Women in Coventry and Warwickshire now have access to a specialist team which is improving the number of referrals accessing appropriate support and receiving positive feedback from users. Although the project has only been in full implementation since November the approach has already attracted national interest and is set to deliver significant benefits for the safety and wellbeing of women and children, improving future life chances
Women in Coventry and Warwickshire now have access to a specialist team which is improving the number of referrals accessing appropriate support and receiving positive feedback from users. Although the project has only been in full implementation since November the approach has already attracted national interest and is set to deliver significant benefits for the safety and wellbeing of women and children, improving future life chances
During pregnancy, and in the year after birth, women can be affected by a range of mental health problems including anxiety, depression, trauma, loss and psychotic disorders. These are collectively called perinatal mental illnesses. Perinatal mental illness affects at least 10% of women and, if untreated, can have a devastating impact on them and their families. When mothers suffer from these illnesses it increases the likelihood that children will experience behavioural, social or learning difficulties and fail to fulfil their potential. The Maternal Mental Health Alliance last year estimated that the cost of perinatal mental illness is approximately £8.1 billion annually; most of this represented in long term impacts for the baby.
The onset and escalation of perinatal mental illness can often be prevented through early identification and expert management of a woman’s condition, and prompt and informed choices about treatment. Even if the illness itself is not preventable, it is possible to prevent many of the negative effects of perinatal mental illness on families. Effective prevention, detection and treatment have a positive impact on the lives of families and improve the wellbeing, health and achievement of children across the country. Universal services, particularly midwives, GPs and health visitors have an important role in identifying mothers who are at risk of, or suffering from, perinatal mental illness, and ensuring that these women get the support they need at the earliest opportunity.
We see women from 14 weeks ante and accept referrals up to six months post natally, we can work with women till twelve months post-partum. We have two pathways covering the whole county and patients may see a psychiatrist, psychologist and or specialist nurses – we work very closely with colleagues from a range of disciplines.
We make a real difference not only to women’s lives but those of their children, families, carers and friends; we know this from our feedback. We identify women who are at risk of developing a mental health problem and/or work with women who have developed a mental health problem either ante or post natally. We work with woman who have experienced birth trauma and attachment issues which are paramount for a child’s development. Our criteria is 14 weeks pregnant up to six months post-partum and we can work with women up to twelve months post-partum. Feedback from our service users has tremendous and we know we are changing lives! We are offering a significantly improved equitable service for women and their families; women have a better service at home and locally. We positively encourage patient’s full engagement in their own care.
Wider Active Support
As well as testing out the new service and pathway with clinicians as part of a stakeholder workshop, patient involvement was actively sought – most successfully through the maternity services patient liaison group. A business case for the new service and pathway was accepted by all three CCGs with implementation beginning in January 2015. This has resulted in a highly innovative service delivery model, involving three CCGs, four locations, three maternity hospital-based NHS Trusts and a county-wide mental health NHS Trust, working together in collaboration to deliver high quality perinatal mental health services
Strong links have been and continue to established, and built on, with relevant services such as the maternity hospitals (in which the perinatal mental health team members spend some time each week), with the health visiting team, midwifery, obstetricians, family nurse partnership, with GP practices, also broader mental and physical health services and very importantly third sector and voluntary services.
We have one senior clinician from each of the five disciplines involved (CPN/manager health visiting, midwifery, clinical psychology and psychiatry) who meet together on a monthly basis to continue shaping the service. This will support the ongoing development of the service as the disciplines continue to learn from one another and build strong working relationships within the perinatal team.
We are delighted to be working so closely with the Commissioning Groups, Maternity and Obstetric staff, Health Visitors, GPs, Social Media, our own Mental Health colleagues, voluntary sector. We cover three CCGs and three maternity hospitals with three NHS Trusts over four localities; we have been led to believe that we are one unique service in the country as we cross so many ‘virtual boundaries’. This team has staff employed by Coventry and Warwickshire NHS Trust and South Warwickshire Foundation Trust but we are one team. We have a very large number of asylum seeking women here in Coventry originating from various ethnic backgrounds and we are proud to offer these women and their families our service to support them through their journey we also work closely with third sector and voluntary services (Refugee Centre, Sahil and MAMTA Project) to offer these women the most appropriate and beneficial opportunities and different solutions for a diverse community.
