Our initiative is a new and innovative cross-agency approach which ensures the timely recognition of mental health needs and the prompt arrangement of suitable interventions in a prison setting, for a vulnerable group of women in the perinatal period. We, as a mental health service, have worked in conjunction with our partners in primary care, midwifery and the prison service to develop a pathway with very little guidance, limited resources and no extra funding. Our pathway ensures that all women in the perinatal period are recognised and listened to, with their needs collaboratively addressed, thus maximising safety and improving outcomes for mother and baby. Since the inception of the pathway in May 2016 we have been able to identify and meet the needs of lots more women, many of whom may of have been missed previously.
What We Did
Our initiative is a new and innovative cross-agency approach which ensures the timely recognition of mental health needs and the prompt arrangement of suitable interventions in a prison setting, for a vulnerable group of women in the perinatal period. We, as a mental health service, have worked in conjunction with our partners in primary care, midwifery and the prison service to develop a pathway with very little guidance, limited resources and no extra funding. Upon review of the published literature there was a minimal amount available which related to our population – we utilised that which was available to develop a new and innovative pathway. Our pathway ensures that all women in the perinatal period are recognised and listened to, with their needs collaboratively addressed, thus maximising safety and improving outcomes for mother and baby. Since the inception of the pathway in May 2016 we have been able to identify and meet the needs of lots more women, many of whom may of have been missed previously. We work with a large number of females, the vast majority of whom are extremely troubled and from disadvantaged backgrounds. All of these women are vulnerable and may require timely access to help and support in the shape of a mental health intervention. The perinatal period, inclusive of pregnancy and 12 months post birth, can exacerbate this need for help and support. Women who are currently pregnant or who have given birth in the past 12 months need specialist care and assessment made available to them at what is a very risky period in a women’s life. We recognise the potential for a concentration in risk for this population of women. Our predominantly nurse-led initiative sets out to meet this need by working in collaboration with our healthcare and prison service partners, as well as the women themselves, to hasten the identification of need, accelerate action, reduce risk and improve safety.
Wider Active Support
The whole perinatal pathway in HMP/YOI Low Newton is reliant upon the collaboration, motivation, flexibility and teamwork of lots of agencies, including the mental health team, healthcare staff and the prison service, as well as the women themselves. However, the mental health component is a new and innovative piece of work, which is predominantly nurse-led and dependent upon the dedication and creativity of our team of nurses, both within the mental health team and the primary care team. We have broken new ground to develop a pathway from nothing – no additional funding or resources, no specialist training, no prison specific national/local guidance or no well-publicised examples of prison related best practice. We have increased our workload, we have re-doubled our already very committed efforts, also we have put the issue of perinatal mental health in female prisons on the local/regional agenda. This has become the expected practice in a short space of time. We achieved that together.
It brings me sadness to state that this initiative was brought about as the result of an unfortunate death in custody involving a young lady who had recently given birth. However, whilst we recognise the significance of this event, we have worked tirelessly to ensure that lessons have been learnt and that we minimise the chances of this occurring again in future. We have used our failings as a springboard to achieve great success so far, which we dedicate to the young women in question. We understand that our population of women are incredibly vulnerable with many of whom having experienced significant amounts of physical and psychological trauma throughout, what have often been, very difficult lives. Perinatal mental health is viewed, rightly so, as a current funding priority for mental health services. However, women in prison are often excluded from help and intervention – we aim to address this inequality.
The initiative began with the realisation that we could and should do more for this population of women. The recognition of need was evident from all stakeholders. We understood the importance of making these resources available and we knew that this had to implemented quickly. The healthcare elements of the pathway, be these physical and mental, were nurse-led from the beginning and remain so now. We discussed the issue of perinatal healthcare at the various forums both inside the prison, but also in our respective organisations. We wanted the recognition and commitment of service management – which we received in abundance. The next step involved a lot of joint-working, testing and evaluating, development and change. We started with an unwavering desire to make this work, partly because of the previous failings. With the impact that our changes have had, we now know that we must make this work, this is imperative.
