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Time for Me – Working with postnatal depression

28th September 2016

This case study is based on a 35 year old female who is a mother of a one year old child – this mother will be referred to a Mrs X.  Mrs X  attended her GP to discuss her low mood, with Mrs X’s consent the GP referred into the health visiting service to support this mother.

Search for health needs-Assessment

Mrs X was offered a home visit as part of the Healthy Child Programme Universal Plus offer – the named health visitor contacted the mother to arrange a home visit. It was clear from the outset that Mrs X had poor eye contact with her baby and Mrs X appeared to look down a lot. In addtion, the home environment was not maintained well.

It was explained to Mrs X what the role of the health visitor is with regards to maternal mental health.  Mrs X was then asked about her history of low mood. She began to explain she had been bullied as a child and this poor mental health led to self-harming behaviours in her teenage years. This was not the case at that time, however Mrs X finds it difficult to build relationships.  A previous abusive marriage had left her experiencing feelings of failure and low self-esteem.  Anxiety and Panic attacks had meant she had not returned to work since the birth of her child.  Poor social networks had led to Mrs X being isolated in her community. Due to this Mrs X did not socialise or meet the social needs of her child. Also she did not wish for her child to attend nursery due to the fact she did not want to be on her own and had social anxiety interacting with other mums.

It was clear that Mrs X needed a mental health assessment. Two different mental health assessment tools were used – the Edinburgh Postnatal Depression Scale (score 12) and Generalised Anxiety Disorder Assessment (score 10).

Stimulate awareness of health needs

The EPDS and GAD highlighted low mood in need of monitoring and support, and high anxiety levels. The results of the assessments were discussed with Mrs X and it was established that this was how she had felt for some time due to isolation and lack of support. It was clear that Mrs X needed to address her own mental health needs to enable her to prioritise her child’s needs, and also to socialise with other mums with similar experiences to increase her confidence and reduce her isolation.

The health visitor was aware of a new service called ‘Time for Me’ that would be perfect to meet all Mrs X’s needs in one. ‘Time for Me’ is a creative group for women experiencing depression and/or anxiety in the antenatal or postnatal period with a child up to the age of 2 years. ‘Time for Me’ provides the opportunity to meet other women with similar concerns, increase self-confidence and self-esteem, and provides a period of relaxation.

Initially Mrs X was reluctant to agree to engage in such sessions due to her poor confidence and lack of childcare; she said ‘ I have never really left my child with anyone else’.  However the health visitor explained to Mrs X she would meet the facilitator of these sessions before the group and childcare would be provided.  After building a therapeutic relationship and providing her with the literature, Mrs X agreed to engage. This would be the first time Mrs X was attending a group of any kind for support.

The facilitation of health enhancing activities

Mrs X attended ‘Time for Me’ sessions on a weekly basis. Mrs X reported she felt supported but not pressured and the group was relaxed, enabling her to talk more freely with peers. Mrs X was also empowered to give herself time out to consider her own needs and away from daily life. She said ‘the best part of it was having time for me, knowing my child was cared for a few doors away, enabling me to fully relax and enjoy the sessions’. Her child also was introduced to the crèche facility which showed Mrs X how independent her child could be and how much she thrived from playing with peers. Mrs X showed the health visitor on her visits the crafts she had made at ‘Time for Me’ classes which were displayed proudly in her lounge and she said ‘It has reignited my passion for art, and I am now considering taking part in community art groups’.

Outcome and Impact

Mrs X feels that attending the ‘Time for Me’ sessions has improved her mood, and increased her energy levels and enthusiasm to play with her child. It has also improved her communication and relationship with her partner, and ‘ I am a lot more open about my feelings now as the group has made me realise its ok to talk about how I feel’.

The socialisation and therapeutic activities have increased Mrs X’s confidence to a level where she now has good eye contact and speaks with confidence. She has begun to socialise with other members of the group outside of the meeting and attends play facilities with other mums. She has started to socialise and gain confidence in building relationships with peers – ‘I have met some lovely mums who I feel understand me’. She has even now taken on a part-time job a few hours a week. All this has led to an improvement in EPDS and GAD scores. Mrs X  has now agreed to a referral for a two-year funded place for the child.

Next steps

The health visitor will still continue to support Mrs X and monitor her wellbeing, and offer support with parenting. However, Mrs X now has the personal confidence to achieve her next goals herself.

Charlotte Keane Health Visitor- Bridgewater Community Healthcare NHS Foundation Trust

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