New resource to Support High-Quality Perinatal Mental Health Care

iHV and the Maternal Mental Health Alliance (MMHA) are proud to share a new resource and accompanying evidence to support high-quality Perinatal Mental Health (PMH) Care.

The Institute has worked closely with the MMHA for many years to bring about positive change for the mental health and wellbeing of families and there have been huge strides made, but there is still some way to go:

At least 1 in 5 women experience a PMH problem, making mental illness the most common serious health problem that a woman might experience in the perinatal period.
Suicide is still the leading cause of death for women when looking across the perinatal period.
The 2022 MBRRACE report again highlighted gaps in mortality rates between women from deprived and affluent areas, women of different ages, and women from different ethnic groups.
Evidence continues to show that people, who identify as LGBTQI+, experience prejudice and discrimination generally and within healthcare services which can lead to worse physical and mental health in the perinatal period.

This latest project brought us together to think about how we can support developing PMH systems across all four nations. The changing landscape of how care is accessed and delivered offers an opportunity for systems to come together to support inclusive high quality family mental health care and this is what led to the latest collaboration between the iHV and MMHA. It has led to the iHV undertaking an evidence review, which we feel will be incredibly useful for families, practitioners and services.

The Evidence Review, conducted by the iHV, is is a comprehensive desktop review that brings together key publications, policy guidance, toolkits, research, and reports of families’ and practitioners’ lived experiences. The focus of the review is “what does high-quality perinatal mental health care look like?” for women, birthing people and their families. Key themes and principles emerging from the evidence review are captured in the related resource:

Supporting High-Quality Perinatal Mental Health Care is the new resource drawn from the Evidence Review. It provides a strengths-based action template to enable and inform high-quality care for families impacted by PMH problems – enabling individuals to come together and plan “what good looks like” for them, as practitioners, services, professions, organisations, pathways, networks, and systems. This new resource highlights:

Why improving PMH care is crucial
What good care looks like to both practitioners and families with lived experience
10 principles of best practice

Read MMHA's news story on the launch of these resources

Karen Middleton, Head of Campaigns and Policy, MMHA, says:

“The iHV’s literature review has been incredibly helpful to understand the wealth of information out there on maternal mental health and what action is still needed to ensure high-quality care is available to all who need it. During the review, several recurring themes quickly emerged as well as clear opportunities for learning across the system, as highlighted in the final resource.

“In recent years, there has been a welcome increase in the understanding of the impact of maternal mental health problems. However, many still face huge barriers to accessing essential care. I hope this work will encourage local systems to have collaborative conversations and help them continue to develop services that provide high-quality maternal mental health support for women and birthing people, babies, and families across the UK.”

Melita Graham, Head of Mental Health, iHV, says:

“Family mental health and wellbeing is complex and, whilst individuals, different professions and services can, and do, make a huge difference – we know that by joining the junctions and pulling together we can achieve so much more. Working closely with the Alliance I have seen the power of collective effort and the positive differences this has made. This latest project aims to support all parts of the PMH system to come together, to think together and to act together – we know that when people with a common interest come together, great things can happen!

“The Institute is committed to promoting family mental health and wellbeing, addressing inequalities and driving change. Alongside the MMHA and other partners, we won’t stop until every family, has access to high quality mental health care in the perinatal period. We very much hope that these new resources will enable high quality perinatal mental care irrespective of where a family may live in the UK.”

Download Supporting High-Quality Perinatal Mental Health Care Resource

Download Evidence Review - Supporting High-Quality Perinatal Mental Health Care: What does good look like?

Emotional Wellbeing at Work update

“The iHV Emotional Wellbeing Group was a bit of a lifeline for me during a very challenging period…. I was in effect, firefighting …and feeling completely overwhelmed. Most weeks I entertained thoughts of resigning…. I found the course instrumental in holding me when I was wavering about my ability to do my job. I learned to be kinder and more accepting of myself and in doing so was able to expect that others would do the same. I think the course also empowered me to prioritise the wellbeing of those I care for as well as myself”

(iHV Group Participant)

Prior to the onset of the COVID-19 pandemic, the iHV State of Health Visiting survey 2019 (published in February 2020) had identified that health visitors were already struggling to cope with the demands placed on their stretched services. However, the pandemic escalated this rapidly, and a further paper surveyed 740 health visitors in England – finding that 68% reported their stress levels at work had increased over the past year, 66% feeling more stressed, worried, tense and anxious generally (Conti and Dow, 2020).

