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Perinatal Mental Health: Development of a new care pathway by Steph Griffiths

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In Liverpool Community Health and NHS Sefton, health visitors felt that a lot of time was being taken up by mental health difficulties took up a great deal of their time, but there was no standardised assessment or monitoring process in place. We had no clear referral pathways to other services apart from to the GP – which wasn’t really adequate or effective due to lack integrated services and support for mothers.

Developing an effective and evidence-based Peri-natal Mental pathway was something we therefore felt was a high priority – not just for ourselves, but supporting other agencies as well.

While there is growing body of evidence around the link between poor maternal mental health and outcomes for children and Peri-natal Mental Health now forming one of the six high impact areas to support evidencing of the impact and difference health visitors make to this issue, we knew that without a proper pathway in place that all service signed up to, we would not be able to make a real difference in the lives of these mothers and their children.

Importantly we wanted this pathway to reduce a lot of the stigma attached to maternal mental health issues. Many still believe their children will be taken away if they admit to problems and for those first time mums, there is the added feeling they should be able to cope and this would be admitting weakness. We wanted to dispel this myth and ensure families felt they would be supported as a key in the design and aims of the pathway.

The aims therefore were straight forward we wanted to develop a peri-natal pathway for women as an integral part of the Healthy Child Programme; ensure the pathway would be accessible by the increasing number of migrant families; identifying training needs for HV staff to implement the pathway effectively and to work with Intelligence and Performance Teams to examine how we could capture meaningful data on the prevalence of mental health difficulties.

Moving the project forward took a little more time and was a ‘little’ more effort!

While we took the lead, we also included Psychologists from Children’s and Adult Services and service users to come together with us and look at the development of a pathway for all health visitors to follow. This in itself was a complex exercise but key to ensuring buy-in across the numerous services involved.

And that was just the start of the journey where we encountered and navigated a number of challenges from a wide variation in practice existed due to the lack of a standardised pathway, which meant that individual practice flourished and women received different care depending on which HV they were under to trying to work on too large a scale across different agencies.

However in the end, we developed a maternal mental health pathway for the care of women in the peri-natal period (defined as that period from conception to when the child is one year old). It provides a seamless pathway from HV services through to specialist services and tackles the variations in mental health assessments and interventions for new mums across NHS Sefton and Liverpool Community Health.

It is evidence-based – based on NICE guidance (CG45) and the Department of Health (DH) requirements for all new mums to have a post-natal depression assessment by 12 weeks post-delivery.

But importantly it is based on what mothers need and how we, as health visitors really do have a leading role in delivering improved outcomes for young children and their families both now and into the future.

Steph Griffiths is a Health Visitor Team Leader in Sefton

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