#WeStNs - Wednesday 15th September 2021 8pm (GMT Standard Time) Looking after parent’s mental health in the perinatal period

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The ‘perinatal period’ is officially considered to be the period from conception of a baby until the baby turns one (NHS England). However, we also know that parents continue to experience perinatal mental illness outside of this time due to a lack of diagnosis,limited access to appropriate specialist services and the stigma and lack of awareness associated with it. One in five mums and one in ten dads will experience some form of mental illness during this time (NHS England).

Many different healthcare professionals will come into contact with parents during this time and as part of ‘Making Every Contact Count’ (Public Health England) it is crucial that all professionals have an understanding of perinatal mental illness along with where parents can seek appropriate support.

Discussion:

What is perinatal mental illness and why are these parents such a unique patient/service user group?

If you see a parent in the perinatal period what red flags should you look out for?

How can we ensure a whole system responsibility for picking up on perinatal mental illness and what can we all do in different roles to manage their care?

What are the barriers we need to consider for these patients/service users accessing appropriate care?

How do we ensure we are getting it right when communicating with these patients or service users?

Further Reading:

https://www.england.nhs.uk/mental-health/perinatal/

https://www.rcgp.org.uk/clinical-and-research/resources/toolkits/perinatal-mental-health-toolkit.aspx

https://fingertips.phe.org.uk/profile-group/mental-health/profile/perinatal-mental-health

https://www.rcpsych.ac.uk/docs/default-source/improving-care/nccmh/perinatal/nccmh-the-perinatal-mental-health-care-pathways-full-implementation-guidance.pdf?sfvrsn=73c19277_2