There is a well-evidenced link between staff wellbeing and quality of care delivery. The World Health Organization (WHO) highlighted that “keeping all staff protected from chronic stress and poor mental health during this response means that they will have a better capacity to fulfil their roles” (WHO, 2020).

We applied for, and are grateful for, the grant received from the COVID support fund from the RCN Foundation. The funding meant that we were able to offer a new Emotional Wellbeing at Work (EWW) virtual programme, aimed at supporting a number of health visitors in the workforce.

The programme was designed as a series of six group support sessions with five places offered to up to 12 organisations. The groups were facilitated by experienced facilitators and ran between October 2020 and March 2021. The EWW programme methodology mirrors health visiting practice by utilising a range of strengths-based, reflective and restorative approaches. These were outlined in the Journal of Health Visiting (Development of the Emotional Wellbeing at Work Virtual Programme to support UK health visiting teams – Baldwin, Stephen, Bishop and Kelly – December 2020). 58 practitioners in total attended the programme, including health visitors from organisations in Wales and Scotland.

Emotional Wellbeing at Work

The overall aim of the EWW programme was to improve staff wellbeing by reducing their levels of stress and anxiety, helping them gain and/or maintain a sense of control and professional self-worth, and providing support to build capacity to cope better with work demands through six facilitated group sessions. Findings from the preliminary evaluation demonstrated positive outcomes in relation to these aims (Baldwin et al, 2020). A further paper outlining in full the early evaluation findings has been accepted for publication in Primary Health Care Journal and is expected to be published in the later Spring.

The iHV has subsequently received additional funding from a separate application to the COVID Healthcare Support Appeal (CHSA), with the aim to improve sustainability and reach of the programme by developing and implementing a “Champions” cascade model. This brand new and exciting Emotional Wellbeing at Work Champions training is due to start in June 2021.

Please contact [email protected] for more information

RCN Foundation funds iHV programme to support the emotional wellbeing of health visitors

The RCN Foundation has awarded £48,300 to the Institute of Health Visiting (iHV) to develop a programme to promote emotional wellbeing at work for small groups of health visitors (HV) working in the community during the COVID-19 pandemic.

The work of HVs has been impacted by COVID-19 in many ways which create additional work-related stress. HVs are seeing significant increases to the numbers of children and families they are responsible for and much of their work focuses on the most vulnerable and disadvantaged families in our communities; those who have been hardest hit by the current pandemic. HVs describe feeling anxious and unsettled by the rapid pace of change, loss of control, sense of professional self-worth, and the wider impact of COVID-19 on many aspects of their practice.

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

“The past six months have been some of the most challenging in memory for health visitors. We are thrilled to now be able to offer them some direct virtual support through this exciting programme. On theirs, and our behalf, we would like to extend our warmest thanks to the RCN Foundation for their support to make this happen.”

This pilot project seeks to address how best to support health visitors adapt to the demands and pressures they are facing as a result of the pandemic, whilst also supporting their mental health and wellbeing and trying to reduce the impact of work-related stress, so that they can continue to support families effectively.

Twelve organisations and sixty practitioners will take part in the pilot programme which begins in October 2020, with findings expected in early 2021.

Deepa Korea, RCN Foundation Director, commented:

“The RCN Foundation is delighted to have awarded funding to this important pilot programme, which will support the emotional wellbeing of health visitors during the COVID-19 pandemic. There is a well-evidenced link between staff wellbeing and quality of care delivery and so it is vitally important that we look at ways in which we can continue to support the nursing community in these challenging times, as they support families and communities across the UK.”

The project forms part of the RCN Foundation’s programme of work and support in response to COVID-19 which has, to date, supported more than 2,800 nursing and midwifery staff.

Emotional Wellbeing at Work Support Sessions for HV Teams

Update 5 October: the call for applications is now closed as we progress towards delivery of the sessions. We have received high interest from organisations across the country. There will be a further call for interest to participate in Phase 2 (to be delivered Jan – March 2021) at the end of November 2020.