We recently asked a selection of the women to complete a small survey in order to gauge their opinion around the following: Support upon arrival into prison and throughout stay; Satisfaction; Responsiveness from the mental health team; Early identification of needs and provision of timely, appropriate support. The feedback received was excellent with all women feeling that they were seen quickly and had access to support in a timely manner, overall satisfaction was very high. This initiative was born out of tragedy, sadly, however we take a great deal of pride in the fact that we have been able to develop a great nurse-led service, based upon excellent communication and interagency working. The fact that we now have such a service in a prison setting, with no additional monies is reassuring in the modern day and reminds us that creativity, passion and people power can genuinely move mountains. Furthermore, this has been developed without the option of learning from others nationally due to the dearth of available literature or other prison specific pathways – this is further commendation of such innovation. We achieve more by working together.
Looking Back/Challenges Faced
This initiative, quite simply, was a ‘must do’ piece of work, we had to develop a pathway in order to ensure that our service users were supported in a way which is, at the very least, equitable to that in the community. We had an awareness that there was a lot of work to do nationally around perinatal mental health issues and the development of appropriate services, however in retrospect we do not feel as though we appreciated the dearth of available guidance in our setting specifically. We have shown great flexibility, creativity, understanding and innovation to adapt the guidance of community-based best practice literature to our setting. This has been no easy achievement.
We are part of the Royal College of Psychiatrists’ Quality Network for Prison Mental Health, on the 12/01/2017 we hosted a peer review by delegates from the network and we chose our pathway to discuss. We received excellent feedback regarding our pathway due to the fact that there is a serious need for similar services, however the reality of making it a possibility renders this a difficult task to accomplish. We have been invited to London later in the year to discuss our pathway at the Network’s annual forum.
We have already shared this with the Quality Network and we will be attending their forum to discuss this further. We will also be submitting a paper to the Network’s periodic bulletin. The mental health team and partners have written a multi-agency, cross service protocol which has recently been ratified. This will be circulated to all prisons across the female estate. We are currently in the process of writing this up with the hope of attaining publication a peer-reviewed journal. There are plans afoot to visit other female prisons, also we wholeheartedly believe in the power of social media.
We have strived to make this issue a priority both locally, from a Trust/regional perspective, and also nationally, through our work with the Quality Network and the rest of the female prison estate. The establishment of a sustainable perinatal pathway will form part of our directorate strategy going forward.
We have also recently been announced as a short-listed finalist for a national award for mental health practice by the Royal College of Nursing
We are part of the Quality Network for Prison Mental Health as discussed above. Within my trust, Tees, Esk and Wear Valleys NHS Foundation Trust, we are dedicated to the use of lean methodology to review/develop our processes and practices in line with our Quality Improvement Systems, this is based upon the Virginia Mason approach from the USA. This initiative will be evaluated via this process as I will be using it as part of a training project over the next six months, I will be exploring our identification of and responsiveness to mental health problems in our population of women.
In the relatively short space of time since the inception of our initiative we have been able to reach a population of women who, quite simply, would have been missed prior to launch. If we view this in the most extreme perspective, given the origins of our initiative especially, then these are women who may have suffered and possibly acted in an unsafe manner.
We are part of the Quality Network for Prison Mental Health, we have recently shared this as part of our peer review. We have been invited to present on this at their annual forum later this year, which we intend to do. We have jointly developed a protocol to outline our practice, this has been shared across the rest of the female prion estate nationally. We have shared this initiative with colleagues across our Trust, as well as this, we will be using our experience to assist with the submission of a bid for funding for a community based perinatal service locally – it is anticipated that this will link in with the work that we have done already in the prison. We have shared our work widely with colleagues via social media, of which we are extremely passionate about. We have also recently been announced as a short-listed finalist for a national award for mental health practice by the Royal College of Nursing
Is there any other information you would like to add?
A couple of points 🙂
First and foremost the lack of available evidence or guidance to help us shape what we wanted to do was incredibly hindering, the recognition of this is of paramount importance. We are a generic mental health team in a female prison and whilst we are very experienced/skilled, none of us have any specialist knowledge of perinatal mental health. This area of mental health practice is slowly developing and there is no shortage of key organisations and people highlighting the needs of women in the perinatal period. However, there is a dearth of such guidance in relation to prisons and the criminal justice system. Secondly, we have managed to achieve success so far at a neutral cost, with no extra resources, whilst also meeting the needs of the rest of our population. We have overcome these challenges through belief, commitment, hard-work, hours of research, networking and persistence. We have adapted our model, increased our workload, influenced opinion, changed practice and met needs. We, as people, service-users and staff alike, have defied the odds and will continue to work hard in order to reach more and more of those in need.