The Bluebell Care Trust is a charity, based in Bristol, established in 2010 by parents with lived experience of perinatal mental illness, alongside health professionals, to deliver grass roots community perinatal mental health services for families during pregnancy and up to 2 years after birth. The purpose and aims of the charity are to meet the needs of mums, dads and infants who may fall between the gaps between primary and secondary care, as they may not meet the thresholds for the NHS specialist perinatal mental health services or may feel unable to ask for the help they need, due to feelings fear and stigma around this.
Please briefly describe your project, group, team or service, outlining what you do and why it makes a difference.
The Bluebell Care Trust is a charity, based in Bristol, established in 2010 by parents with lived experience of perinatal mental illness, alongside health professionals, to deliver grass roots community perinatal mental health services for families during pregnancy and up to 2 years after birth. The purpose and aims of the charity are to meet the needs of mums, dads and infants who may fall between the gaps between primary and secondary care, as they may not meet the thresholds for the NHS specialist perinatal mental health services or may feel unable to ask for the help they need, due to feelings fear and stigma around this. The charity has grown over the past 8 years, from it’s early days of working with teenage mums in a highly disadvantaged area of Bristol, to now delivering services for families across Bristol, South Gloucestershire, Torbay and the South Hams and soon also Bath and North East Somerset (BANES).
Bluebell works very closely with our colleagues in NHS perinatal mental health services, GP’s, Health Visitors, Midwives, Children’s Centres and many other agencies across the South West to ensure we provide a safe and joined up pathway for families. The main services the charity delivers, are: – Mums’ Comfort Zone – a 12-week therapeutic course, led by Occupational Therapists and Peer support workers (Buddies) in Children’s Centres in Bristol, South Glos, Torbay and the South Hams. – the Bluebell Buddy service – a 1-2-1 home visiting service delivered by Buddies, peer support workers with lived experience, who recovered, trained and paid to support others. – Dads-In-Mind – a peer support service for Dads experiencing perianal mental health difficulties themselves, or who are supporting their partners, delivered by a paid and trained dads’ Buddy with lived experience and who runs after work groups and 1-2-1 support. – Bluebell Place – an innovative city centre perinatal emotional wellbeing hub in Bristol City Centre offering a weekly menu of drop-ins for mums, dads and infants which includes: knitting, time to talk, pampering and feel good sessions, creative writing, life-coaching, parents and babies together sessions, all alongside a sensory and therapeutic creche for infants under 2. Our approach is to develop services in partnership with parents with lived experience and we have a multi-disciplinary team from a variety of back grounds including: Midwifery, Occupational Therapy, Health Visiting and parents who have been through recovery and are now also employed by Bluebell.
We aim to provide a step-down service for parents who may have spent time in inpatient services, who may also be supported by specialist PMH teams and who may have found it hard to access other support due to barriers, such as lack of free child care, transport and fear. We spend a great deal of time and attention in ensuring we liaise with professionals and other agencies also supporting a family and ensure everything we do is mindful of keeping families safe and supported. We have our main office in Bristol, at Bluebell Place, however we now have teams in Devon and South Glos and soon to be Bath, who work remotely but we join up frequently and all very much work as one large team. We are also very much embedded into the PMH strategies and pathways for all the areas we work in, as well as national groups such as the Maternal Mental Heath Alliance and the South West Strategic Clinical Networks for PMH.
What makes your service stand out from others? Please provide an example of this.
Over the past year Bluebell has been awarded several national and local awards for its’ work including at last year’s Positive Practise awards in Blackpool. Others include the Maternal Mental Health Alliance award for best trans-generational award in recognition of or work with the whole family and the Bristol Post best Voluntary sector team of the year. This year Bluebell was shortlisted as one of 30 charities nationally for the National Charity Awards with a reception at the Tower of London organised by Civil Society Media and has also been shortlisted as one of the National Lottery best health care projects which is just about to go live for voting!