We are thrilled to share that RCN Foundation has awarded funding to enable us to develop and deliver a programme of brand-new virtual support sessions to health visiting staff.

Our emotional wellbeing at work support sessions are for small groups of health visitors (HVs) and HV staff working in the community.

Recent research has highlighted the impact of COVID-19 on the wellbeing and mental health of health visiting staff:

68% of respondents reported stress levels at work have increased over the past year
Of these 37% reported they would leave their posts if they could

“The impact of working during the COVID-19 pandemic on staff wellbeing cannot be underestimated – a proactive plan is needed to ensure staff have the right support during the restoration of services and to create high quality workplaces for all staff in the future”.

Conti & Dow, Sept 2020 – The impacts of COVID-19 on Health Visiting in England

“Health and wellbeing of (health visitors) are essential to the quality of care they can provide for people and communities, affecting their compassion, professionalism and effectiveness”.

The Kings Fund, Sept 2020 – The Courage of Compassion: Supporting nurses and midwives to deliver high quality care

Who are the support sessions for?

We invite applications for places from health visiting services from across the UK nations, on behalf of their practitioners, who will be representative of the whole health visiting workforce regardless of grade or rank, gender/sex, race/ethnicity etc. Ours is an inclusive approach with an aim to acknowledge and meet everyone’s individual needs, using a sensitive approach to ensure the sessions are accessible to all.

What is the aim of the support sessions?

The overarching aim is to create a bespoke programme co-produced with health visiting teams to meet the needs for emotional wellbeing of the workforce at this current time – through provision of:

A safe forum for practitioners to acknowledge and reflect confidentially on pressures created by the ongoing pandemic and to explore any impact on emotional wellbeing at work
Protected time for practitioners to explore new approaches to promote reflection on practice and to develop skills in sharing thoughts and feelings via innovative virtual group formats
Space for practitioners to consider a range of innovative strategies that may be helpful in promoting emotional wellbeing at work
The opportunity for practitioners to devise and review their own personal action plans to support their emotional wellbeing at work

What is included in the support sessions?

The support sessions are a series of 6 innovative workshop-based interactive discussion group sessions. The content of the workshops and discussions will be person-centred and participant-driven but may include:

appreciative enquiry strengths-based discussions
solution-focused coaching methods
emotional containment or restorative supervision styles (e.g. Wallbank, 2016)
the use of mentalising stances (e.g. Fonaghy et al)
the sharing of emotional wellbeing strategies (e.g King, 2016)

Note:

The virtual emotional wellbeing at work sessions provided by the iHV do not replace an organisation’s responsibility for the provision of safeguarding and managerial supervision.
The sessions are underpinned by robust governance processes with protocols in place for managing confidentiality, with an escalation process to flag concerns and enable further discussion outside the group should this be required.

What is the commitment to the support sessions?

We are looking for organisations wishing to offer the opportunity to 5 practitioners who will attend an online programme of 6 x 2-hour emotional wellbeing workshop sessions on a Wednesday or Thursday.

Participants must be willing to commit to attending all sessions and be supported by their managers to prioritise their attendance. They need a private space and access to the Zoom platform.

Each workshop will be delivered virtually by iHV expert facilitators to a small group of up to 10 total participants, providing the opportunity for high quality sharing and learning with and from each other.

Participants will share useful strategies learned with their colleagues and provide feedback to shape future sessions and support evaluation of the programme.

Sessions:

Wednesdays – am or pm
Thursdays – am

Starting week commencing 19^th October 2020 – time of session to be confirmed on approval of participation

Length of programme: A total of 6 support sessions will be provided to each participant – October 2020 – January 2021

Location: Zoom platform (secure password-enabled sessions sent directly to participants)

Cost:

We can offer this opportunity free of charge to organisations wishing to take advantage of this programme due to the grant funding kindly provided to iHV by RCN Foundation.
Please note that delivering these sessions is not without cost and we do ask for participants able to commit to attending their place/sessions offered for this limited opportunity.

Calls for expressions of interest in your organisation participating are now closed.

