PATHways to improving perinatal mental health…

On World Maternal Mental Health Day and during UK Maternal Mental Awareness Week 2019, the Institute of Health Visiting (iHV) is delighted to be part of PATH – a newly EU-funded project which will enable women, families and healthcare professionals to prevent, identify and successfully manage mild and moderate perinatal mental health issues.

Becoming a new parent should be an exciting time – however, for up to one in five women this isn’t the case. Perinatal mental illnesses (PMI), such as postnatal depression, are not always recognised and carry a long-term cost to society of £8.1 billion¹ for each one-year cohort of births or approximately £74,000 per mother and child.

This cross-border initiative involves thirteen partners from France, Belgium, the Netherlands and the UK. Partners from the UK include the Health and Europe Centre as the Lead Partner, Plymouth and District MIND, Southampton City Council, Kent County Council, Kent & Medway NHS & Social Care Partnership Trust as well as the Institute of Health Visiting. PATH has been awarded more than €5 million of European funding for this €8.5 million partnership.

Dr Cheryll Adams CBE, Executive Director of the Institute of Health Visiting, said:

“Many mothers suffer from perinatal mental illness following birth and up to a year after, of which a majority may not be receiving all the support they need.

“The PATH project will deliver a multi-media campaign to raise awareness of and de-stigmatise PMI and promote prepared parenting, reaching a total of 600,000 people across the 2Seas area.”

“Through this project we will produce a suite of online resources and face-to-face training for health professionals in order to increase their confidence in recognising PMI symptoms and providing appropriate care for mothers and fathers. Alongside this will be resources for employers, helping them to support the return to work of new mums.”

PATH will prepare parents pre-birth for their new role and help them avoid or lessen the impact of possible PMI. The project will also improve the skills of healthcare professionals equipping them to address PMI confidently and effectively. PATH will innovatively design, deliver and implement new, durable services both online and face-to-face, aiming to increase recognition and prevention of PMI and support new families’ mental wellbeing which will, in turn, benefit their children.

PATH will also develop a new online multi-media international support hub, a course of support sessions for 4000 new families in mixed groups of pre-pregnant/pregnant/parenthood and a ground-breaking new model of holistic family support. This model will include peer supporter training and a network of intergenerational community support groups to increase recognition and understanding of PMI and enable greater community support to new families.

¹ LSE and Centre for Mental Health – The Costs of Perinatal Mental Health Problems Report summary (Oct 2014) – Annette Bauer, Michael Parsonage, Martin Knapp, Valentina Iemmi & Bayo Adelaja

Political parties in Northern Ireland agree landmark maternal mental health Consensus Statement

Despite the stalemate in Stormont, all political parties in Northern Ireland have co-signed a ground-breaking Consensus Statement, drafted as part of the Maternal Mental Health Alliance Everyone’s Business campaign, committing to close the gap in specialist mental health provision for women during pregnancy and the first year after giving birth.

England, Scotland and Wales have faced similar challenges with their specialist perinatal mental health services, but in recent years each have seen significant improvements due to specific and targeted investment. While stakeholders in Northern Ireland have shown support in principal, until now a formal commitment had not been made.

Key facts:

Women and families in 80% of Northern Ireland cannot access specialist perinatal mental health community services and there is no Mother and Baby Unit in Northern Ireland.
All political parties in Northern Ireland have now officially signed a historic statement agreeing to work together to change this.
The Maternal Mental Health Alliance (MMHA) is calling on the parties to unlock urgently needed funding for women and families requiring an inpatient Mother and Baby Unit and specialist community services in every Health Trust.
Untreated perinatal mental illnesses can have a wide range of effects on the mental and physical health of women, their children, partners and significant others.
In severe cases, perinatal mental illness can be life-threatening: suicide is a leading cause of death for women in the UK during the perinatal period.
The economic cost to society of not effectively treating perinatal mental illness far outweighs the cost of providing appropriate services.
If perinatal mental health problems were identified and treated quickly and effectively, these serious and often life-changing human and economic costs could be avoided.

The MMHA – a UK-wide coalition of over 90 organisations including the Institute of Health Visiting – together with 18 Northern Ireland-based organisations, including NSPCC NI and AWARE, welcomes the parties’ commitment to deliver life-saving perinatal mental health services in Northern Ireland.

Read MMHA's full press release

New! Multi-Professional PMH Awareness training for individuals – book now!