We feel the things that make our work stand out include: A passion for meeting the needs of parents and listening to what they want from services and then aiming to remove the barriers to access which they often experience. Our model in the community, comprising of the 12-week group programme alongside the Buddy service, is seen as highly effective and we see from the monitoring and evaluation we gather, that it has a very positive impact on mums’ recovery from start to the end of the programme. The Buddy service is also seen as innovative, in that we invest a great deal in training, supporting and equipping the Buddies with lived experience, to support others and the role offers them a great way back into work. Bluebell Place, our city centre hub, is one of the only perinatal emotional wellbeing drop-in hubs in the UK and we have seen extremely high visitor numbers accessing this, much higher than we initially anticipated. It attracts many parents, including Dads, who may not have felt able to access other services and offers a really effective way to start the process of recovery for many families. We are then able to help these families connect with other services, or with their GP and other health professionals to access further support and services.
The Dads-In-Mind service also stands out as it is only one of very few perinatal mental health peer support services specifically for Dads in the UK and has been generating lots of interest and some very interesting learning we have been able to share with others, including a film made by BBC Tomorrow’s World of our Dads’ worker, Louis’ story “Feeling Bad as a New Dad” Finally, one of the ways we are now developing further and which is again paving the way for other services, is in the replication of the 12-week Mums’ Comfort Zone group programme and the Buddy service into other areas of the UK, which has been another interesting learning experience and one we now plan to replicate more widely in partnership with other CCGS.
Here is one example of the difference make and what makes us stand out from a mum who accessed our services: “Dear funders of Bluebell Care Trust, I would like to express my gratitude for the incredible care I received from all the team at Bluebell Place, in the last six months. Without the professional support and community feel provided by Paula, Anna and the team of volunteers like Hayley my story may well have ended very differently. The funding you provide them to do their job has changed my life. The charity ensured I remained safe and supported when I suffered from severe antenatal anxiety – my first real experience of mental health challenges, whilst referring me to all the relevant mental health support networks in the NHS. After suffering from severe headaches and exhaustion from the start of my pregnancy, I didn’t recognise my symptoms to be that of mental health until my midwife diagnosed me. My challenges became so severe I struggled to walk or talk, and experienced terrifying panic attacks. The team at Bluebells were a lifeline from the moment I called them (following the midwife’s insistence). I was unable to speak, but Anna shared all the information I would need on the phone calmly and with compassion. I was encouraged to leave the house by being enrolled in the yoga classes, where I was surrounded by women who understood my situation and didn’t judge my inability to communicate. I could focus on my breathing which in turn made my panic attacks more manageable, and leaving the house ensured I had access to mentoring from the team over a cup of tea. I could discuss options from medication to daily self-care tips to psychological fears with a group of trained, caring people. The Bluebells team helped me remain visible in the local NHS services, and thanks to the referral from Bluebells (along with that of the midwife and my GP) I was lucky enough to be picked up by Sasha Barber, the mental health lead at Southmead Hospital, whose assistance during my pregnancy has made a life changing impact on me and my family. Following the birth of my perfect, healthy baby following induction at 38 weeks due to my mental health, the cloud of illness lifted – I have no doubt that I didn’t have any postnatal illnesses due to the tactics, guidance and support I picked up at Bluebells. However, due to my experience I visit the team at their Tuesday coffee mornings every couple of weeks. It gives me the time to share my feelings with a group of women who understand, and I can “check in” with my mental health, which is so important in ensuring my little boy has the healthy, happy Mum he deserves. Bluebells provide a safe haven for women experiencing mental health challenges during a uniquely vulnerable time of their life, as well as ensuring clear communication flows throughout a stretched NHS. Bluebells is a life changing place as it helps ensure women suffering with mental illness can not only improve their current challenges, but pick up tools & connections that will help them (and therefore their children) for the rest of their life. Thank you wholeheartedly from myself and my family, for facilitating the exceptional care Bluebells provide. Kind Regards, Georgia”
How do you ensure an effective, safe, compassionate and sustainable workforce?
Bluebell has a multidisciplinary team made up of a mix of parents with lived experience of perinatal mental illness, health professionals and others. We also have a board of trustees who bring a wealth of experience covering, perinatal mental health psychiatry, mental health nursing, GP, business, finance and lived experience. We make sure that we look after all our team including volunteers, peer support workers, health professionals and trustees. We provide monthly, 1-2-1 and group supervision for all paid staff including our Bluebell Buddies plus we also provide regular group supervision for all volunteers, as well as team days and ongoing training.