https://www.hee.nhs.uk/our-work/mental-health/perinatal-mental-health





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 #WeStNs transcript

 
@WeStudentNurse
15 September 2021 20:00
Hi everyone, Welcome to this tweet chat looking at perinatal mental health. Who do we have today and where are you all from? #WeStNs https://t.co/qBl1l9DsKV
@WeStudentNurse
15 September 2021 20:02
Just a little reminder! #WeStNs https://t.co/AkrJWu95f5
@WeStudentNurse
15 September 2021 20:03
@samkitchen03 @HullNursing Welcome ?? there's been a lot of work around supporting parents with learning disabilities during this time as there's lots of extra complexities to consider! #WeStNs
@lucy_uo
15 September 2021 20:04
@WeStudentNurse Hi everyone. I'm Lucy, a 3rd year adult student from @UniBham_Nursing I don't have much experience of this topic so looking forward to learning #WeStNs https://t.co/6X18xF35ww
@scPALMERNASH
15 September 2021 20:04
@WeStudentNurse Hay ! I'm Sam, just going into year 2 at the Uni of Hull. Learning Disability nursing. #WeStNs.
@WeStudentNurse
15 September 2021 20:04
@BragancaCheryl Welcome Cheryl ?? #WeStNs
@WeStudentNurse
15 September 2021 20:05
So lets start with Q1... #WeStNs https://t.co/8StSpYI6VW
@nikkilouh
15 September 2021 20:05
@WeStudentNurse Hi I am Nikki a returning year 3 MH student after having a little time out but ready to return. #WeStNs
@WeStudentNurse
15 September 2021 20:06
@lucy_uo @UniBham_Nursing Welcome Lucy! Hopefully you'll pick up lots of useful pieces of advice! ??It's something you could come across frequently depending on where you go post-qualification! Particularly if general nursing on postnatal wards/health visiting/ practice nurse in GP surgery etc #WeStNs
@WeStudentNurse
15 September 2021 20:08
@BragancaCheryl Welcome Cheryl! Lovely to have you! ?? #WeStNs
@lucy_uo
15 September 2021 20:08
@WeStudentNurse @UniBham_Nursing I'm hoping to go into general practice so I'm sure it will be helpful #WeStNs
@lucy_uo
15 September 2021 20:08
RT @WeStudentNurse: So lets start with Q1... #WeStNs https://t.co/8StSpYI6VW
@WeStudentNurse
15 September 2021 20:09
@scPALMERNASH Welcome Sam! Lots of interesting work on perinatal mental health for parents with learning disabilities - so many extra considerations and complexities ?? #WeStNs
@WeStudentNurse
15 September 2021 20:10
@lucy_uo @UniBham_Nursing Definitely! Heard lots of good stories about amazing nurses picking up on mums who aren't themselves when going for smears or baby imms! #WeStNs
@lucy_uo
15 September 2021 20:11
@WeStudentNurse Perinatal mental illness is mental illness with onset during the perinatal period. For these parents lots of different factors could go into their MH. Their life is likely to have undergone a drastic change and the extra responsibility of having a child #WeStNs
@TuckwoodBethany
15 September 2021 20:11
@WeStudentNurse Perinatal mental health which occurs during the pregnancy or up to one year post birth #WeStNs
@lucy_uo
15 September 2021 20:13
@WeStudentNurse This can also have an impact on relationships, sleep patterns, work status (e.g. paternity leave). For women there's also the impact of changing hormones. Then there is the social pressure to be a 'perfect' parent and in live with your child from the beginning #WeStNs
@lucy_uo
15 September 2021 20:13
@WeStudentNurse And if it was a difficult birth this could have a psychological impact on both parents. #WeStNs
@WeStudentNurse
15 September 2021 20:15
Q2: #WeStNs https://t.co/8R0KvvJt3U
@nikkilouh
15 September 2021 20:15
@WeStudentNurse I am looking forward to it very much #WeStNs
@WeStudentNurse
15 September 2021 20:15
Fantastic! Recently NHS England have heavily funded this area to ensure that all parents have access to a specialist perinatal mental health service and that they can access this for up to 2 years postnatally! Referrals can now be made up to baby's 1st birthday! #WeStNs
@BragancaCheryl
15 September 2021 20:16
@lucy_uo @WeStudentNurse specially for the first time parents #WeStNs
@WeStudentNurse
15 September 2021 20:16
There is also now a specialist perinatal mental health team in every area of the UK and referrals can be made from healthcare professionals into these teams for specialist support! #WeStNs
@WeStudentNurse
15 September 2021 20:18
@lucy_uo Definitely - re change a really common one is losing a parent in pregnancy or after baby's birth (especially if they lose their mum), also being a professional places you at high risk as you are used to control & order! #WeStNs
@WeStudentNurse
15 September 2021 20:18
Many people also don't know that the majority of parents who experience perinatal mental illness have no history of mental illness at all #WeStNs
@BragancaCheryl
15 September 2021 20:19
@WeStudentNurse acts of violence or self harm #WeStNs
@BragancaCheryl
15 September 2021 20:20
@WeStudentNurse new and persistent expressions of incompetency #WeStNs
@lucy_uo
15 September 2021 20:20
@WeStudentNurse Change in behaviour from previous visits, nit appearing to take care or self and/or baby, low mood, disclosures of difficulty eating/sleeping, #WeStNs
@AmySmith_5
15 September 2021 20:20
@WeStudentNurse Hello ???? #westns I’m just here to advocate that a diagnosis of peri/post natal mental illness can, and often does occur following the 12 month post birth period due to a number of factors including stigma, lack of support and masking coping mechanisms.
