Institute of Health Visiting welcomes Sport Relief’s focus on maternal mental health

As Sport Relief announces their campaign to raise the profile of maternal mental health, the Institute of Health Visiting (iHV) highlights the vital role that health visitors have in supporting parents with perinatal mental ill-health, yet they currently have insufficient time or capacity for this important task.

Health visitors are the largest public health workforce. Through their delivery of services to every family with pre-school children, they are the best-placed public health professionals to identify, manage and provide early support for mothers and fathers with mild to moderate perinatal mental health problems and to seek early specialist help for those with more serious conditions.

In addition, health visitors are the trusted source of support for families according to research by the Early Intervention Foundation (2015). When parents were asked who they turned to for support, over 60% said their health visitor, closely followed by family and friends.

Dr Cheryll Adams, Executive Director of the Institute of Health Visiting, said: “Although parents will turn to their health visitor for support, often there is insufficient time for the health visitor to do an assessment. In a recent iHV survey, the results showed that 68% of health visitors have seen an increase in postnatal depression over the last two years. However, 1 in 4 health visitors cannot provide every family with a postnatal mental health (PMH) assessment at 6-8 weeks, and 3 in 4 cannot at 3-4 months as recommended by the Healthy Child Programme.

“While these figures have improved from previous years due to the investment in health visiting by the government, they make clear that sustained investment is needed to ensure that every mother has access to prompt help.”

Go to full press release

Dr Cheryll Adams, Executive Director of the iHV

Resources for Parents’ Emotional Health and Wellbeing on #MumTalk day

As Sport Relief’s maternal mental health campaign gets underway today, it’s important to share our Parent Tips on Emotional Health and Wellbeing for Mothers and Fathers.

If you’re a health visitor, please share these with your parents.

Emotional Health and Wellbeing for Mothers

Mood changes, irritability and episodes of tearfulness are common after giving birth. These symptoms are often known as the “baby blues”, which affects 50% of new mothers and usually lasts around 5 to 10 days. More than 1 in 10 women develop a mental illness during pregnancy or within the first year of having a baby.

Emotional Health and Wellbeing for Fathers

Men go through a multitude of complex changes during the transition to fatherhood, making the postnatal period a particularly vulnerable time in a man’s life. Fathers can experience depression in the postnatal period resulting from the different demands placed on them. This is often known as paternal postnatal depression.

iHV at the LGA/ADPH Annual Public Health Conference

“Strengthening perinatal mental health services for families across England using iHV Perinatal Mental Health Champions” is the title of this afternoon’s policy session being delivered by Dr Cheryll Adams, Executive Director of the iHV, and 2 iHV Fellows at the LGA/ADPH Annual Public Health Conference in London, to promote the importance of a universal health visiting service for perinatal mental health.

A health visiting service at 6-8 weeks and 3-4 months is essential to detect postnatal depression and other perinatal mental illness promptly before it has an impact beyond the mother on the child and family unit. Health visitors can do this but only if they are commissioned in sufficient numbers to also follow through with the support the mother/family requires.

Cheryll, together with iHV Fellows Melita Walker and Sharin Baldwin, will share information on the iHV perinatal mental health champions who exist in almost every organisation employing health visitors across England – whose core remit is to ensure all health visitors are trained to the iHV standard for working with mothers and fathers who may be suffering perinatal mental illness.

The iHV has created over 500 Champions, with the total reach of our training being to over 10,000, including many others requiring awareness training in perinatal mental health. These include social workers, children’s centre workers, midwives and many more.

During the policy session, they describe the PMH Champions programme and the many other innovations for health improvement involving the whole multi-professional team around the child and family, including a case study and opportunities for discussion with the audience.

Follow today’s conference on Twitter using #lgacwb

Dr Cheryll Adams, Executive Director, Institute of Health Visiting (chair); Melita Walker, iHV Perinatal Mental Health Officer; Sharin Baldwin, Clinical, Academic and Innovations Lead (Health Visiting), London NW Healthcare NHS Trust

Duncan Selbie, CEO PHE, catches up with the iHV team at the LGA/ADPH conference -3 Feb 2016. From left: Melita Walker, Sharin Baldwin, Stef Watkins, Duncan Selbie, Cheryll Adams, Bonnie Gibson.