We offer staff wellbeing sessions, such as head and shoulder massages and we also run regular refresher training sessions and workshops bringing everyone together to top up on skills. Many of the team with lived experience have not been in the workplace for while when they initially start with us, and so we ensure they are supported really well with supervision, regular team meetings, time for reflection and also going training to help them feel equipped and able to support others. We always ensure that all peer support workers have their own Bluebell mobile phone and can check in with us whenever they feel they need to, make safety calls and generally know what to do and who to go to if they feel in any way triggered or vulnerable in their roles. In addition to supervision, we also have regular team meetings and days together and we aim to provide several CPD training opportunities each year for all.
Who is in your team?
Ruth Jackson, CEO/Founder – full-time, Anna Thompson, Project Manager – 30 hrs per week, Rachel Jenkins – Occupational Therapist lead 24 hrs per week, Paula Bentley, Central Bristol Buddy – 30 hrs per week, x4 other Buddies – from 14-20 hrs per week. x 2 further Bristol groups leaders/OT’s – both x 10 hrs per week. Bluebell administrator/referrals: Jess Sanzo x 14 hrs per week. Dads-In-Mind: Dads’ peer support worker x 10 hrs per week. Creche lead for Bluebell Bristol, Emma Peyton – 24 hrs per week x 2 Creche workers for Bluebell – x 13 hrs per week each. Sessional creche workers in Devon & S Glos – various hours. Devon team – Selina Dare, Lead OT – 10 hrs per week, Mel Williamson, Devon co-ordinator – 10 hrs per week, x 2 Devon Buddies – 10 hrs per week. Volunteers x 20 – various hours in Bluebell Place. Board of Trustees – Jo Menon (Chair, Management Consultant and Mother with lived experience) , Dr Karl Scheeres (Perinatal MH Psychiatrist) , Dr Christine Jackson/Munday (Doctor at Mother & Baby inpatient unit) , Angela Appiah Shippey (Treasurer) Mike Reynolds (dad with lived experience), Sasha Barber (PMH lead at North Bristol Trust) Dr Jennie Shouls, GP, Holly Starkey, Mental Heath Lead at St Michael’s Maternity Hospital.
How do you work with the wider system?
Bluebell works closely with the wider perinatal mental health system in Bristol, S Glos and Devon which includes, regular meetings and liaison with the Bristol and Devon NHS specialist PMH teams, with local GP’s who refer many women into our services, with local Health Visitors and Midwives who also refer many women and very closely with the Children’s Centres where we run our 12-week group programmes. An example of how we work closely, is that the Bristol specialist PMH team use our hub, Bluebell Place, each Monday to run a group for mothers who they are working with around more serious PMH concerns and many of these women then also start to access Bluebell’s services.
Another example, is that Bluebell’s lead Occupational Therapist who runs our groups there, works part-time for Bluebell and the rest of the time in the Devon Partnership Trust Perinatal Mental Health Team. Also, in Bristol, one of the Buddies, Paula Bentley, has been working one day per week in the North Bristol Trust maternity unit and on the wards, to offer a peer support service to women in hospital, and then many of them start to access Bluebell’s other services when they are discharged. In addition to working closely with the PMH teams, we also work closely with many other agencies including housing support, domestic violence agencies, drug and alcohol services, home start, grief and loss counsellors and many others in all areas and which our Buddies regularly support mums and dads to navigate if they are finding it hard to access the support they need.
In addition, Buddies often accompany mothers to appointments with professionals if they are finding this process overwhelming. The Bluebell team are also often involved in delivering joint training with NHS colleagues, such as recently attending and sharing at over 20 training sessions at the North Bristol Trust for Midwives, sharing lived experience and how we deliver and develop our services and models. Our CEO and others has been a member of the perinatal mental health strategy groups for Bristol CCG and spent many years campaigning and working with this group to input into the bids for specialist community team funding from NHS England resulting in Bristol and S Glos CCG’s securing wave 1 funding of £1.3 Million.
