New – Perinatal Mental Health Toolkit launched

A ‘one-stop’ hub of resources to support GPs to deliver the best possible care to patients with perinatal mental health conditions has been launched by the Royal College of GPs (RCGP).

This toolkit is a set of relevant tools to assist members of the primary care team to deliver the highest quality care to women with mental health problems in the perinatal period. As well as offering a diverse collection of resources, the Perinatal Mental Health Toolkit gives details of additional learning for individual practitioners.

RCGP has launched the free-access perinatal mental health toolkit for family doctors and other healthcare professionals, as a go-to collation of resources that could support them to deliver the care their patients with perinatal mental health need.

There is a variety of resources to offer patients from information leaflets, links to supporting charities and social media peer support groups amongst many others. Health professionals may face additional challenges in seeking help for perinatal mental health problems and there a specific section of the Toolkit to address this need.

This resource is a tool developed by the RCGP designed to make the NICE guidelines on antenatal and postnatal mental health more accessible and focused for GPs. It is presented in the form of ten questions to help GPs identify the crucial, but often hidden, signs of perinatal mental health issues in their patients as early as possible to enable them to discuss support and treatment with the woman.

The tool is based on and designed to be used alongside NICE guidelines, and has been approved by NICE. It also aims to reduce variation in the care of women with perinatal mental health problems, many of whom face a ‘postcode lottery’ in trying to access specialist referral and follow-up services.

RCGP Perinatal Mental Health Toolkit

PMH and other trainers required

The Institute is setting up a bank of independent trainers who could be called on to support the iHV training programme from time to time.

If you would like to be considered, please send your CV and a cover letter detailing your experience to [email protected]

iHV welcomes new HEE Guidance on Specialist Health Visitors in Perinatal and Infant Mental Health

The Institute of Health Visiting warmly welcomes the new commissioning and workforce development guidance on Specialist Health Visitors in Perinatal and Infant Mental health (PIMH) – What they do and why they matter, published today by Health Education England (HEE). It concludes that all women and their partners should have access to a specialist health visitor in perinatal and infant mental health (PIMH) and recommends at least one for every health visiting service.

Creating Specialist Health Visitor posts in PIMH within every health visiting service will play a valuable part in reducing the incidence and impact of postnatal depression and other perinatal mental health problems. This will be through earlier diagnosis, better intervention and support – creating savings on child and adult mental health services, and improved public health.

Dr Cheryll Adams, Executive Director of the Institute of Health Visiting (iHV), said:

“The iHV is delighted to endorse this new guidance which provides a framework for improvements in the services that health visitors can provide to families to promote their mental health.

“Through the health visiting ‘universal’ service, health visitors are well-placed to identify those families requiring additional support, especially where the mother (or indeed father) may be suffering from perinatal mental illness, or where the bond between parent and baby may be compromised. However, health visitors have many other roles and responsibilities taking their time during this important period of every child’s life and they would benefit from specialist support in this challenging arena.”

The framework sets out the important role of specialist health visitors in PIMH, illustrates the value to parents and other health professionals involved in a mother’s care and recommends that every woman should have access to a specialist Health Visitor as part of the multi-disciplinary team.

Read the full press release

iHV welcomes new NHSE clinical directors for perinatal mental health

Dr Jo Black and Dr Giles Berrisford have been appointed as the new Associate National Directors for Perinatal Mental Health for NHS England.

Dr Jo Black is Associate National Clinical Director for Perinatal Mental Health for NHS England

Dr Jo Black is a consultant perinatal psychiatrist with Devon Partnership NHS Trust, SW regional representative on the perinatal faculty at the Royal College of Psychiatrists and Chair of the Regional Reps Committee. She has developed an integrated community perinatal mental health service, with perinatal expertise embedded in the three maternity units serving families in Devon.

Jo has experience of working with teams, bringing together clinical, management and commissioning colleagues from primary care, acute and mental health services, women, families and colleagues from the third sector. She looks forward to bringing her energy, experience and ideas to this national role.

Dr Giles Berrisford is Associate National Clinical Director for Perinatal Mental Health for NHS England

Dr Giles Berrisford is the Clinical Lead at the Birmingham Perinatal Mental Health Service at BSMHFT – leading one of the largest inpatient Mother and Baby Units in the country. He is the Chair of the national charity Action on Postpartum Psychosis (APP) – working closely with women and families directly affected by postpartum psychosis – the most severe form of perinatal mental illness. He is the Vice-Chair Elect of the Perinatal Psychiatry Faculty within the Royal College of Psychiatrists and is the West Midlands’ Senate representative for the Perinatal Psychiatry Clinical Reference Group. He is committed to bringing about improved access to maternal mental health services and reducing the unwarranted variation in care currently seen across the country.

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)