Launch of the new framework for specialist health visitors in perinatal and infant mental health

Monday (18 January) saw the launch of the new framework for specialist health visitors in perinatal and infant mental health – we just need to get them funded everywhere now.

We know some of you already hold these posts but its lovely to have a national endorsement about how important they are.

The Framework is not available yet but it’s coming soon from HEE!

New Framework – Specialist Health Visitors in Perinatal and Infant Mental Health – What they do and why they matter

Institute of Health Visiting supports manifesto to turn around children’s lives

The Institute of Health Visiting (iHV) welcomes the cross-party manifesto that highlights the importance of acting early to enhance the outcomes for children. The relaunch of the 1001 Critical Days Manifesto, on Monday 14 December, brings the importance of early years care for children to the forefront of politics ahead of a debate in the House of Commons on Thursday.

The relaunch of this key policy commitment is to achieve better perinatal mental health and stronger attachment between babies and their parents right from the start. The ‘1001 Critical Days Manifesto’ was originally launched in the last Parliament to persuade all political parties to incorporate these measures into their election manifestos.

Dr Cheryll Adams, Director of the Institute of Health Visiting, said: “The Institute of Health Visiting is delighted to endorse the 1001 Critical Days Manifesto. As far as health visitors are concerned, the 1001 Critical Days Manifesto may yet prove to be one of the most important developments of the new millennium. It has created a long overdue focus on the essential first days of life when the blue print for an individual’s future health and wellbeing is laid down. Hence, this period also determines the future health of our society. If we are to manage many of society’s physical, social and emotional health challenges efficiently and effectively, health visitors know that we must start in the first 1001 critical days of life. The fact that government now knows that too will drive health improvements in our society.”

Read the full press release

Relaunch of 1001 Critical Days Manifesto

Relaunch of 1001 Critical Days

iHV briefing for HVs on new NICE Guidance on Antenatal and Postnatal Mental Health

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.

Read iHV briefing for health visitors

To read NICE Guidance (national Clinical Guideline Number 192)

iHV Perinatal Mental Health Conference in association with RSPH – Perinatal Mental Health, a priority for public health

It is now known that perinatal mental illness can have significant long term public health and societal consequences when it goes undiagnosed and without intervention.

This conference is a joint event from the Institute of Health Visiting and their founding partner the Royal Society for Public Health. This conference will consider the effects of perinatal mental illness ante and postnatally on the infant, the mother, the father and on society and how these can be reduced. It will also share some important new national developments in the field which have been designed to reduce its impact. The day will take a public health perspective to a very common condition suffered by at least one in seven mothers.

Speakers

Chair: Dr Cheryll Adams, Director iHV
Sally Russell, Chair iHV
Professor Vivette Glover, Emeritus Professor, Imperial College, London
Dr Alain Gregoire, Maternal Mental Health Alliance
Dr Jane Hanley, President International Marcé Society
Dr Ann Hoskins, Children’s Director, Public Health England
Chris Cuthbert, Head of Strategy & Development for Under Ones, NSPCC
Dan Poulter, MP (TBC)
Emeritus Professor John Cox, Keele University co-developer of the EPDS
Mark Williams, Director, Fathers Reaching Out

Who should attend?

The programme is designed to be of value to health visitors, GPs, midwives, those working in mental and public health and those commissioning these services

Early Bird Special

Book by 10th January 2014 to receive places from as little as £115!

Book via the RSPH website

Online Therapy May Relieve Postnatal Depression, Helping As Many As 30% Of New Mothers

The Medical Daily reports that online support groups exist for a surfeit of mental health conditions including uncontrollable anger, depression, anxiety, loneliness, and kleptomania to name a few. But whether such groups provide anything beyond mere moral support for sufferers remains an open question for science, deserving — as they say — greater empirical study.