Do you use co-production approaches? If so, please illustrate how you involve individuals, families and carers to drive improvement and deliver services?
Right from the start, Bluebell has worked closely with parents with lived experience to develop, inform and shape services. With our very first group with young parents in South Bristol, where they were instrumental in designing the 12-week group programme and all the marketing materials to today we consult with and involve mums and dads in all aspects of the charity from sitting on the board of trustees, to helping as volunteers and to consulting and inputting into the services. Another key way in which we work with parents with lived experience is by involving them regularly in delivering training to health professionals, often sharing their own stories and also helping professionals understand some of the barriers and challenges they’ve experienced in accessing support and services. We involve parents also in evaluation a a great deal, giving their feedback, their advice on what is and what isn’t working well with the services and adapting these.
Parents also sit on working groups for new services and play a huge part in media work, with interviews, making films and generally speaking about their experiences. We always support parents to do this safely and ensure that they know they can be anonymous or not take part also if they don’t feel ready. The major benefit of our co-production model is that we feel we have services that truly meet the needs of parents and families and that remove many of the barriers, that are accessible and flexible depending on the needs of families in different localities. Finally, most of the staff team at Bluebell also have their own lived experience, including our CEO and other senior team, who have also experienced perinatal mental health difficulties.
Do you share your work with others? If so, please tell us how.
We share our work regularly by speaking at conferences for local CCG’s and strategic networks, by networking with the Maternal Mental Health Alliance and other national groups and by delivering regular training for health professionals and the private sector, such as in the workplace. We take part in regular media work and publicity, including film making and we have recently been a partner on the making of a new animated film “perinatal positivity” for which mothers and fathers supported by Bluebell have shared their stories, and which will be released nationally in September. Our Dads worker Louis has also made a film with BBC Tomorrow’s World about fathers experiences of perinatal mental illness. Our work has been featured many times in local and national radio, print and TV including the Guardian, The Mirror and the BBC and we work closely with our funders, Children In Need, Comic Relief and The Big Lottery to promote perinatal mental health and innovation through the media including many mums and dads being involved in filming for Sport Relief and Comic Relief campaigns.
We are part of and share our learning at any local networks and strategy groups for the VCS and more specifically for perinatal mental health and also with other CCG’s around the Uk who may be planning to deliver similar services. In addition, we regularly support and work with other local charities around the UK who may also be working in similar ways to see if we can partner and share our learning. Bluebell is also one of the founding member of the Perinatal Mental Health Partnership, which is a UK wide group made up of individuals with lived experience and charities, set up to run Maternal Mental Health Week each year.
What outcome measures are collected, how do you use them and how do they demonstrate improvement?
We use a range of outcome measures, both qualitative and quantitative across all of out services, these include: The EPDS (Edinburgh Postnatal Depression Scale) and the GAD7 (General Anxiety & Depression Scale) – we use this at the start and the end of the 12-week programme with every mum to track their mental health baseline and improvement and also with each mums at the start and end of the Buddy support sessions. We see very positive results with an overall 80% improvement rate. We also use a wellbeing questionnaire with every parent who accesses the drop-ins at Bluebell Place, measuring levels of isolation, wellbeing, confidence, stigma and ability to ask for support, which again show very positive feedback with 90% of parents reporting an improvement in all areas.
To capture feedback more creatively we use ‘Knowledge Cafes’ at the end of all the 12-week programmes and ask mums to reflect creatively on their time in the programme and think about how they feel now at the end, compared to how they felt when they first arrived. We have gathered hundreds of amazing drawings and poems that reflect mums’ journeys, many of which are framed and on the walls at Bluebell Place, and also sent to our funders as part of their monitoring reports. In addition, we capture data through registers, diversity and equity questionnaires, interviews and focus groups with parents. We also gather case studies from parents to show how the service has made a difference for them. Finally, we capture the wellbeing of the infants in all our creches and mum and baby groups, through feedback wellbeing questionnaires, diaries and journals and observations from our creche team.
Has your service been evaluated (by peer or academic review)?
