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Parental Mental Health and Wellbeing

The following pathway should not be read as stand-alone and MUST be read in conjunction with Section 3: Pathways.

  • The Parental Mental Health and Wellbeing pathway specifically needs to be considered in conjunction with the Infant Mental Health pathway.
  • The pathway identifies postnatal depression and parents with a history of previous mental health issues that potentially can impact on the child and family.

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Birth - 8 weeks

At Birth or soon after


To meet statutory requirement to notify birth/ death of a baby

Midwifery

Complete notification to registrar:-

  • Still Birth - register non-live birth
  • Live birth - but baby dies later both birth and death registration
  • Termination for abnormality

At Birth or soon after

To facilitate information sharing and co-ordination of support.

Midwifery

Notification of death to other agencies To ensure other agencies are informed.

Notification to CC to facilitate ongoing support.

At Birth or soon after

To meet legal requirement to obtain consent for post- mortem with the exception of Coroner's case

Midwifery

Consent for Post Mortem obtained by most appropriate registered professional

Ongoing

Provision of support to the family and appropriate referral to other agencies.

Health Visiting

Provision of ongoing support for existing family.

Midwifery

Appropriate management and support provision:

  • Midwife
  • Obstetrician
  • Paediatrician
  • GP
  • HV
  • SANDS
  • Hospital Chaplin /liaison team
  • Children’s Centre’s

Childrens Centres & EYFS

Provision of ongoing support for existing family.

Primary Care & GP

Provision of appropriate ongoing care and support.

Ongoing

Provision of support for future pregnancy.

Midwifery

Debrief and follow up discussion for future pregnancy planning/management delivered by:

  • Midwife
  • Obstetrician
  • Paediatrician
  • Specialist Consultant, etc.

At Birth or soon after

Care of unwell mother, provision of appropriate specialist care pathway & co-ordination of care.

Midwifery

Transfer to ward, ITU, HDU as appropriate , where possible with baby.

Mental Health Admission to Mother & Baby unit supported by community midwifery postnatal care provision.

Maternal Mental Health

Provision of appropriate care pathway Liaison with multidisciplinary team.

Primary Care & GP

Ongoing support and care provision.

At Birth or soon after

Provision of care for baby if not resident with mother and ongoing support to family.

Midwifery

If necessary undertake assessment of who will look after baby in partnership with social worker.HV etc eg:

  • NICU
  • Postnatal Ward
  • Home with relative
  • Paediatric Ward

At Birth or soon after

Co-ordination of care.

Midwifery

Discharge home notification to GP and HV and other relevant professionals.

At Birth or soon after

Co-ordination of care

Midwifery

Discharge home prior to 28 days P/N midwife to visit, post 28 days referral to relevant community professionals.

New Birth Visit (NBV)

Universal Plus all services and corresponding rationale as for Universal with additional as detailed in this section for Universal Plus.

To identify health needs and assess maternal emotional wellbeing and referral to specialist mental health services.

Health Visiting

Comprehensive assessment of the physical and emotional health of mother and baby ,to include a review of the mothers’ mental health; to include 3 WHO questions and clinical judgement to assess maternal mood.

A supplementary mental health assessment may also be used e.g. HADS, EPDS.

Prompt referral to Perinatal Psychiatry Services (puerperal psychosis).

Adult services to work with children’s services in the event of child safeguarding concerns.

Reference local referral pathway to specialist services – inform GP.

Promote support within social networks and family, promote breastfeeding.

Midwifery

Update HV on the health and emotional and social status of both mother and baby - notify GP.

Ask NICE recommended predication questions (only asked again if answers ‘no’ at midwife booking appoint).

Prompt referral to Perinatal Psychiatry Services (puerperal psychosis).

Adult services to work with children’s services in the event of child safeguarding.

Maternal Mental Health

In-depth liaison with Midwifery /HV services to determine level of parental mental health problems.

Assessment of parental isolation.

Prepare Mother for Health Visiting led Post Natal Depression support group if previous depressive history.

Refer to counselling as appropriate and liaise with GP.

A detailed discussion regarding attachment and attribution, transition to parenthood, family involvement and support required.

Observe for parents interaction with baby and signs of attachment and attribution.

Arrange follow up visits in agreement with parents.

