In the London borough of Barnet, the NHS and council have worked together to ensure mothers get good support from their dedicated perinatal mental health pathway.
The pandemic has been a difficult period for new mothers. Many of the social networks and opportunities to take new babies to mother and baby activities have been limited.
Barnet’s integrated pathway
Perinatal mental health problems are those which occur during pregnancy or in the first year following the birth of a child. It affects up to 20 per cent of new and expectant mums and covers a wide range of conditions. If left untreated, mental health issues can have significant and long-lasting effects on the woman, the child, and the wider family.
In Barnet there has been a big focus on perinatal mental health since the government published its mental health strategy in 2016, which highlighted pregnancy and the first year after birth as a key priority.
An integrated pathway has been developed involving a range of NHS and local government services. There is significant input from the third sector too with organisations such as the Pandas Foundation and Cocoon Family Support providing their expertise.
Bespoke offers are available for specific groups. For example, the since 2019 Menucha has been part of the pathway. It was set up by a group of Orthodox Jewish women with first-hand experience of postnatal depression and perinatal mental health issues.
Three levels of support
There are three parts to the pathway – green, amber and red. All health and care professional and non-clinical staff who work with mothers have been trained to ask about mental health and refer women on to the most appropriate pathway.
Midwives register pregnant women at children’s centres at the 16-week appointment and from that point on all health professionals – midwives, health visitors and GPs – assess mental health during their contact with the women.
On the green pathway parents are supported by the universal services. These include breast-feeding help, sleep and crying support and the routine child health clinics.
Those identified as having moderate emotional health concerns or possible attachment issues which may negatively impact on the parent-infant relationships and baby’s development are put on the amber pathway.
That means the midwife and then health visitor is accountable and coordinates any support they may need. It could involve talking therapies or help from the wellbeing hub, which includes services such as employment, debt and welfare advice and social prescribing activities.
There is a service called Home Start which involves one-to-one support in the home from volunteers to improve physical and emotional wellbeing. There is also an online wellbeing programme available by smartphone, laptop or tablet.
If evidence of immediate or severe mental health concerns are identified the woman is put on the red pathway. That involves referral to the specialist perinatal mental health service. This is a community-based team. If the woman is in hospital there are dedicated teams in Barnet Hospital and the Royal Free Hospital.
Pandemic has made problems worse
Senior Children and Young People Commissioner Clare Slater-Robins, who chairs Barnet’s perinatal mental health service network, which coordinates the work, said: “Perinatal mental health is complex and does not occur in isolation. It requires a multi-agency response and that is what we have tried to develop in Barnet, bringing together a wide range of partners.
We know the pandemic has been particularly difficult for women who are going through pregnancy or who have just had their baby. The normal networks and activities they rely on have been disrupted.
To continue to support women, some of the services, including Home Start and support from health visitors, were provided remotely. But Ms Slater-Robins said when face-to-face contact was needed this was provided.
She added: “As restrictions have eased more of the face-to-face services have returned, but we are still able to offer virtual appointments. It has become very much a blended offer.”
She said there are now signs of an increase in referrals being made, reflecting how the pandemic has affected the mental and emotional health of pregnant women and new mothers.
To help ensure women get the most timely support, the network of perinatal champions – health visitors, children centre’s staff and GPs – are being given refresher training.
“As we continue our recovery from the pandemic, we know providing the best support we can during the perinatal period will be vital to the health and wellbeing not only of women, but their babies,” Ms Slater-Robins added.
Clare Slater-Robins, Senior Children and Young People Commissioner, Barnet Council