What this guide covers and offers

This guide is for specialist perinatal mental health services and commissioners. It relates to the families of mothers receiving care from inpatient and community specialist perinatal mental health teams. This includes partners, grandparents of the baby, siblings of the baby, and any significant others identified by the mother. It covers how to support and involve these family members.

The guide describes underpinning principles and key ideas for what services can do to involve and support partners and other family members, and why this is needed as a result of the impact on the whole family. The actions and practice tips offer suggestions to guide services. The practice examples help to illustrate these ways of working. The majority of points apply to both inpatient and community settings. Some are specific to Mother and Baby Units and this is clearly indicated in the text.

When implementing the suggestions in this guide, teams should refer to their local policies and guidelines, including safeguarding, information governance and data protection, as these differ across services.

“Often we rely on these people within the family to be caring for their relatives or loved ones that are really unwell.

And so it’s one of partnership between services and family members, because we can come home and we leave that person in their house with their family around them to be able to care for them.

So, I think making sure that they’re valued and supported, and understanding the importance of their role within the full care package is vital.”

Practitioner, Yorkshire and Humber MBU and Community team

Why this guide is needed

When a mother experiences a moderate to severe perinatal mental health disorder, the whole family is affected.

  • Partners and other family members have to manage their own worries about the mother, cope with changing relationships, and deal with other people’s concerns and questions.
  • They may be the mother’s main support in the community or following discharge. Mothers who are well supported by their family (especially their partner, but often also the baby’s grandparents) are likely to recover more quickly, and require less input from specialist services [ref. 1].
  • They may take on additional childcare and household tasks, alongside their other commitments. For some, this involves becoming the main carer of the baby or an older sibling for the first time, at a time of considerable psychological stress.
  • Babies require consistent, sensitive, responsive caregivers for healthy brain development. Where a mother’s ability to meet her baby’s needs is impaired by poor mental health, the baby’s psychosocial and emotional development may be protected by positive relationships with other caregivers [ref. 2].
  • If a mother and baby need to spend time away from the family in a Mother and Baby Unit (MBU), this may affect the relationship that partners and other family members develop with the baby.
  • Children in the family may not understand what is happening, particularly if their mother  has  been  admitted to hospital, and may not feel able to tell their parents about their distress.

Some partners and other family members are also dealing with their own mental health difficulties, and this is more likely amongst partners of mothers with moderate to severe perinatal mental health disorders.

Poor mental health can impact on their relationship with both the mother and the baby.

  • The couple relationship is more likely to deteriorate if both parents are ill [ref.3].
  • Depressed fathers (like depressed mothers) are less likely to interact with their babies in an engaged way, which can contribute to poorer child development outcomes [ref. 4].

The national context

The transformation of specialist perinatal mental health services in England is ambitious and world leading. Mothers in every area of England now have access to evidence-based specialist perinatal mental health care.

Research into baby mental health, couple functioning in the transition to parenthood, and the role of social support in the course of perinatal mental health disorders, all highlight the importance of specialist services working with the whole family to support recovery.

The transformation programme has created new roles. Workforce recommendations for a community team include consultant psychiatrists, nurses, psychologists, occupational therapists, nursery nurses, social workers and linked specialist midwives and health visitors, alongside team managers, administrators and peer support workers. This new workforce brings different skills, knowledge and expertise, and opportunities for new ways of working with families.

NHS England and NHS Improvement commissioned this guide to support professionals and commissioners in understanding how to support and involve partners and other family members of mothers accessing specialist services, in line with the NHS Long Term Plan.

Partners, fathers and other family members in policy and guidance documents

NHS Long Term Plan (2019) [ref. 5]: “Offering fathers/ partners of women accessing specialist perinatal mental health services and maternity outreach clinics evidence-based assessment for their own mental health and signposting to support as required.”

Perinatal Competency Framework (HEE, 2018) [ref. 6]: the ability to understand the father/partner’s mental health is a core competency.

Saving Lives, Improving Mothers’ Care (MBRRACE- UK, 2018) [ref. 7]: “Partners and other family members may require explanation and education regarding maternal mental illness and its accompanying risks.”

RCPsych Standards for Community Perinatal Mental Health Services [ref. 8] and RCPsych Standards for Inpatient Perinatal Mental Health Services [ref. 9]: These standards set out criteria by which services can review and improve the service they provide, and include standards around the involvement and support of partners and other family members.