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Specialist Health Visitors in Perinatal and Infant Mental Health: where they are and what they’re doing.

Maternal Mental Health Awareness Week 2023 (#MMHAW23) focuses on being ‘together in a changing world’. Today’s theme, Tuesday 2 May, offers an opportunity to ‘shine the spotlight on support’ – so what better time for the iHV to shine the spotlight on the unique role of Specialist Health Visitors in Perinatal and Infant Mental Health across all UK nations by giving a snapshot of where they are and what they are doing.

Seven years on from the seminal publication on the role of Specialist Health Visitors in Perinatal and Infant Mental health (Sp HV PIMH) by Health Education England¹ and one year since the follow-on report by Homonchuk and Barlow² made further specific recommendations for these practitioners, the Institute of Health Visiting (iHV) has compiled a snapshot of provision and practice across the UK – Specialist Health Visitors in Perinatal and Infant Mental Health: where they are and what they’re doing.

The good news is that there are now Sp HV PIMH in each UK nation, providing strategic leadership, undertaking pivotal training, education and supervisory functions, influencing service redesign and pathway development, and ensuring robust quality assurance through accurate data collection, analysis and audit. We regularly hear examples from Sp HV PIMH of how they continue to advocate for families and use their position and voice to influence local decision makers to ensure perinatal and infant mental health remains prominent in local policies and the political agenda.

A deeper dive at a regional level, however, reveals patchy provision and inconsistent commissioning arrangements for these specialists, with variations in:

job descriptions
clinical case-loading expectations
training and supervision for the practitioner
where the role sits – within universal health visiting or specialist perinatal and infant mental health services

In addition, the dire shortages in the health visiting workforce need to be urgently addressed by national government to enable Sp HV PIMH and the wider health visiting workforce to deliver clinically and cost-effective perinatal and infant mental health care.

Melita Graham, Head of Mental Health, says:

All families want and deserve high-quality and joined-up care for PIMH problems. This report highlights the unique leadership role that Specialist Health Visitors in Perinatal and Infant Mental Health have contribute to achieving this. Furthermore, it shines a light on how specialist provision within health visiting services offers the opportunity to drive clinically and cost-effective high-quality evidence-based PIMH care across the whole system.

There is still work to be done but much to be celebrated. The leadership and commitment of these pioneering specialist health visitors ensures that families at risk of, and those impacted by, mental health problems have the best chance of receiving timely, high-quality, cost-effective care within health visiting services and beyond, helping to give all babies and young children the very best start in life.

Recommendations

Recommendations from previous reports on Sp HV PIMH still stand², particularly that:

Sp HV PIMH should continue to be commissioned by every Local Authority in England, every Health Board in Wales and Scotland, and every Health and Social Care Trust in Northern Ireland. Such commissioning should include the provision of necessary resources to enable them to work both strategically and clinically
A national set of Perinatal and Infant Mental Health quality standards for Sp HV PIMH, health visiting and health visiting services are needed
The contribution and recognition of the Sp HV PIMH role would be strengthened by the development of credentials for Advanced Clinical Practice (ACP-health visiting)

In addition, this report recommends that:

All services should ensure there is a robust offer of reflective clinical supervision for Sp HV PIMH
Demand-driven workforce modelling with further exploration of workload weighting for Sp HV PIMH is needed to provide a benchmark for safer staffing and ensure equity of provision
Further research into the role of Sp HV PIMH within universal health visiting services compared to specialist services is needed to build a strong evidence base for the NHS and Local Authorities to make the best decisions in designing, commissioning and delivering services in the interests of local people
Further research is needed to support the translation of the evidence from the UK Confidential Enquiries into practice, focusing on public health aspects, inequalities and the Sp HV PIMH role
The health visiting service should be strengthened by national government through sufficient funding, a demand-driven, well-resourced national workforce strategy to ensure that all families receive high-quality, evidence-based support, regardless of where they live

Download report - Specialist Health Visitors in Perinatal and Infant Mental Health: where they are and what they’re doing