The service has collated direct feedback from patients and will continue to do so. A number of service users have agreed to be involved in the production of a patient video to help healthcare professionals better understand the needs of women with maternal mental health difficulties patients individual views are key to our service. Our next initiative is to invite service users to participate with our recruitment and selection.
We have listened to service users about how they would like to be seen and where. We carry out our Friends and Family Test with all service users. Susan Drewitt Team Manager attends the Maternity Services Liaison Committee Meeting where service users also participate. We have taken part in a live Facebook chat, which was very successful and we hope to continue this. We have set up a Facebook, internet page and a Twitter account so we can promote the service not only to professionals but to service users in an attempt to reduce the sigma of maternal mental health, we are also utilising apps, which service users really find beneficial and user friendly. We are very keen to utilise service users as they bring so much to the service with their experiences and knowledge, we would very much like to involve some of these women when interviewing for staff as their contribution would be valuable. Our Manager works very closely with the National Childbirth Trust (NCT) offering supervision to enable volunteers to support women in the ante and post-natal period this is called ‘Parents in Mind’. The perinatal team members also work closely with a Parenting and Nurturing Project that works to support parents with a variety of mental health problems to support them parenting their children.
The team are actively encouraged to develop themselves not only from a professional stance but also about “caring for ourselves and each other” Our Trust have ‘Indulgence days’ massage, health checks, yoga etc and the staff are encouraged to attend.
The five leads (Nurse, Psychologist, Psychiatrist, Midwife and Health Visitor) meet monthly to discuss ways of improving and developing the service. We have a weekly team meeting, and the Psychologists and Nurses hold their own discipline forum meeting every 6 weeks. All staff receive regular supervision.
The development of a service which crosses so many ‘virtual boundaries’ (in terms of CCGs, trusts, providers and locations) has been challenging!
Some parts of the service were already in place, and these were built on. It is not always most appropriate to dismantle existing services and start again – the valuing and extension of existing knowledge, skills, experience and enthusiasm has been a key part of this service development. This has resulted in successfully retaining all the existing staff bringing with them a combined total of many years of relevant perinatal experience
There were challenges we could never have envisaged! Especially working across three NHS Trusts! However, it has been a steep learning curve and together as a team we have worked through these difficulties to overcome them – we are constantly striving to develop and maintain our excellent service. A successful conclusion has been dependent on overt partnership working, with strong central leadership. Bringing an equitable perinatal service for women was “a must do project” and we have worked tirelessly to develop and operationalize this in a relatively short space of time.
Some parts of the service were already in place, and these were built on. It is not always most appropriate to dismantle existing services and start again – the valuing and extension of existing knowledge, skills, experience and enthusiasm has been a key part of this service development. This has resulted in successfully retaining all the existing staff bringing with them a combined total of many years of relevant perinatal experience. As manager I participate in local sustainability transformation programmes (STPs) mainly with maternity services.
We have developed pathways for Health Visitors and Midwives and this will also include training packages to assist in identifying perinatal mental illness and in supporting women, where this fits within the scope of their roles.
Strong links have been established and our service will continue to remodel and redevelop the perinatal service to meet local need.
We will commence our annual evaluation later in 2017.
We utilise the Friends and Family test
Feedback from service users is paramount
Perinatal Key Performance Indicators will be effective from mid 2017.
As a team we constantly reevaluate our service to ensure we are delivering best practice that is safe, high effective, works in partnership and has a driving vision.
The service has collated direct feedback from patients and will continue to do so. A number of service users have agreed to be involved in the production of a patient video to help healthcare professionals better understand the needs of women with maternal mental health difficulties patients individual views are key to our service. Our next initiative is to invite service users to participate with our recruitment and selection.
