adoption and loss.
Actions to consider
- Consider partners’ and other family members’ needs at transition points alongside the needs of the mother.
- ‘Map’ the local area to identify services to signpost or refer family members to, and build relationships with those services.
- If a mother is admitted into an inpatient service out of her home area, investigate whether the partner and other family members are supported by the out of area service or whether their local services can play a role in this.
- Share knowledge with relevant professionals about the difficulties that can arise at these times as well as the importance of involving the wider family.
Practice tips: box 14
- Clear care pathways and consultation between teams is important. Teams need to be aware of all local services and support available and to promote partnership working.
- Establish what support and interventions are offered by local services for partners and families
- what are their eligibility criteria?
- how well do these services consider the needs of partners and other family members?
- what is specifically available for partners and other family members?
- ensure this information is readily accessible for partners and other family members.
- Other services, particularly third sector organisations, often have a specific offer of support for the wider family. Partners and families may need support to realise that they are entitled to access these services.
- Consider what your team might be able to learn from these organisations to support partners and families. For example:
- invite local organisations and other NHS teams (e.g. midwives and social workers) to meet your perinatal team, such as attending team meetings to provide expertise and develop working relationships
- approach specialist teams for consultation and guidance on how to support the family, such as seeking advice from the local Children and Young People’s Mental Health Services if concerned about older siblings
- liaising with local paediatricians to gain advice on supporting families with babies’ needs, such as colic, reflux and crying. These baby needs can significantly impact on parenting experiences; and feeling supported with these aspects can be crucial in reducing additional stress.
- Consider whether your perinatal mental health team can have a dedicated ‘link worker’ to liaise with local services, such as IAPT.
- Offer professional training to local services about perinatal mental health, and how to adapt their clinical practice to meet the particular needs of partners and other family members.
- Consider providing public events in conjunction with the local network to promote the needs of partners and other family members.
- Work with universal services to promote the needs of partners and other family members and encourage onward signposting to GP/IAPT if needed. Consider the importance of antenatal appointments providing information about perinatal mental health.
Practice tip: box 15
Supporting families during transitions
- Where possible, support partners’ and other family members’ wishes to be involved in the process of admission to an inpatient setting, even in the case of an emergency admission.
- Where the partner or other family member is involved in supporting the mother to access services, it is helpful for this to be clearly communicated in the mother’s care plan.
- The needs of the partner and wider family need to be considered at discharge planning to ensure they are enabled to continue supporting the mother and baby. If the mother has been on an MBU she may have been receiving a lot of support to care for the baby. When considering and planning discharge, families may welcome information and guidance on how to manage this transition back home and the new level of responsibility they may feel in caring for the baby.
- Partners and other family members appreciate being involved in transition or discharge planning meetings with professionals to discuss transfer of care, the ongoing care plan and everyone’s needs and wellbeing. Good information sharing is crucial at these time-points; facilitating these meetings enables good clinical practice, safety and continuity of care.
- If partners or other family members have been involved in the mothers’ care, invite them to complete evaluation and outcome measures providing feedback on their experience of the service.
Practice examples: Partnership working with voluntary and community sector organisations (VCOs)
VCOs offer opportunities for perinatal mental health services to jointly work, share specialist knowledge and expertise, and signpost families for additional support. Consulting with local community groups helps to better understand the local needs and consider cultural factors which might impact on wider family engagement with mental health services.
These examples show some of the organisations working with mothers, fathers and families experiencing anxiety and depression during pregnancy and up to two years after birth in England.
Dads in Mind: Bluebell Care Trust (Bristol, South Gloucestershire and South Devon)
Dads in Mind is a Bluebell project that employs Dads workers with lived experience of perinatal mental illness to support fathers who are unwell or supporting an unwell partner.
The charity has good working relationships with the local community perinatal mental health service in Bristol.
Together with one of the Consultant Perinatal Psychiatrists they provide a monthly support group evening ‘meet up’ for dads at the Bluebell hub. This partnership enables fathers to access clinical expertise (and further signposting into clinical services if required) as well as peer support.
Fathers can self-refer using a dedicated fathers’ phoneline for one-to-one peer support (offered by phone or face-to- face). Self-report measures of depression and anxiety (EPDS [ref. 47] and GAD-7 [ref. 48]) are used to measure severity of depression and anxiety, which helps identify fathers who may require further support.
Often fathers are signposted to IAPT or other local mental health services. The Dads workers are supervised by a Psychiatrist from the community perinatal service, also supporting the workers to manage any emotional impact of the work.
Acacia Family Support (West Midlands)
Acacia is led by volunteers and staff with lived experience of perinatal or other mental health disorders, providing community-based support.
Acacia’s services include telephone support, group work, individual listening and befriending support, practical help at home and baby massage. Acacia has a fathers’ service offering support to men who are themselves experiencing depression or anxiety or whose partner is experiencing perinatal mental illness. This includes befriending for fathers, delivered by male volunteers over approximately six sessions.
All mothers with a male partner are given a leaflet at their first contact with the organisation, giving information about fathers’ mental health and the fathers’ service.
Using professional interpreters instead of family members promotes confidentiality and allows fathers to build trust with the befriender. The fathers often report preferring to work with someone from a different ethnic and cultural background to their own.
At every contact, fathers are asked to complete self-report measures of anxiety and depression (PHQ-9 [ref. 49] & GAD-7 [ref. 48]) to indicate severity of need and track outcomes. Acacia have developed strong links with GPs and social care, facilitating further assessment of fathers’ mental health needs, onward referrals, and better access to carers’ assessments.
To better understand cultural factors that may impact on engagement with mental health support, Acacia work closely with local communities and regularly deliver cultural awareness training to families, staff and volunteers. They hold community events to share information about perinatal mental health and support. They have positive working relationships with local children’s centres and find engagement is helped by having a focus on family support rather than mental health.
Practice example: Parent-infant mental health
Tameside and Glossop: Integrated parent- infant mental health care pathway
The pathway encourages equal attention to perinatal mental health, infant mental health and parent-infant relationships.
It brings together all services who come into contact with families during the perinatal period, including the Specialist Perinatal CMHT, Tameside & Glossop Early Attachment Service, IAPT perinatal and parent infant mental health and universal services including the voluntary sector, such as Home Start. The pathway has been adapted and refreshed by Stockport and is being rolled out across Greater Manchester.
More details of the pathway and services in Tameside and Glossop are available on the Greater Manchester Health and Social Care Partnership’s website.