Investigators in the United Kingdom reported evidence supporting the effectiveness of online therapy for postnatal depression, a silent suffering affecting as many as 30 percent of new mothers. The study, published in an academic journal, supports work by researchers in Sweden last year showing promise for online therapy in treating general depression, too. Here, researchers at the University of Exeter, with support from the U.K. National Institute for Health Research, found a reduction in depression symptoms — including work and social impairment, as well as anxiety scores — following six months of treatment using a modified online “behavioural action” program supplemented with telephone calls with a mental health worker. Via Netmums.com, investigators recruited 83 women who had recently given birth and met diagnostic criteria for major depressive disorder, splitting them into two groups — one receiving traditional treatment and the other participating in Internet-based treatment.

“The online treatment we are offering via Netmums is the first treatment of this type—specifically designed for postnatal depression,” Joanna Bowler, a representative of Exeter, told Medical Daily. “Netmums.com offers an online chat room for postnatal and antenatal depression that is supported by trained parent supporters who are supervised by health visitors.”

Bowler said that although women with postnatal depression appeared to make heavy use of the website, and perhaps others, many chatroom users reported no local access to treatment, suggesting an unmet mental health care need among the wider population. Still others eschewed available treatment options for lack of perinatal focus or simply to avoid the stigma of mental health problems. “As a result, I paired up with Netmums.com to offer women treatment directly to fill this gap,” Bowler said.

The findings bolstered those of another study by the same research team on a more self-directed version of online therapy, in which 364 women completed a course of treatment, according to lead investigator Heather O’Mahen. “The high number of cases of PND, and the comparatively poor take up of help from those affected by it, are worrying,” she said in a statement. These studies “are the first to investigate the effectiveness of using an Internet-based therapy to provide [mothers] with [postnatal depression] with the support they would have traditionally received in a clinic-based environment.”

Evidence gathered from the two studies proved sufficient to convince the researchers of the feasibility in implementing the therapy on a wider scale. “Our hope is that this will allow more women to access and benefit from support, with all the knock-on positives that come from that: happier families, improved quality of life for [mothers], and a reduction in the demands such [postnatal depression] cases can bring to stretched health services around the world. This treatment is an accessible and potentially cost-effective option, and one that could easily be incorporated into mental healthcare provision.”

Interestingly, many new mothers interviewed for the study professed a strong preference for drug-free forms of treatment, including talk therapy — but found online therapy most convenient of all options.

Sources: Griffiths KM, Mackinnon AJ, Crisp DA, et al. The Effectiveness Of An Online Support Group For Members Of The Community With Depression: A Randomized Controlled Trial. PLoS ONE. 2013.

O’Mahen H. Internet Therapy May Help Postnatal Depression. Psychological Science. 2013.

Link to full article

Mothers and babies missing out on vital support says NSPCC

The wellbeing of more than one in 10 newborn babies in England could be improved if all new mothers with mental illness had equal access to good services, an NSPCC report reveals today. The charity is calling on Health Ministers to lead a drive to address major gaps in access to mental health services for pregnant and new mums.

Mental health problems can begin or escalate when a woman is pregnant or in her child’s first year. They can have a damaging effect on family life, and in the worst cases, impact on babies’ health and welfare.

Evidence shows the vast majority of these illnesses are preventable and treatable, with the right support. The charity recognises there are many excellent services working hard to ensure families get the support they need. However it describes how a lack of focus on mother’s mental health has led to a ‘postcode lottery’ for families, with less than half of mental health trusts having specialist mental health services for expectant and new mums.

Peter Wanless, CEO of the NSPCC, said: “This report clearly shows that with the right services, it is possible to prevent the harm caused by maternal mental illness. But opportunities to help many more families are being missed.

“We have to start treating the mental health of mums and babies with the same importance as their physical health.

“Pregnancy and the first months of a child’s life are critical for their future wellbeing and parents naturally play a vital role. If the Government is serious about giving every child the best start in life it must take action to fill the gaps in services.”

Dr Ian Jones, Vice-Chair of the Royal College of Psychiatrists’ Perinatal Section, said: “Maternal mental health remains a neglected area but is of huge importance and has long-lasting impact on the woman herself, her family and wider society. This NSPCC report highlights the need for specialist perinatal mental health services and the postcode lottery that characterises current provision. We must work to give women and their families the care they require.”