Our services have been incorporated into many research bids as patient groups who contribute to a project, through the University of Bristol and Exeter Uni. We also regularly input and feedback to research teams the views of parents on their bids and proposals. Whilst not 100% externally evaluated, we have produced two much longer term overall service evaluations which have been written for us by PHD students and which cover two year periods. We are in the process of commissioning another of these at the moment covering the years from 2016-2018.
How will you ensure that your service continues to deliver good mental health care?
We continue to work closely with commissioners and develop our services further with them and with the local specialist perinatal mental health teams in Bristol, S Glos, Devon and BANES. In addition, we work closely with Comic Relief and the Big Lottery, both of whom have a passion and commitment to maternal mental health and our work. We seek funding on an ongoing basis with over 20 bids going out each month and we are in the exciting process of working with a London based Scale Up Fund over the next three months, to deliver our services more widely based on the learning from our recent replications in Devon and S Glos. We have a robust and professional team and have worked hard to ensure we have the right people in place, and on our board, to continue our work into the future and are not dependent on any one key member or team, but have a constantly developing pool of talented and passionate team members who we have invested in with training and mentoring.
What aspects of your service would you share with people who want to learn from you?
We have recently been sharing our Buddy/Peer support model quite widely as we have a service that is unique in that we invest in training and paying our peer support workers, rather than using volunteers. As we have been running this model for over 8 years now we have developed a great deal of learning along the way, we have encountered many challenges and found ways to overcome these, which we can now share with other similar charities wanting to deliver a similar service. Some of the most challenging aspects of delving a peer support service and employing Buddies with lived experience have been: – ensuring the safety and wellbeing of the Buddies with regular supervision, lone working procedures and policies and best practice for safeguarding. – offering robust and wide ranging training depending on the needs of the peer support workers which covers areas such as; risk, self-disclosure, boundaries, triggers to own wellbeing and listening skills – all areas we have been sharing with others and which we have learnt a great deal from. Another key challenge and area we can share with others is around barriers to accessing support and how to remove these, for example, we have invested heavily in our creche teams as we see that providing high-quality and well trained child care for mums in order to enable them to access time-out and support for themselves, is key to them being able to fully access and embrace support.
How many people do you see?
1,300 referrals received in past 12 months – 1,000 accepted and supported. 1,400 likes on the Bluebell Face Book Page, over 20,000 webpage views, 1,400 twitter followers. Average number of group attendees – for each group we run, and average of 8 mums attend the full 12-week programme = we run 21 groups per year in the community, therefore 168 women access these. The Buddy service supports another 300 women per year. 40 Dads through the Dads In Mind services. The remaining 492 parents supported at Bluebell Place drop-ins per annum.
How do people access the service?
Self – Referral – around 40% of parents Referral from Health Professionals/GP/Health Visitors/Midwifes/PMH teams – 50% 10% referrals from other agencies and children’s centres. All referral forms and referral criteria are clearly on our website and all forms downloadable from there, we ask referrals to be posted back to us at Bluebell Place, where they are all called within one week to discuss the services we may be able to provide, logged on our database with initials and postcodes, signposted on to other services if outside of our remit and if referred by a Health Professional then we will always also contact them to let them know the status of each referral. Access is promoted also through a range of marketing materials in community spaces, GP surgeries, cafes, clinics, hospitals and other spaces and parents can self-refer or call us for a chat to find out more. Many parents are encouraged to visit Bluebell Place with a friend, their partner, their mum/sister or health visitors can come along with a mum for the first time. We can offer some travel help for bus fares, etc, if this is a real barrier to access.
How long do people wait to start receiving care?
The average time from receiving a referral to receiving an initial call back to discuss is one week. We can normally provide a service to a parent within two weeks from referral. Parents can access our drop-ins at Bluebell Place straight away.
How do you ensure you provide timely access?