One week – 6 - 8 weeks

Additional Assessment Visit

Needs to be carried out for each parent when the Mental Health issue is identified.

Listening Visits

Health Visiting

Maternal Mental Health

PHQ9 assessment reviewed and additional support contacts with parents identified.

Inform and refer to GP as needed. Refer to counselling with consent.

Facilitate access to Infant massage courses, postnatal education groups.

Negotiate Listening Visits.

More detailed discussion regarding attachment and attribution, transition to parenthood, family involvement and support.

Attachment Therapeutic Groups.

6 weeks - 6 months

6 weeks - 6 months

Core Purpose 3

Encourage strong attachment and bonding.

Childrens Centres & EYFS

Maternal Mental Health

6 weeks - 6 months

Provision of additional support

  • Promote the importance of parent and baby mental health/attachment.
  • Promote attuned, sensitive parenting that supports baby’s early development.
  • Promote importance of father involvement.
  • Provide information on, and registration with, local Children’s Centres.

Maternal Mental Health

Listening Visits

Infant mental health intervention to support mother/baby relationship
more emphasis on targeted approaches that promote the parent-infant relationship such as Solihull Parenting Groups.

Mellow Babies programme for clients that have accessed Mellow Bumps and those low risk
or unidentified clients who have experienced attachment difficulties in the postnatal period due to post traumatic stress, unresolved childhood loss or abandonment alongside other clients with current social difficulties -social care involvement and mental ill health - also learning disabilities.

Make referrals with consent to services and liaise (dependent on parent’s wishes).

Inform and refer to GP. Refer to counselling.

Offer referral to Video Interactive Guidance or locally commissioned attachment therapeutic groups via local Primary Infant Mental Health Services with HV involvement.

More detailed discussion regarding Attachment Therapeutic Groups
attachment and attribution, transition to parenthood, family involvement and support attachment and attribution, transition to parenthood, family involvement and support.

Arrange follow-up according to parental wishes promoting awareness of infant’s capacity e.g. use of Newborn Behavioural Observation.

0 - 1 year

0 - 1 year

Additional Assessment Visit

Needs to be carried out for each parent when the Mental Health issue is identified.

  • Review parental mental health.
  • Promote the importance of parent and baby mental health/attachment.
  • Promote attuned, sensitive parenting that supports infant mental health & development.
  • Promoting importance of father involvement.
  • Work in partnership with local IAPT services to promote perinatal guidance.

Health Visiting

The assessment visit require the:

  • Undertaking / review of the PHQ9 assessment.
  • Establishment of an action plan based on the parent’s individual support needs - with full support of both parents where possible. This plan will also be informed by in-depth liaison with relevant service providers to determine level of parental mental health problems.
  • Provision of targeted support e.g.
    • Listening visits to support transition to parenthood
    • Referral to counselling as appropriate and liaise with GP
    • Referral to Children’s Centre activities/services.
    • In cases where there are identified concerns regarding parental bonding and attachment, parental emotional availability and inappropriate parental expectations: targeted support should be provided.

Maternal Mental Health

Appropriate targeted support

Listening Visits Infant mental health intervention to support mother/baby relationship.

Postnatal depression support group.

Befriending services by volunteer services e.g. Homestart

Early intervention and prevention work.

Therapeutic group with the provision of a Crèche and co-facilitated by a Mental Health Professional with a focus on attachment.

Risk and resilience

Self esteem

Diet and exercise

Confidence building Basic Cognitive Behavioural Therapy- based on 5 areas of depression awareness.

Consider CAF as a gateway to Universal Partnership Plus.

Primary Care & GP

GP medication management (Need a regional pathway in consultation with specialist services)

Referral to a range of appropriate services e.g.

  • Crisis team
  • CBT
  • LA safeguarding
  • Adult mental health
  • Counselling
  • IAPT
  • HV

0 - 1 year

Additional Visit

Health Visiting

  • Observe for parents interaction with infant/child and signs of attachment and attribution.
  • Prepare mother for HV led Postnatal support group if previous depressive history
  • Promote breastfeeding
  • Encourage the building of parental resilience through family involvement support and the promotion of social networks if necessary including walk to door e.g. Children Centre groups or parent and toddler groups.
  • Signpost, refer, liaise to relevant services (dependent on parent’s wishes). Inform GP.

