Informing Perinatal Mental Health Services
SERVICE MANAGERS
Organisational aspects
How the organisation and services are designed can impact implementation of perinatal mental health services, and women’s access to care.
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Co-location of services.
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Adequate workforce provision.
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Collaborative working across services.
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Assessment and referral processes.
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Collaborative working within services.
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Training.
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Supervision.
Co-location of services
Location of the service including co-location of different services within the same building may be a facilitator to care.
"Another community resource that women mentioned as an enabler for seeking help …was having a comprehensive medical care system, offered at well-baby clinics, which met their own and their baby’s physical, psychological and emotional needs."
Evidence level: Low
Parts of the care pathway affected: Deciding to consult, Access to treatment, Provision of optimal treatment.
Key literature:
Collaborative working across services
Collaborative working across services can be a facilitator to care, whereas no collaborative working across services is a barrier.
"I think [referrals] are dependent on the nurses … Some nurses refer more than others. It all boils down to the amount of interaction the nurse has with the social worker and how much she/he believes in the ability of the social worker."
Evidence level: Moderate
Parts of the care pathway affected: Assessment, Referral, Access to treatment, Provision of optimal treatment, Women’s experience of treatment.
Key literature:
Collaborative working within services
Collaborative working within services can be a facilitator to care, whereas no collaborative working within services is a barrier.
"Midwives had concerns that not all women were referred appropriately, but with support from one another, this situation was rectified: ‘if someone finds that there’s something that hasn’t been enacted properly, then they would always do something about it’".
Evidence level: Moderate
Parts of the care pathway affected: Assessment, Referral, Provision of optimal treatment.
Key literature:
Adequate workforce provision
Employment of an adequate workforce to meet women’s needs and to ensure health professional’s have an achievable workload is a facilitator to care, whereas insufficient workforce is a barrier.
"I’d like to do a lot of things, but time dictates that there’s only so much one can do".
Evidence level: High
Parts of the care pathway affected: Assessment, Referral, Access to treatment, Provision of optimal treatment.
Key literature:
Assessment and referral processes
Clear assessment and referral processes with an organisation can be a facilitator to care, unclear processes can be barrier.
"We have to send the form; the patient has to ring to say did you get the form and I am now confirming that I am going to go and then they get an appointment, for someone who is very distressed and you are asking them to jump through hoops".
Evidence level: Moderate
Parts of the care pathway affected: Assessment, Referral.
Key literature:
Training
Provision of high quality training for all professionals who come into contact with perinatal women is a facilitator to care. No training, or poor training is a barrier.
"I’ve never received any formal training in this area. I do not feel adequately trained to detect postpartum depression."
Evidence level: High
Parts of the care pathway affected: First contact with health professionals, Assessment, Referral, Provision of optimal treatment.
Key literature:
Supervision
Supervision for health professionals may be a facilitator.
"...Discussing it with the supervisor gave us the clarity and also suggestions if we need to do it differently in our next session."
Evidence level: Very low
Parts of the care pathway affected: Assessment, Provision of optimal treatment.
Key literature:
Recommendations
We recommend service managers ensure an adequate workforce to meet women’s needs by utilising a workforce planning tool and considering if there are a sufficient number of people in each of the key roles (psychiatrist, pharmacist, nurse, psychologist, occupational therapist, support staff, admin, peer support).
We recommend service managers develop clear & easily accessible guidelines on where to refer women to depending on their need. We encourage the development of one referral form that can be uploaded and amended, discussed at multidisciplinary team meetings (this is a process used at the Perinatal Mental Health Service at South West London and St Georges Mental Health NHS Trust).
Encouragement of a workspace that involves co-location, a culture of team working, sharing knowledge, approachability.
Provision of training for all people working in a health service. Consider the use of simulation training, such as the one used by Brighton and Sussex University Hospitals NHS Trust provide Perinatal Mental Health Simulation Training on the identification and management of common perinatal mental health problems using actors and ‘real-life’ settings.
Training should:
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Be ring fenced/time protected.
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Provide accreditation, matched to competencies and appropriate to level of involvement.
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Be expected for all health services staff who have contact with perinatal women.
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Be interactive and provided by a knowledgeable person or network.
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Where relevant be face-to-face.
Training should cover:
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Symptoms of PNMI - not just depression.
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How to talk about PMH, what questions to ask, language use.
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How and where to refer to.
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Diverse family structures.
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Vulnerable groups.
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Health inequalities.
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Lived experiences.
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Trauma informed care.
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Cross cultural presentations of mental illness.
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How to engage women from diverse backgrounds (see The Motherhood Group, who provide training related to engaging with Black women).
Service managers and policy makers could consider health professionals receiving accreditation for participating in Perinatal Mental Health Simulation Training.