We are delighted to offer this rare opportunity to experience our one day PMH Awareness training alongside other practitioners from a variety of professional backgrounds – a wide range of the professional workforce working alongside women and their families perinatally e.g. Health Visitors, Midwives and Maternity Staff, Neonatal nurses, Early Years staff, Mental Health professionals.

Our programme is designed to enhance your own awareness of a wide range of issues associated with perinatal mental health and wellbeing.

Please note: this training is a different format of programme from our Champions training and does not equip participants with training resources to deliver further training does – so it does not support an onward cascade.

Date: Monday 10 December 2018, London

Costs: £80 iHV Members/ £95 Non-members – don’t miss out on this great opportunity!

For more details

Professional bodies and maternal mental health experts welcome report highlighting need for more maternal mental health experts

The Maternal Mental Health Alliance (MMHA), the Institute of Health Visiting (iHV), the Royal College of Obstetricians and Gynaecologists (RCOG), and the Royal College of Midwives (RCM) are delighted the NHS Benchmarking report on Universal Perinatal Mental Health Findings was published on Friday 14 September.

Prior to this study, information on service provision and staffing of universal perinatal mental health (PMH) services was not available at a national level. The study sought to gain an understanding of the extent of PMH provision in universal services across England, supplementing an annual audit of Specialist PMH services undertaken by the NHS Benchmarking Network for NHS England.

The data collected from providers suggested that:

Capacity in universal services is very limited and does not provide the necessary broad base from which the Specialist PMH services can operate effectively and efficiently as a secondary care tier.
The provision of specialist perinatal mental health care within universal services is highly variable across England, with some areas having no, or limited, provision (obstetric & midwifery providers 61%; health visiting providers 30%).

Specialist provision within universal services is necessary to coordinate, inform and support evidence based PMH care across the whole service, and therefore offers a clear reflection of the care women are able to access. The large gap in health visiting PMH capacity was particularly evident, with 70% of providers having no specialist provision within the service.

If we are to deliver on the ambition of the Five Year Forward View for Mental Health, attention must be paid to the full spectrum of need. This report is critical because it focuses on the universal element, where the vast majority of women need to receive their care. Most recognition of mental health problems and risks, most prevention and early intervention, can only be coordinated and provided within universal services. Universal services are therefore a crucial element of the PMH care pathway at every local level and have the potential to create great savings in relation to both human and economic costs in the short and long term.

Dr Cheryll Adams, Executive Director at the iHV, said:

“The Institute of Health Visiting warns that the real state of today’s health visiting support for mothers suffering with perinatal mental illness (PMI) may be significantly worse than that found by the NHS Benchmarking report based on data from 2016, as there have been further cuts to the workforce and the development of a significant postcode lottery of services up and down the country. Health visitors across the country nevertheless continue to strive to deliver an excellent service to children and families, and will do everything in their power to promote good family mental health.”

Alain Gregoire, Chair of the MMHA, said:

“There has been excellent progress in funding specialist perinatal service provision across England, but we know that specialist services alone are not enough. All women in pregnancy and postnatally should have equitable access to the support, prevention and treatment they need for their mental health as much as for their physical health. This report shows that investment is essential to ensure that there are sufficient, well-trained staff across universal services so that women get the care they should expect from the NHS, and our children can get the best start in life.”

Janet Fyle, Professional Policy Advisor at the Royal College of Midwives, said:

“Whilst there is progress in some areas, there is still a lot more to do. Our survey showed that we remain seriously short of specialist maternal mental health midwives and services to support women with mental health problems and needs in the community and in their homes. There is also a need to ensure that all midwives involved in the care of pregnant women receive adequate training, so that they can identify women with mental health problems and refer them appropriately for care and support as required.”

Dr Alison Wright, Consultant Obstetrician and Vice President of the Royal College of Obstetricians and Gynaecologists said:

“Despite maternal mental health being a key priority of the Government, this report shows the extreme pressure faced by obstetricians and psychiatrists, midwives and health visitors who provide perinatal mental healthcare. Healthcare professionals are usually the first point of contact that a woman reaches out to and we must ensure that all staff involved in the care of women during pregnancy and beyond, have the relevant education and training in perinatal mental health. Every maternity unit across the country should have in place a clearly defined care pathway for referring women to local specialised perinatal mental health services which all women can access when needed.”

