17th December 2014
The Institute welcomes the 2014 update of the original NICE Guidance for managing antenatal and postnatal mental health and the contribution it will make to improved early recognition and management of perinatal mental illness.
The iHV is especially delighted that NICE has included the need to support the mother–baby relationship. This is something that health visitors are best placed to do but they will require more capacity to do so well. Currently the iHV is rolling out Infant Mental Health training for all health visitors to strengthen their contribution to this important area for future wellbeing.
We are also very pleased that NICE has endorsed use of the EPDS as part of a fuller assessment of the mother’s emotional wellbeing and the need for holistic assessment.
The iHV is issuing this briefing to help our perinatal mental health (PMH) champions, and health visitors in general, interpret the Guidance in relation to health visiting (HV) interventions. On first reading some aspects seem to suggest that the intervention services they have been trained to deliver are not being supported by NICE despite their method of case finding and holistic assessment being endorsed.
The iHV PMH Champions training was cascaded during the development of this Guidance, and the early indications are that the content of the ‘listening visit’ is consistent with the recommended evidence base and messages in the Guidance. However, it is disappointing that there is little made of the scale of the role that health visitors specifically have in this respect in terms of recognising and managing risk, early intervention and on-going support for mothers. Their contribution as part of primary care low intensity interventions is included in the Guidance, just not given much specific emphasis.
There is an evidence base demonstrating that health visitors, specifically, can both prevent and successfully manage mild to moderate postnatal depression. It is essential that they continue to be commissioned to deliver this role to prevent any further deterioration in the mother’s mental wellbeing before any other treatment becomes available. NICE does not specifically consider the role of any professional group so may not have looked at the evidence from the London School of Economics, for example, on the economic benefits of health visitor intervention at one year in relation to the mother’s quality of life and ability to return to work (Health visiting and reducing postnatal depression (2011) Bauer A, Knapp M, McDaid, D).
Hence this new Guidance, as with all NICE guidance, should be considered in the context of its limitations as well as its very many benefits for improving care. In relation to health visiting practice this NICE Guidance seems to have been inhibited by:
- the availability of sufficient high-quality research evidence e.g. for the role of health visiting and specifically the use of listening visits which were considered to not be well defined or researched
- the generalisability of the available research findings.