Update 5 October: the call for applications is now closed as we progress towards delivery of the sessions. We have received high interest from organisations across the country. There will be a further call for interest to participate in Phase 2 (to be delivered Jan – March 2021) at the end of November 2020.

iHV co-signs letter to Prime Minister to act now to improve babies’ wellbeing

At the start of Infant Mental Health Awareness Week, the leaders of nearly 80 organisations, including the Institute, have signed a letter to the Prime Minister calling on him to make the youngest children a national priority in order to mitigate the secondary and potentially long-term impact of the COVID-19 crisis.

Dr Cheryll Adams CBE, Executive Director iHV, said:

“Health visitors have seen at first hand the impact of COVID-19 and the lockdown on new families, and therefore support this important call for much more attention to be placed by government onto the earliest days. There is no other time in the lifespan where investment will save so much on later fiscal spend. It is not only the right thing to do, it also makes sound economic sense and we hope that the prime minister will want to support this call.”

The letter from the First 1001 Days Movement argues that, as politicians decide on COVID-19 relief and recovery packages, there is an opportunity now to invest in the wellbeing of babies and toddlers and the parents that care for them, as part of efforts to build back a better Britain.

The signatories, which include major children’s and mental health charities and professional bodies who are all part of the First 1001 Days Movement, ask the Prime Minister to champion a cross-government strategy for improving outcomes for all children. This should set out a vision for how families will be supported to recover from the impact of COVID-19 and how the Government will begin to ‘level up’ and close gaps in outcomes which have widened during the pandemic.

Download First 1001 Days Movement letter to Prime Minister

iHV welcomes RCPCH State of Child Health 2020 report

iHV welcomes today’s publication of the Royal College of Paediatrics and Child Health (RCPCH) report, State of Child Health 2020, the largest ever compilation of data on the health of babies, children and young people across all four UK nations.

The report shows that for many measures of children’s health and wellbeing, progress has stalled, or is in reverse – something rarely seen in high income countries.

Across most indicators, health outcomes are worse for children who live in deprived areas. Inequalities in some outcomes have widened since the last State of Child Health report in 2017. Progress has also been seriously affected by deep cuts to local authority budgets – used to finance public health initiatives and community services.

Commenting on the launch of the State of Child Health 2020, Dr Cheryll Adams CBE, Executive Director of the iHV, said:

“The results of this report make very sad reading. They build on the evidence base from the recent Marmot 10 years on report and our own latest published research with the health visiting workforce. The State of Child Health 2020 recommendations are excellent and now need to be implemented by ministers. You don’t get a second chance with children – those most disadvantaged today, will be drawing disproportionately on health and wellbeing services tomorrow.

“If the government has any ambition to leave the country in a better place than it was in when they picked up the reins, they must listen and respond quickly to all these recent reports. Our most vulnerable citizens are becoming more vulnerable and only government can change that. Children really can’t wait. Already, many children face uncertain futures as their families haven’t received vital support during their early years.

“It is positive to see health visiting identified as a solution in the RCPCH report. Yes, it is a solution, but very urgent action is required to reinvest into public health before the implications of not doing so become even more stark.”

State of Child Health 2020 brings together 28 measures of health outcomes, ranging from specific conditions – such as asthma, epilepsy, and mental health problems – to risk factors for poor health such as poverty, low rates of breastfeeding, and obesity.

The authors make a number of policy recommendations for each nation. For England, these include:

Introduce a cross-departmental National Child Health and Wellbeing Strategy to address and monitor child poverty and health inequalities.
Restore £1 billion of real-terms cuts to the public health grant for Local Authorities.
Ensure future investment in public health provision increases at the same rate as NHS funding and is allocated based on population health needs.
Implement in full commitments from the prevention green paper, Advancing our health: Prevention in the 2020s.
Implement commitments to provide a Youth Investment Fund, with protection of the committed £500m funding.
Provide health-based support for children throughout education, including funding for increased numbers of school nurses and school counsellors.
Provide renewed investment in services for children and families, which support the child’s school readiness.
Ensure that health visiting services are protected, supported and expanded with clear and secure funding.

Go to RCPCH State of Child Health website for more information

Health visitors’ fear for children’s wellbeing due to relentless service cuts

Public health budget cuts have left health visiting services unable to offer the minimum level of support in many areas

Many health visitors across England have been robbed of their ability to protect vulnerable families by devastating cuts to public health budgets. That is the headline finding of an annual survey of health visitors in England, published today by the Institute of Health Visiting (iHV), alongside calls to ring-fence new funding for the profession.