@lucy_uo
15 September 2021 20:21
@WeStudentNurse A bit like how healthcare professionals are meant to be the worst patients #WeStNs
@WeStudentNurse
15 September 2021 20:22
@nikkilouh Definitely! Some cultures require mum to isolate after a baby is born for a period of time and I can imagine that must feel really difficult if your mental health is already struggling! #WeStNs
@AmySmith_5
15 September 2021 20:24
@WeStudentNurse #westns Perfectionism. Catastrophic thinking.
@WeStudentNurse
15 September 2021 20:24
@lucy_uo Definitely!! #WeStNs
@WeStudentNurse
15 September 2021 20:25
Q3: #WeStNs https://t.co/zuElN9gkrv
@BragancaCheryl
15 September 2021 20:25
@WeStudentNurse @nikkilouh Also when the baby is premature baby the mental health of the parents gets disturbed as the baby is kept away in an incubator for certain days #WeStNs
@lucy_uo
15 September 2021 20:25
RT @WeStudentNurse: Q3: #WeStNs https://t.co/zuElN9gkrv
@WeStudentNurse
15 September 2021 20:26
@AmySmith_5 Definitely! #WeStNs
@WeStudentNurse
15 September 2021 20:27
Interesting thoughts on red flags tailored to fathers? They often get overlooked so key to be aware of these! #WeStNs https://twitter.com/MichelleDyerPMH/status/1438222501709033472
@WeStudentNurse
15 September 2021 20:28
@MichelleDyerPMH Great insight into specific factors affecting dads! They so often get overlooked and find it harder to reach out don't they! #WeStNs
@nikkilouh
15 September 2021 20:28
RT @WeStudentNurse: Interesting thoughts on red flags tailored to fathers? They often get overlooked so key to be aware of these! #WeStNs
@TuckwoodBethany
15 September 2021 20:28
@WeStudentNurse Holistic assessments & more education so clinicians are aware of how to support someone or who to refer to #WeStNs
@WeStudentNurse
15 September 2021 20:29
@AmySmith_5 Not at all! You're very welcome! it's great to be able to provide extra input to those professionals who are here to learn more! ?? #WeStNs
@lucy_uo
15 September 2021 20:29
@WeStudentNurse #WeStNs
@nikkilouh
15 September 2021 20:29
@BragancaCheryl @WeStudentNurse Also difficult births eg emergency c sections or forceps etc can have an impact too . #WeStNs
@AmySmith_5
15 September 2021 20:30
@WeStudentNurse Continue to raise awareness and reduce associated stigma. Support open dialogue from those with lives experienced. Education is key! #WeStNs
@WeStudentNurse
15 September 2021 20:30
@MichelleDyerPMH Definitely! Also their worries around being a father - I've heard there can be an increased risk if dad doesn't have a great relationship with his own father! #WeStNs
@AmySmith_5
15 September 2021 20:31
@WeStudentNurse Continue to raise awareness and reduce associated stigma. Support open dialogue from those with lived experienced. Education is key! #WeStNs
@WeStudentNurse
15 September 2021 20:31
Then we've also got the added dyad of LGBTQ+ parents who struggle to navigate the system! #WeStNs https://twitter.com/MichelleDyerPMH/status/1438223250740363273
@WeStudentNurse
15 September 2021 20:32
@BragancaCheryl Agreed - so often for healthcare professionals to unintentionally feed into these thoughts as well with comments which are intended to be helpful #WeStNs
@nikkilouh
15 September 2021 20:32
@WeStudentNurse Frequent colds , feeling run down , self neglect or too perfect ( if that makes sense ( , tearful , unable to cope with simple tasks , self medicating , appetite changes . #WeStNs
@WeStudentNurse
15 September 2021 20:34
@lucy_uo Societal pressure is huge on parents. There's so much stigma associated with mental illness generally but then add in a baby and society expecting this to be the happiest time of their lives !! #WeStNs
@WeStudentNurse
15 September 2021 20:35
Q4: #WeStNs https://t.co/HLmtaOMac7
@WeStudentNurse
15 September 2021 20:35
@lucy_uo Birth Trauma is another big factor and potential cause of postnatal depression and anxiety particularly! #WeStNs
@lucy_uo
15 September 2021 20:36
RT @WeStudentNurse: Q4: #WeStNs https://t.co/HLmtaOMac7
@nikkilouh
15 September 2021 20:36
@WeStudentNurse Public health awareness on Perinatal health , ensure face to face appointments where possible and regular appointments, reassuring parents it is ok to ask for help , good person centred care , support groups. #WeStNs
@WeStudentNurse
15 September 2021 20:37
@lucy_uo Yep! So often professionals will ask "how is your sleep?" and mum will reply "baby sleeps well" - its then picking out "well how have you been sleeping" - easy things to miss! #WeStNs
@AmySmith_5
15 September 2021 20:38
@WeStudentNurse Shame, be it intrinsic, cultural or otherwise. Also, for people with a learning disability, for example, difficulty communicating changes in mood. #westns
@WeStudentNurse
15 September 2021 20:39
@BragancaCheryl @nikkilouh There's a huge extra dynamic for parents of a baby in NICU. Covid visiting restrictions have definitely made this worse as both parents cant be there! Bonding can be affected as well as you mention! #WeStNs
@lucy_uo
15 September 2021 20:41
@WeStudentNurse Worry about the baby being taken away. Worry about appearing to be a 'bad' parent. The idea that it's just the 'baby blues' and they'll get over it. Possibly worry about how MH medication might impact their ability to look after the baby & concerns with breast feeding #WeStNs
@WeStudentNurse
15 September 2021 20:41