If parental mental health impacts on Child's safety a referral to Children’s Social Care must be made.

0 - 1 year

Additional Visits

Health Visiting

  • Observe for parents interaction with baby/infant and signs of attachment and attribution.
  • Prepare mother for Health Visiting led Postnatal Depression Support group if previous depressive history.
  • Encourage the building of parental resilience through family involvement support and the promotion of social networks.
  • Promote breastfeeding.
  • Encourage socialisation if necessary including walk to door e.g. Children Centre groups

If parental mental health impacts on Child's safety a referral to Children’s Social Care must be made.

0 - 1 year

Health Visitor led Postnatal Depression Support Group - Maternal

Delivery of Care Of the Next Infant (CONI) programme

Health Visiting

Therapeutic group with the provision of a Crèche and co-facilitated by a Mental Health Professional with a focus on attachment.

  • Risk and resilience
  • Self esteem
  • Diet and exercise
  • Confidence building
  • Basic Cognitive Behavioural Therapy- based on 5 areas of depression awareness.

Delivery of CONI programme to support the family with the increased anxiety caused by the death of a previous child.

0 - 1 year

Core Purpose 2, 3

Promote mental health and wellbeing.

Reduce risk of/actual child abuse/neglect practices/ competency.

Promote infant mental health.

Childrens Centres & EYFS

Family Support Worker provision

  • Encourage attendance at PN groups and support them (social integration)
  • Host Low Mood / Postnatal Depression groups
  • Provision of crèche to support the groups
  • Host and participation in the delivery of therapeutic groups
  • Delivery of evidence based early intervention attachment programmes - Targeted interventions such as Solihull Parenting Groups.

Delivery of Mellow Parents programmeSignpost to appropriate groups and liaison – communicate and share information.

1 - 5 years

1 - 5 years

Additional Assessment Visit

Needs to be carried out for each parent when the Mental Health issue is identified.

  • Review parental mental health.
  • Promote the importance of parent and baby mental health/attachment.
  • Promote attuned, sensitive parenting that supports infant mental health & development.
  • Promoting importance of father involvement.
  • Work in partnership with local IAPT services to promote perinatal guidance

Health Visiting

The assessment visit will require the:

  • Undertaking / review of the PHQ9 assessment.
  • Establishment of an action plan based on the parent’s individual support needs - with full support of both parents where possible. This plan will also be informed by in-depth liaison with relevant service providers to determine level of parental mental health problems.
  • Provision of targeted support e.g.


    • Referral to counselling as appropriate and liaise with GP
    • Referral to Children’s Centre activities/services.
    • In cases where there are identified concerns regarding parental bonding and attachment, parental emotional availability and inappropriate parental expectations: targeted support should be provided.

Health Visiting

Appropriate targeted support reviewed by caseload holder - HV. For example:
Listening visits Parental groups.

Befriending services by volunteer services e.g. Homestart

GP medication management (Need a regional pathway in consultation with specialist services).

Early intervention and prevention work. Consider CAF as a gateway to Universal Partnership Plus.

Health Visiting

GP medication management (Need a regional pathway in consultation with specialist services).

Referral to a range of appropriate services e.g.

  • Crisis team
  • CBT
  • LA safeguarding Adult mental health Counselling
  • IAPT
  • HV

1 - 5 years

Additional Visits

Health Visiting

  • Observe for parents interaction with infant/child and signs of attachment and attribution.
  • Encourage the building of parental resilience through family involvement support and the promotion of social networks if necessary including walk to door e.g. Children Centre groups or parent and toddler groups.
  • Signpost, refer, liaise to relevant services (dependent on parent’s wishes). Inform GP.
  • Explore parental feelings regarding the increasing independence of child and parental separation, anxiety regarding child attendance at pre-school setting.

If parental mental health impacts on Childs safety a referral to Children’s Social Care must be made.

0 - 5 years

Core Purpose 1, 2, 3

Promote mental health and wellbeing

Reduce risk of/actual child abuse/neglect practices/ competency.

Promote infant mental health

Childrens Centres & EYFS

Family Support Worker to work alongside caseload holder - i.e HV. to support family.

Encourage use of befriending services by volunteer services e.g. Homestart

Early intervention and prevention work.

Signpost to appropriate groups and liaison – communicate and share information.