Collectively, we will continue to push for equitable access to evidence based PMH care for women with mental health problems and their families through robust universal services alongside the development of specialist PMH services – women and their families need both. We support the call for all maternity and health visiting services (and GP services) to be sufficiently resourced, so that all professionals across universal services have sufficient capacity, competence and confidence to deliver top quality proactive mental health care to all families. Furthermore, we advocate that these healthcare professionals should be supported by having lead specialist professionals/Champions from within their respective professions in every organisation.

Download the NHS Benchmarking report on Universal Perinatal Mental Health Findings

Background Information to the report

In January 2017, the NHS Benchmarking Network was commissioned by Health Education England, funded by NHS England, and partnered with the iHV, RCOG and RCM to complete a stocktake of perinatal mental health (PMH) care within maternity and health visiting services. Data collection took place from February to May 2017 and referenced the year January to December 2016. Universal PMH services in this report included obstetrics, midwifery and health visiting.

There was a high response rate from organisations across England, with numbers of responses by service type as follows:

Obstetric services 141
Midwifery services 123
Health visiting services 88

In total, the following specialist practitioners were identified in the study:

Obstetric services = 40.8 WTE (1.3% of total obstetric capacity)
Midwifery services = 228 WTE (1.4% of total midwifery capacity)
Health Visiting services = 60.6 WTE (0.78% of total health visiting capacity)

iHV publishes response to NHS Mental Health consultation

The Institute of Health Visiting (iHV) has published its response to the consultation – Mental Health in the Long-Term Plan for the NHS.

The consultation is to identify opportunities to deliver the NHS’s goal to provide world-class mental healthcare – improving the outcomes for everyone who uses the NHS services.

Dr Cheryll Adams CBE, Executive Director, Institute of Health Visiting said:

“At the Institute, we firmly believe there is no health without mental health, which is why we have perinatal and infant mental health (PIMH) as a priority focus. We welcome the opportunity to respond to this consultation to ensure that all families get consistent, accessible, high quality care and support for their mental health during the perinatal period. Our response reflects the many consultations and surveys we have done with our members and other stakeholders over the recent months and years.”

The Institute’s response includes its top three priorities in mental health:

Resourcing health visiting services through joint commissioning which formally requires health visitors to take a specific lead for perinatal and infant mental health;
Closing the gap between knowledge of what affects child and family mental health, and how services are commissioned and organised to implement this knowledge;
A need to concentrate efforts to create a much wider understanding of the epidemiology of mental illness with so much of it having its origins in the very first years of life.

Dr Adams continued:

“Early intervention for families in the perinatal period will reduce the burden of mental illness across the life-course! We have to get that message over to politicians and policy makers, so that funding is allocated upstream and not disproportionately spent on secondary and tertiary care, fixing problems that could have been prevented from occurring in the first place.

“This submission focuses on how, with the right support from the NHS and partner organisations, health visitors can ensure that all families with children receive the right care and support for their mental health, at the right time, in the right place.”

Download iHV's response to Mental Health in the Long-Term Plan for the NHS Consultation

Download Appendix to Mental Health in the Long-Term Plan for the NHS Consultation

Mental health minister celebrates NHS 70 years with iHV Perinatal & Infant Mental Health Champions

On Thursday 5 July, the Minister for Mental Health and Inequalities, Jackie Doyle-Price MP, celebrated 70 years of the NHS with Institute of Health Visiting (iHV) Perinatal Mental Health Champions and Perinatal & Infant Mental Health Champions in Manchester.

During the celebration event, the Minister heard about the work of the health visitor, with a specific focus on the critical role that health visitors play in preventing mental illness, promoting mental wellness across the life-course and supporting/offering evidence-based interventions to families suffering from perinatal mental illness. She also heard a very powerful presentation from Jane Fisher, a mother with lived experience, on the importance of her relationship with her health visitor as part of her recovery.

Minister for Mental Health and Inequalities Jackie Doyle-Price meeting iHV PIMH Champions in Manchester to mark #NHS70

Dr Cheryll Adams CBE, Executive Director at the Institute of Health Visiting, said:

“5^th July was such a special day for the NHS. We were delighted to celebrate its 70^th year with some of our wonderful Perinatal & Infant Mental Health Champions in Manchester – a very appropriate location as health visiting started in Salford /Manchester in 1862 and there is a long history of Manchester supporting public health improvement. This was a great opportunity to share with the Minister the fantastic and essential work that health visitors and our Champions provide to mothers and their families.