Released just days after the Duchess of Cambridge highlighted the importance of a secure childhood for future health and wellbeing, the iHV State of Health Visiting survey indicates that those professionals best placed to help children get the best possible start in life lack the resources to do so.

Official figures indicate that around one in five health visitors were lost between 2015 and 2019 – the full-time equivalent of 18% of the workforce. This is due to public health budget cuts and the failure to protect health visitors’ preventative role by many cash-strapped local authorities, after health visiting commissioning moved from the NHS to local authorities in 2015.

The consequences can be devastating, with 48% of health visitors saying they feel so stretched that they fear a tragedy where they work.

As one health visitor told the iHV: ‘Larger caseloads and fewer staff mean families are not getting a tailor-made service to meet their needs. Vulnerable children are slipping through the net.’

Almost a third of health visitors report they are now responsible for between 500 and over 1000 children. Meanwhile, the iHV considers the optimal maximum to be 250 children in order for health visitors’ work to be fully effective, less in areas of high vulnerability. Consequently, 58% of health visitors are working long hours and feeling ‘worried’, ‘tense’ and ‘anxious’.

One health visitor said: ‘I have taught myself to become numb to what is happening within health visiting – as a coping mechanism.’

The iHV is calling for urgent action to address this crisis – before more damage is done.

Dr Cheryll Adams CBE, Executive Director of iHV, said:

“It is absolutely unacceptable that many families are struggling through the significant demands of early childhood without the vital support that they need and are entitled to through the government’s flagship Healthy Child Programme. Indeed, the government’s pledge to give every child the best start in life has been left in tatters after year-on-year cuts to the public health grant, which have dismantled the health visiting services designed to support them in many areas.”

The Institute is calling for:

New ring-fenced cross-government funding for early intervention and the health visiting profession.
Statutory protection for the health visitor role in leading the delivery of the Healthy Child Programme and for health visiting to be returned to statutory regulation.
Workforce modelling and a new workforce strategy for health visiting.
A new focus on improving the quality of services which health visitors can offer families, regardless of where they live.

Dr Adams continued:

“Our survey indicates that health visitors have seen rising demand for support from families, almost certainly related to austerity. Meanwhile, they themselves have battled with ever increasing caseloads, due to the fall in health visitor numbers. It was particularly disturbing that one in four health visitors told us that they are seeking professional help from a GP or elsewhere, due to the demands of their job.”

“Health visitors worry about children being at risk and there is no doubt that their stress levels directly related to them feeling unable to deliver the quality of service that they know they can – and should be able to – offer, as well as the fear of children’s needs being missed. Our children are our future. They deserve much better than this.”

The headline findings of the iHV State of Health Visiting survey are:

Only 21% of health visitors rated the quality of care that they can now offer families as ‘good’ or ‘excellent’.
48% of health visitors said they feel so stretched that they fear a tragedy where they work. This is up from 23% in 2015, which even then suggested a profession under pressure.
29% of health visitors are now responsible for between 500 and more than 1000 children.
While in 2015, 65% of health visitors were able to offer continuity of carer to all, or most, families, by 2019 that number had fallen to just 35%. Continuity of carer has been shown to be greatly valued by parents and health visitors, as it allows them to build a trusting relationship and gives parents confidence to ask for help.
58% of health visitors reported that they are working longer hours and are feeling worried, tense and anxious.
36% of health visitors said they would leave health visiting if they could.
Despite being mandatory, only 34% of health visitors reported that they were able to offer an antenatal contact to families.
81% of health visitors reported that they are not conducting 12-month reviews of children and 90% were not completing the 2 to 2.5-year review. This directly contradicts government’s call to reduce the language gap. These essential checks are most frequently delegated to more junior members of staff. This means that many families will not see a health visitor after their infant is 6-8 weeks old – especially with the closure of many child health clinics alongside the cuts to health visiting numbers.

Download State of Health Visiting in England: Results from a survey of 1040 practising health visitors

Find out more about Our Vision for Health Visiting

New publications on fathers’ mental health and wellbeing

iHV Fellow, Sharin Baldwin, publishes Systematic Review on First Time Fathers’ Mental Health and Wellbeing and accompanying editorial on the importance of men’s mental health to coincide with International Men’s Day (19 November) – a worldwide celebration of the positive value that men bring to the world, their families and communities.