@TuckwoodBethany More training is definitely needed! Also to professionals outside of the obvious midwives, health visitors etc - I know Public Health England are doing a lot of work around Making Every Contact Count (MECC) for wider professionals who may come into contact with parents #WeStNs
@AmySmith_5
15 September 2021 20:41
@WeStudentNurse @lucy_uo Yes, absolutely, or previous experiences of trauma that may be triggered by the birthing process. #WeStNs
@WeStudentNurse
15 September 2021 20:42
As a couple of people have mentioned this evening - an MDT approach can be crucial to picking up on those small signs! #WeStNs https://twitter.com/lucy_uo/status/1438223465597767688
@lucy_uo
15 September 2021 20:43
@WeStudentNurse Or I don't sleep because the baby is awake, when actually that could be a way of justifying #WeStNs
@WeStudentNurse
15 September 2021 20:43
@nikkilouh @BragancaCheryl They can! We almost need a flag on notes for when a mum has had a traumatic birth or complications so other professionals can see this. Sometimes things go on baby's notes but a professional seeing mum wouldn't necessarily see these! #WeStNs
@WeStudentNurse
15 September 2021 20:45
Question 5: #WeStNs https://t.co/Rg7rglZIB4
@WeStudentNurse
15 September 2021 20:45
@AmySmith_5 Co-production is vital in all aspects of healthcare but definitely in perinatal mental health! #WeStNs
@AmySmith_5
15 September 2021 20:45
@WeStudentNurse Understanding that the assessment tools being used do not create a whole picture. And the need for the assessing practitioner to read nonverbal cues and covert signs of asking for help. #WeStNs
@lucy_uo
15 September 2021 20:45
RT @WeStudentNurse: Question 5: #WeStNs https://t.co/Rg7rglZIB4
@WeStudentNurse
15 September 2021 20:46
@AmySmith_5 As someone with experience what would you say would help to raise awareness and reduce stigma? #WeStNs
@WeStudentNurse
15 September 2021 20:46
@MichelleDyerPMH I guess they see more than mum as well which can't be easy! #WeStNs
@WeStudentNurse
15 September 2021 20:47
@sarahemilnes @ParentingQueer What a fantastic resource! Do you have any insight to tips to share on what can be done particularly to support these parents? #WeStNs
@nikkilouh
15 September 2021 20:48
@WeStudentNurse #WeStNs
@WeStudentNurse
15 September 2021 20:48
A great resource for supporting LGBTQ+ parents shared here! #WeStNs https://twitter.com/sarahemilnes/status/1438224693266460678
@WeStudentNurse
15 September 2021 20:49
@MichelleDyerPMH Definitely! What confounding figures do you think people need to be most aware of? #WeStNs
@WeStudentNurse
15 September 2021 20:50
Key message here: It's ok to ask for help!! #WeStNs https://twitter.com/nikkilouh/status/1438225331262038020
@lucy_uo
15 September 2021 20:50
@WeStudentNurse Being open and non judgemental. Making sure even if you are treating the baby you are asking about the parents too. If possible try and see the parents apart as they might be worried about speaking in front of a partner #WeStNs
@WeStudentNurse
15 September 2021 20:51
@nikkilouh Makes you realise the huge impact covid has had on perinatal mental health doesn't it! #WeStNs
@WeStudentNurse
15 September 2021 20:52
We have a few learning disability nurses here tonight. Can anyone share tips for communicating with patients with a learning disability about potential concerns re their mental health? #WeStNs https://twitter.com/AmySmith_5/status/1438225629837766662
@WeStudentNurse
15 September 2021 20:53
@AmySmith_5 Yes and definitely aggravated by the fear of their baby being removed! #WeStNs
@AmySmith_5
15 September 2021 20:54
@WeStudentNurse Kindness and compassion goes a long way. And of course, considering a trauma informed approach when choosing language. How do we know we have got it right? Seek feedback, reflect and always be willing to learn. #westns
@nikkilouh
15 September 2021 20:54
@WeStudentNurse Be sensitive and not been too intrusive, respect cultural / religious views/experiences ,build a rapport as it can be hard to admit you are not coping etc , reassure parents that every baby is different as pressure from other parents /family can pressure #WeStNs
@WeStudentNurse
15 September 2021 20:55
@lucy_uo So many mums worry about baby being taken away! It's important parents are reassured by this and professionals seek support from specialist perinatal teams before making safeguarding referrals just because a mum has OCD type thoughts etc #WeStNs
@WeStudentNurse
15 September 2021 20:55
@AmySmith_5 @lucy_uo ?? #WeStNs
@shakilak
15 September 2021 20:56
RT @WeStudentNurse: So lets start with Q1... #WeStNs https://t.co/8StSpYI6VW
@AmySmith_5
15 September 2021 20:57
@WeStudentNurse Proactive strategies (suited to the individual’s style of communication) to empower the person/parents to understand warning signs and when and where to seek help. #westns
@WeStudentNurse
15 September 2021 20:57
It can be tricky as all professionals use a variety different assessment tools for the mental health of parents. What are the pro's and con's of these? #WeStNs https://twitter.com/AmySmith_5/status/1438227443056353289
@WeStudentNurse
15 September 2021 20:57
Any advice for Sarah? #WeStNs https://twitter.com/sarahemilnes/status/1438229505789792256
@WeStudentNurse
15 September 2021 20:58
@lucy_uo Great idea! Seeing the family as a whole is definitely key but agree seeing the parents separately could give you more! #WeStNs




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