“Perinatal mental health is key for all parents and their families – at the Institute we recognise the importance of this and have a range of accredited training programmes to ensure that health visitors and other health professionals have the correct information knowledge and understanding to support parents and families to promote and maintain their mental wellbeing. On marking the 70^thbirthday of the NHS, I am delighted to announce that the iHV has now trained over 1500 Perinatal & Infant Mental Health Champions – and, if each cascaded their knowledge to only 20 colleagues, then that’s over 30,000 healthcare professionals who have better insight to supporting perinatal and infant mental health – quite amazing!

“This celebratory event shone a light on health visitors and our amazing Champions who play such an important role in helping ensure all children have the best start in life.”

Minister for Mental Health and Inequalities Jackie Doyle-Price said:

“I was privileged to spend some of the NHS’ 70th birthday with such fantastic advocates for the Health Visiting profession.

“They really are our eyes and ears for good perinatal health, and do an important job in supporting new parents and families through a child’s early years. I know they are working under increasing pressures, and expect local authorities to make sure they support health visitors in communities across the country.”

Minister for Mental Health and Inequalities Jackie Doyle-Price meeting iHV PIMH Champions in Manchester to mark #NHS70

Andrea Johns FiHV, Professional Lead Wirral- 0-19 and Cheshire East- Health Visiting, commented:

“I was delighted to see that the Minister was focusing on health visitors on the NHS 70^th birthday. The role of the health visitor is key to improvements in perinatal and infant mental health. Health visitors are highly skilled in identifying mental health issues and work closely with partner agencies to deliver high quality, evidence-based support in the community.”

Melita Walker FiHV, Mental Health Lead, Institute of Health Visiting, added:

“NHS70 for the health visitors who met with Jackie Doyle-Price will be remembered as a day of celebration and hope. It was brilliant to be able to share the great work that health visitors are doing and also have the opportunity to discuss the challenges and think collaboratively for solutions.”

Survey – Fathers’ experiences of maternity services

The iHV is committed to raising awareness of Fathers’ mental health – and we want to share a short survey from the Fatherhood Institute www.fatherhoodinstitute.org and Fathers’ Network Scotland http://www.fathersnetwork.org.uk .

The survey asks first-time fathers about their recent (within 5 years) experiences of maternity services in Britain. We think this is an important issue and hope you can spare five minutes to fill it out yourself (if you are eligible) or share it among friends, family and work colleagues.

So far 750 fathers have already shared their experiences in the survey – it would be great to get more feedback for them – so please do share the survey link.

Go to Father's survey

The closing date is 31 May, and the results will be published in time for Father’s Day on 17 June 2018.

As part of the highly acclaimed iHV Perinatal and Infant Mental Health training offers, the iHV has a one-day Fathers and Perinatal Mental Health Champion training programme for all health and social care professionals

Find out more about the iHV Fathers and Perinatal Mental Health Champions training programme

For further information please contact [email protected]

New MMHA campaign maps launch today!

New maps launched today by the Maternal Mental Health Alliance’s Everyone’s Business Campaign show that pregnant women and new mums in a quarter of the UK still cannot access lifesaving specialist perinatal mental health services, which meet national guidelines.

The Maternal Mental Health Alliance welcomes the encouraging signs of progress seen in some parts of the UK but raises the alarm: there is not progress for all parts of the country at the same rate, meaning right now, women and families still face a postcode lottery.

According to the new data, pregnant women and new mums in 24% of the UK still have no access to specialist perinatal mental health services (rated red on the map). The maps show that whilst many more women now live in an area coloured green on the map, meaning specialist perinatal mental health services are available in their locality, it is unacceptable that so many women and their families still cannot access essential care.

More than 1 in 10 women develop a mental illness during pregnancy or within the first year after having a baby. Women with the most severe perinatal illnesses need to be able to access vital specialist services wherever they live. If left untreated these illnesses can have a devastating impact on women and their families. In the most serious cases, perinatal mental illness can be life threatening: suicide is a leading cause of death for women during pregnancy and one year after giving birth.

When a woman lives in an area where she is able to access specialist services, with a team of trained staff, it can make all the difference to her quality of care, speed of recovery and support both for her and relationships with her baby and family.

Dr Cheryll Adams CBE, Executive Director iHV, said:

“The Institute of Health Visiting is fully committed to supporting the Maternal Mental Health Alliance’s Everyone’s Business Campaign and, as active members of the Alliance, the Institute is delighted to see the progress which has been made to provide access to specialist perinatal mental health services for all mothers.