We have listened to service users about how they would like to be seen and where. We carry out our Friends and Family Test with all service users. Susan Drewitt Team Manager attends the Maternity Services Liaison Committee Meeting where service users also participate. We have taken part in a live Facebook chat, which was very successful and we hope to continue this. We have set up a Facebook, internet page and a Twitter account so we can promote the service not only to professionals but to service users in an attempt to reduce the sigma of maternal mental health, we are also utilising apps, which service users really find beneficial and user friendly. We are very keen to utilise service users as they bring so much to the service with their experiences and knowledge, we would very much like to involve some of these women when interviewing for staff as their contribution would be valuable. All patients complete the HADS assessment at least twice, and from this we can demonstrate outcomes for them.
Our Manager works very closely with the National Childbirth Trust (NCT) offering supervision to enable volunteers to support women in the ante and post-natal period this is called ‘Parents in Mind’. The perinatal team members also work closely with a Parenting and Nurturing Project that works to support parents with a variety of mental health problems to support them parenting their children.
The team are actively encouraged to develop themselves not only from a professional stance but also about “caring for ourselves and each other” Our Trust have ‘Indulgence days’ massage, health checks, yoga etc and the staff are encouraged to attend.
The five leads (Nurse, Psychologist, Psychiatrist, Midwife and Health Visitor) meet monthly to discuss ways of improving and developing the service. We have a weekly team meeting, and the Psychologists and Nurses hold their own discipline forum meeting every 6 weeks. All staff receive regular supervision.
All patients complete the HADS assessment at least twice, and from this we can demonstrate outcomes for them
This approach is relevant to maternal mental health services in other areas. We have already received approaches from other health economies that are keen to learn how we have made this happen. We are currently exploring the best way to facilitate this, such as video material, so that learning is available to all.
Conversations have been held with a number of commissioners in other areas within the UK, who are particularly interested in thinking about the way this service has developed without being wholly ‘bespoke’. Instead, they are interested in the development of services which fill gaps in existing services. This is cost-effective and provides local care to local women, when they need it.
The key to making this project work has been bringing together a large number of partners who were all essential to implementing change. This included three Clinical Commissioning Groups, three acute providers, the mental health provider, the local community providers, NHS England, Public Health and the local authorities
We strive to work closely with the above, in addition GPs, Health Visitors, Midwives, MIND, and Voluntary Sector, Forums, Obstetric staff and colleagues within mental health.
Coventry and Warwickshire now has a consistent, safe, high quality service which is compliant with NICE guidelines with the right specialist staff in place, including experienced consultant psychiatrists. The team now also comprises experienced clinical perinatal psychologists who can provide intervention and support to women experiencing a range of perinatal mental illness such as trauma following delivery or loss, moderate to severe anxiety and depression, and phobias. (Existing evidence, directions and guidelines are clear those women who are psychotic must be under the care of a qualified perinatal psychiatrist as general adult psychiatrists lack the experience to work with perinatal women and their rapidly changing presentations.) Specialist perinatal CPN staff members are in post, providing home-based support and care to women who require this during the perinatal period. The team is in position to provide perinatal mental health training to GPs, health visitors, IAPT, midwives and obstetricians, ensuring early identification of risk and vulnerability, as well as of those experiencing current mental health issues.
The service has already begun delivering a bespoke training package for local professionals to ensure that everybody is working to the same pathway, receiving the same messages and that there is consistency across Coventry and Warwickshire. We are now attracting not only local but national interest!
We were finalist for the Patient Experience National Network Awards 2015 (PENNA)
In 2016 we were finalists for a prestigious HSJ Award.
We have won ‘Q’ Awards within our own Trust for the innovative service we are bringing for women.
We are working with Royal College of Psychologists to be an “adopter” site to train Improving Access to Psychological therapy (IAPT) workers to become perinatal competent.
We are also working closely with the Royal College of Psychiatry to be an “adopter” site for Consultant Psychiatrists to train other Psychiatrists to become perinatal competent. We are very excited to be part of these initiatives, developing individual’s knowledge so they can deliver high quality expertise to women.
Susan Drewitt is working with the National Childbirth Trust (NCT) to develop their peer to peer volunteer service (which is now up and running) to deliver support to women with Perinatal mental health difficulties.
The aim of our service is to establish partnership working so we can deliver a safe, high quality and equitable service, countywide – and we feel we deliver this to women and their families with compassion, respect and dignity.
