Principle 1: ‘Think Family’

The expansion of specialist perinatal mental health services as a result of the NHS transformation programme provides an opportunity for services to embrace a ‘Think Family’ approach. For some services this might involve building on existing ways of working. For others adopting a ‘Think Family’ approach will require a change in their underlying ethos of practice to be consistently family-inclusive.

‘Think Family’ [ref. 10] means that services:

• consider the mother in her family context
• think about the people who use their services as parents, and consider the needs of the whole family
• hold in mind that what affects the parent will affect the child, and what affects the child will affect the parent
• consider ways in which they can involve family members in the mother’s care and support family members as individuals, as partners/relatives to the mother, as parents/relatives to the baby.

Principle 2: ‘The Perinatal Frame of Mind’

The ‘Perinatal Frame of Mind’ is at the core of the Competency Framework for Perinatal Mental Health Professionals (HEE, 2018) [ref. 6], which sets out components of best practice when working with mothers and their families at every stage of perinatal care.

The Perinatal Frame of Mind means thinking about the needs of multiple family members and, specifically, the ability to be aware of:

• the father/partner’s mental health and how this affects the mother and baby
• how the pregnancy affects the father/partner and other family members’ mental health and wellbeing
• how the absence of a partner or lack of support from the family may affect the mother, baby and mother-baby relationship.

Principle 3: ‘Stay Curious’ – inclusivity

Our understanding of family is shaped by our own experiences, family structures and family roles.

The definition of family may encompass different family structures, with diverse experiences. These may include:

• single parent families
• separated parents
• same-sex or same-gender parents. The gestational parent may not be the biological mother, and/or each may have been gestational parents of different children in forming the family
• more than two parents being identified by the family
• families where the gestational parent is a father
• families affected by perinatal loss
• families whose older children have been taken into social care, or whose baby will be going into care after birth
• parents who have themselves been or are currently in care
• siblings with different parents, including older children living with an adult who does not have parental responsibility
• close friends
• multigenerational households.

Staying curious means thinking inclusively about family formations, and being opened minded about who may be important to the mother.

This means being aware of:

• cultural considerations, such as how the family’s culture views perinatal mental health disorders and services, and the role of men and fathers within the family
• cultural assumptions in professionals, who may need support in recognising and reflecting on their own unconscious biases
• cultural competency training to challenge cultural assumptions and unconscious biases about which family ‘should’ be involved with a mother and baby.

Working in this way is also important for addressing inequalities. Minority groups face increased vulnerability to perinatal mental health disorders and barriers to accessing services.

Consultation with stakeholders highlighted the importance of inclusivity, for example, in relation to Black and Minority Ethnic parents, LGBTQ parents, and to lone parents.