“It is unacceptable that there is still a lack of parity for mental health in the perinatal period and that suicide is still a leading cause of maternal death. These new maps show that much has been achieved, and the great strides are to be applauded – but we must press on, there is still much to do to turn the map green.

“Women with severe perinatal illnesses require timely referral to specialist perinatal mental health services, and health visitors are crucial – to not only accessing specialist perinatal mental health services, but they also work upstream, often preventing a potential mental health problem becoming a mental health crisis/severe mental illness. Thus, alongside supporting the call for continued funding of specialist perinatal mental health services, the Institute is urging additional investment to ensure there is a confident, competent, capable and committed universal health visiting service at every local level.

“To ensure that every mother (and her family) does indeed, get the right help, in the right place, at the right time, we need properly funded and supported pathways of care at every local level. It is most definitely #everyonesbusiness”

Download the UK map as well as maps for England, Northern Ireland, Wales and Scotland on the MMHA website

Read the MMHA press release

Final call for PIMH abstracts

This is a final call for abstracts for the iHV National Multi-agency Perinatal and Infant Mental Health Conference: The Hidden challenges, taking place in Manchester on 24 April 2018. Abstract submission deadline is tomorrow, Tuesday 13 March 2018!

We’ve received some great abstracts already – why not send in an abstract yourself? Abstracts are welcome in areas of new research and local innovations in the fields of perinatal and/or infant mental health.

We would not want you to miss out on this great opportunity to showcase your work in perinatal and infant mental health (PIMH) – with exciting prizes for best poster/presentation

Abstract Submission and Timeline

The abstract should be no more than 250 words and provide an overview clearly demonstrating excellence, innovation and novel approaches to improve outcomes in perinatal and/or infant mental health.

Please submit your abstract as a Microsoft Word document to [email protected]

Tue 13 March 2018 – Abstract submission deadline

14 – 26 March – iHV peer-review process on submissions

Tue 27 March 2018 – participants informed of acceptance of abstracts for a poster. Full guidance on the poster format will be provided if your abstract is successful.

Tue 24 April 2018 – Poster presentations at the iHV National Multi-agency Perinatal and Infant Mental Health Conference: The Hidden challenges in Manchester.

It is important that you book to secure your conference place on or before the final registration deadline for accepting your offer to present.

Early bird tickets (for iHV Champions, iHV members and non-members) are available until 29 March 2018, so don’t miss them!

Get your abstracts written and submitted – don’t miss out!

For further conference details, programme and to book your place

iHV presents at European Midwives Association annual conference

On 23 September 2017, the iHV was invited to give a presentation at the European Midwives Association’s (EMA) annual conference, this year dedicated to Perinatal Mental Health (PMH). The conference, hosted by the national organisation of Spanish midwives known as Federacion de Asociaciónes de Matronas de España (FAME) in Madrid, was attended by high level representation from 35 European member states.

Melita Walker (iHV Perinatal Mental Health Lead) presented on behalf of the iHV on UK Policy and best practice in Perinatal Mental Health, discussing the UK approach to PMH and national policy and research direction for the UK.

Melita Walker presenting at the EMA annual conference

The conference also heard from Mental Health Europe Director, Maria Nyman, who introduced the European landscape on Perinatal Mental Health, highlighting existing opportunities to further advance the issue at EU level. Presentations throughout the day shared good practice in PMH from across Europe and also the challenges faced by respective nations.

EMA annual conference 2017

Following the formal presentations, Melita joined a working group to think through what the direction of travel should be in relation to PMH and the education and training for midwives. The agreed action from the workshop was that the EMA would develop a position statement on PMH that will enable the mental health of mothers and fathers to be seen as important as physical needs during the perinatal period. There was consensus that PMH should be a “red thread”, running through all midwifery care, not separate, or as an add-on, and that midwifery training should also be designed to integrate mental health alongside physical health.

Melita Walker commented:

“It was a privilege to represent the iHV at this event. The EMA is a fantastic organisation, dedicated to improving outcomes for women and their families. The Institute has worked closely with our colleagues in midwifery services and understands the important role they play in achieving good health outcomes, which is why we have recently developed our Maternity PMH Champions programme. It was wonderful for the iHV to support this event, to share our learning and to contribute to raising parity of esteem for mental health across a huge geographical area. PMH is immensely complex and no one agency can achieve good outcomes alone. It is only by working together, in partnership, that we will realise our collective aspirations for a mentally well society.”

Find out more about our Multi-agency Perinatal Mental Health Champions Training