We have a dedicated admin support worker who deals with all referrals and will all each parent and/or HCP back to update and discuss. We prioritise by postcode, as for example, the Buddy service covers designated areas only, these are all clearly stated on our referral guidelines which are on our website and can be downloaded for reference. We also prioritise by our referral criterial, that our remit is for parents whose main presenting concerns are related to depression and anxiety during pregnancy and up to two years after birth. We have a managed case-load for each Buddy and groups in the community and a team of extra volunteers to support our drop-ins at Bluebell Place, our hub.
What is your service doing to identify mental health inequalities that exist in your local area?
We are involved in many working groups, focus groups, and local community health work that is identifying the needs of the local population and aiming to fill these gaps. We collect diversity and equality data from all parents who access our services. We have been instrumental in pushing ahead with innovative services, such as Bluebell Place, to identify the needs of parents and then work with them to provide accessible, high street community services.
What inequalities have you identified regarding access to, and receipt and experience of, mental health care?
There are many around perinatal mental health including: – lack of support for Dads – which is why we set up Dads In Mind – lack of childcare – so we invested in providing this – stigma around BAME groups of mums – we provide services in local centres which they find easier to access and many find accessing Bluebell Place easy, as it is in the shopping centre and therefore less stigmatised.
What is your service doing to address and advance equality?
We have specifically designed services to meet the needs of parents from all demographics as stigma is felt amongst all of these groups, including older, professional women. With the Buddy service we are able to provide a service in the home to any woman who may need it, therefore reaching some of the most isolated mothers who may not be leaving the home at all. We have also been innovative in developing our support for Dads, which is pretty much non existent within maternity and perinatal mental health services generally. We have been involved in a great deal of media work, making films and speaking at events to raise awareness and normalise perinatal mental wellbeing.
How do you identify the needs of a person using the service (such as their physical, psychological and social needs)?
We use a wide range of screening tools such as the EPDS, GAD7 but also emotional wellbeing questionnaires, referral forms, client details forms, and initial assessment meetings with the Buddies and support workers to gather a fuller picture from a mum or dad.
How do you meet the needs of people using the service and how could you improve on this?
We meet needs by proving a wide range of services which can appeal to many different types of parents and address a range of concerns, from their own wellbeing to their infants wellbeing and we offer services at home, in the community and in our hub, therefore offering a range of venues, all of which are accessible. We aren’t an NHS service, however do aim to meet and be mindful of the NICE guidelines for PMH and we work closely with our local NHS teams to develop pathways between our services for families.
What support do you offer families and carers? (where family/carers are not the service users)
Our services are open to the whole family; mums, dads, partners, carers, infants and others such as grannies, sisters, friends who are supporting a parent and we often support mums at Bluebell Place who may come along with their own mum, or with their friend – we try to work with everyone to ensure anyone around a mum or dad who is the service user, feels they can also come to us with questions or ask for our support too if they need it.
Only that the work we do comes from a place of wanting to always give mums, dads and infants, the best quality service we possible can which runs through the ethos of Bluebell in everything we do, even down to making sure mums and dads have a nice coffee, tea, home made cakes, and that Bluebell Place is decorated in lovely colours, is full of lovely art and sensory toys and offers a little sanctuary in the middle of the city.
Brief description of population (e.g. urban, age, socioeconomic status):
Mothers, fathers and infants in Bristol, city centre, South Gloucestershire and also in more rural areas of South Devon – Torbay and the South Hams, experiencing perinatal mental health difficulties through pregnancy and up to two years after birth. Parents of all ages and demographics, including very young parents and parents from BAME communities, lone parents and parents facing multiple disadvantages such as low income, housing difficulties, relationship breakdown and other social care factors.
Size of population and localities covered:
Bluebell supports in the region of 1,000 mums, dads and infants per annum across Bristol, South Gloucestershire, Torbay and the South Hams.
Commissioner and providers
Commissioned by (e.g. name of local authority, CCG, NHS England): *
We are an independeny charity rather than a commissioned service and raise our funds mainly from idependent funders however we do receive some funding from the Bristol & South Glos (BNSSG) CCG and from the Devon Partenrship Trust charitable fund, Little Something for our work in South Devon and we about to enter into an agreement with the Bath & North East Somerset CCG.
Provided by (e.g. name of NHS trust) or your organisation: *
Bluebell Care Trust (registered charity)