What’s the idea?
Involving partners and other family members in a mother’s care is relevant across the duration of a mother’s contact with perinatal mental health services: triage, admission to the service, during care, at discharge, post-discharge and when transferring between services and settings.
This involvement can take a number of different formats, such as:
- providing information and advice to enable the family member to support the mother
- directly involving the partner or family member in practical aspects of the mother’s care
- inviting family members into therapeutic interventions designed to help the mother overcome her mental health symptoms, using approaches which focus on family relationships and systemic aspects, such as couple-focused interventions or family therapy. For example, NICE recommend couple-therapy as one suggested approach to help overcome maternal perinatal bipolar depression [ref. 14].
“It’s difficult if the partner has to keep working. Many appointments for the woman are in the daytime, so the partner is unable to attend; this means they can end up out of the loop.”
Why implement it?
Involving partners and other family members can help them to provide support and care for the mother, ultimately promoting the mother’s mental health and her ability to care for the baby.
Partners and other family members may be:
- the first to notice a deterioration in the mothers’ mental health
- the first to pick up early signs of relapse
- the main support for mothers following discharge from mental health services.
Building strong partnerships with partners can therefore enable mothers to have timely access to services. Couple-focused work can also help families to address any difficulties in the relationship or communication patterns, helping alleviate maternal mental health difficulties using a more systemic approach.
Actions to consider
If appropriate, work with the partner and other family members to gather their perspective on the mother’s history, to inform a thorough understanding of the mother’s difficulties, and to develop a treatment plan.
Where inviting partners and other family members to take part in family-based interventions, such as family therapy or couple-focused therapy, be open and honest about why this treatment is being recommended. Encourage them to ask questions and help them engage with this treatment model. Work collaboratively with them to set realistic goals for the treatment, taking all perspectives and wishes into account.
Involve partners and other family members in collaboratively developing care plans. This includes:
- how they can support the mother to make informed choices regarding treatment options, such as discussing potential outcomes, risks, limitations and any areas of uncertainty of concern
- ways they can actively support the mother’s recovery such as through adherence to medication or treatment plans, and encouraging sleep, rest and appropriate activities
- how they can support the mother at home when returning ‘on leave’ from an inpatient setting, including discussing the impact this may have on the partner and other family members
- how they can recognise signs of relapse and be actively involved in preventing further deterioration.
Practice tips: box 4
Involving partners and other family members in the mother’s care
- Call or send appointment letters directly to partners or other family members, inviting them to relevant appointments so that they feel welcome and included.
- Consider offering appointments out of hours and in places that may be more accessible, such as children’s centres or at home.
- During appointments, encourage partners and other family members to be actively involved. Invite and listen to their views, and give them the opportunity to ask questions.
- There may be childcare needs. In some cases it may be supportive to invite partners and other family members to bring babies and children with them to an appointment, but this is not always appropriate. They may need support to think about the content of the appointment, and developmental stage of the child.
Practice example: Involving partners and other family members in the mother’s care
Kensington, Chelsea and Westminster Community Perinatal Mental Health Service, Central and North West London (CNWL) NHS Foundation Trust
The multi-disciplinary teams routinely invite partners and other family members to join mothers for their first assessment into the service, and to then participate in ongoing treatment sessions.
In their experience the majority of mothers consent to this, meaning partners or other family members are often directly involved in mothers’ ongoing care, including:
- development of risk management plans
- recognising relapse: discussions around how to recognise signs of relapse and how to respond
- practical ways to support mothers, to prevent relapse or reduce the impact of perinatal mental health disorders. For example, staff discuss with family members how to support mothers to get the sleep they need, by helping to look after and feed the baby during the night. Health visitors may become involved to help partners and other family members feel confident with feeding the baby with expressed breastmilk or baby formula
- participating in couple therapy within a systemic approach.