References

Health Education England. Specialist Health Visitors in Perinatal & Infant Mental Health. What they do and why they matter. 2016. Available from: https://www.hee.nhs.uk/sites/default/files/documents/Specialist%20Health%20Visitors%20in%20Perinatal%20and%20Mental%20Health%20FINAL%20low%20res.pdf [Accessed 19^th April 2023]
Homonchuk, O. and Barlow, J. Specialist Health Visitors in Perinatal and Infant Mental Health. 2022. Department of Social Policy and Intervention, University of Oxford. Available from: https://spi.web.ox.ac.uk/sites/default/files/spi/documents/media/specialist_health_visitors_in_perinatal_and_infant_mental_health_-_january_2022.pdf [Accessed 19th April 2023]

Oxford University study recommends commissioning of Specialist Health Visitors in Perinatal and Infant Mental Health throughout UK to tackle growing social cost issue

Oxford University has published research examining the training and qualifications of Specialist Health Visitors in Perinatal and Infant Mental Health (Sp HV PIMH), and their role in supporting health visitors and families at risk of /or experiencing mental health problems during the perinatal period.

The report recommends that Sp HV PIMH should be commissioned throughout the UK to tackle this issue, which has an extremely high social and financial cost. Currently, Sp HV PIMH constitute just 0.8% of the health visiting workforce (in England). The Oxford research found that in some areas Sp HV PIMH posts had never been funded, and in other areas the funding had been discontinued or cut – these were cited as the biggest barriers to the promotion of perinatal and infant mental health.

Perinatal mental health issues can have a devastating impact on women and their families, and results in a financial cost of £8.1 billion for each one-year cohort of births in the UK, with 72% of this cost relating to adverse impacts on the child. As such, maternal and family mental health has been designated as one of six high-impact areas for the health visiting workforce.

Abigail Reynolds, a mum with lived experience, shared:

“I was diagnosed with severe Anorexia Nervosa in early 2019, when I was seven months pregnant with my second child. The past three years have been unimaginably challenging, but my health visitor‘s support throughout my illness and recovery has enabled me to rebuild my life, to learn how to care for myself as well as my children – and to believe I am worthy of that care – and to gain the confidence to begin using my personal experience to help educate and support others in both the eating disorders and perinatal mental health areas.

“Health visitors are so well placed within the community, and have a unique opportunity to build trusting relationships with the whole family to support family mental health – they are a vital part of the system.”

The study surveyed 41 Sp HV PIMH and 3 Perinatal and Infant Mental Health Champions, who described their casework as focusing on areas such as parental antenatal depression, antenatal anxiety, general anxiety, birth trauma, postnatal depression and panic attacks, using a range of interventions including listening visits and motivational interviewing amongst others.

Survey respondents reported current barriers to the promotion of PIMH as being a lack of funding (82.3%) and a lack of understanding among commissioners about PIMH (64.7%) and the role of HVs in PIMH (73.5%) – with the discontinuity in funding that has occurred over recent years being perceived to have led to a constant need to reinvent the wheel.

Melita Walker, Head of Mental Health at the Institute of Health Visiting, said:

“We welcome this timely report which clearly sets out the important role of Specialist PIMH Health Visitors. Health visitors have a key role in supporting good family mental health. However, even before the Covid-19 pandemic, there were many system challenges to ensuring that all families had access to the right care at the right time. So this year, more than ever, the time has been absolutely right to have a focus on leadership – the role of the Specialist Health Visitor in Perinatal and Infant Mental Health and how a well-resourced health visiting service, as part of the PIMH system, can maximise the opportunity for good family mental health and wellbeing.

“The timing of this report fits very well with priorities for family mental health and the Government’s recent commitment for PIMH in the last budget. Its recommendations echo what national think tanks, such as the Maternal Mental Health Alliance and the First 1001 Days Movement, are campaigning for and provides policy makers and commissioners with sound evidence to improve family mental health through an effective health visiting service.”

Download Specialist Health Visitors in Perinatal and Infant Mental Health (Sp HV PIMH) Report