They both are open access publications.

Sharin Baldwin

Systematic Review on First Time Fathers’ Mental Health and Wellbeing

The findings from the systematic review on first time fathers’ mental health and wellbeing revealed that fathers wanted:

More guidance and support to prepare them for parenthood, specifically to better prepare them for subsequent relationship changes with their partner
Access to tailored information and to be equally included in consultations and contacts with relevant health professionals.

Go to Mental health and wellbeing during the transition to fatherhood - a systematic review of first time fathers’ experiences

The synthesis of the international evidence has important implications for healthcare professionals working with families in the early years, with particular reference to the need to consider the mental health and wellbeing of mothers and fathers. The review also highlighted that healthcare professionals need a greater understanding of the dilemmas and challenges that new fathers face to better support their mental health and wellbeing during this crucial transitional period.

Evidence from our systematic review adds further support for an urgent review of how we plan, provide and resource maternity and early years services, in order to recognise the impact that pregnancy and birth may have on a father’s mental health, as well as the essential role fathers play in supporting their partner and infant. If the aim of health research is to improve outcomes through the implementation of evidence and use of evidence-based practices, we should ask ourselves why barriers persist to address and recognise paternal mental health needs. Now is the time to use this evidence to change practice towards supporting both parents and provide more equitable care and use of resources.

Editorial piece on the importance of men’s mental health

Editorial: Mental health of first time fathers – it's time to put evidence into practice

Further information

For further information on Sharin’s research, please see her study website.

Sharin Baldwin RN, RM, RHV, QN, FiHV, HV Research Champion, BSc (Hons), PG Dip, MSc

NIHR Clinical Doctoral Fellow, King’s College London

Clinical Academic for Community Nursing, London North West University Healthcare Trust

MPs launch inquiry into impact of social media on young people’s mental health and wellbeing

The All-Party Parliamentary Group (APPG) on Social Media and Young People’s Mental Health and Wellbeing has today (29 June 2018) launched an inquiry to establish what actions must be taken both to tackle the negative impacts of social media use, and to maximise the positives for young people.

The inquiry aims to build on the work of the Royal Society for Public Health (RSPH)’s 2017 report, #StatusOfMind, which found that although social media use has many potential positives for mental wellbeing, such as maintaining friendships and providing a source of emotional support, for young people the impact is primarily negative, fuelling feelings of anxiety, depression, and ‘fear of missing out’.

Polling conducted by RSPH in April 2018 on behalf of the new APPG found that more than half of the UK public (52%) say not enough is being done by social media companies to address the impact of social media on mental health and wellbeing, with two in five (41%) also saying the Government is not doing enough. Four in five (80%) say tighter regulation of social media companies is needed, with almost half (45%) saying this should be done through a self-regulated Code of Conduct, and more than one third (36%) saying it should be legally enforced by Government.

The APPG’s inquiry aims to determine what should be contained in any such Code of Conduct, and how it should be enforced. It will also seek out and recommend other progressive and practical solutions that can help maximise the positives and mitigate the negatives of social media for young people.

The inquiry will be open to receive written and recorded evidence until 13 August 2018, with a number of oral evidence sessions to be held in Parliament in the autumn. The APPG hopes to engage with expert stakeholders including academics, charities, government officials, social media industry representatives, parents and young people themselves, in order to answer four broad questions:

What is the latest evidence of the impact of social media on mental health and wellbeing?
What constitutes a ‘healthy’ and beneficial relationship with social media for young people?
What should be done by government and by the social media industry to address these issues?
What solutions can be provided in terms of technological innovation and education?

Organisations and individuals interested in submitting evidence to the inquiry should download the Call for Evidence from the APPG website at www.rsph.org.uk/socialmediaappg.

Download Call for Evidence

LGA report: Health and wellbeing in rural areas

This report from the Local Government Association (LGA), produced in partnership with Public Health England, highlights the specific needs and challenges for health and care provision in rural communities. The report includes case studies showcasing the ways in which local authorities in England are tackling health inequalities, improving access to services and building up community resilience.

Read LGA report: Health and wellbeing in rural areas