Infant mental health awareness week – the Powys picture

Photo by Jonathan Borba on Unsplash

This week’s guest post is from Jolene Duggan, a mental health nurse who works for Powys Teaching Health Board as a Specialist Perinatal Mental Health Team Lead.

The post is published to coincide with Infant Mental Health Awareness Week, which runs from 13 – 19 June 2022, and is hosted by the British charity the Parent-Infant Foundation. The week provides an opportunity to discuss the importance of babies’ mental health as well as some of the issues that affect it. The theme this year is Understanding Early Trauma.

“The experiences we have in the earliest years of our lives impact the development of our brains. Experiencing trauma, such as exposure to domestic abuse, in the earliest years can have a significant impact on brain development, potentially leaving serious and lasting consequences that can create difficulties for the child into their adult years. This is not inevitable. Secure relationships with parents and carers can reduce stress caused by trauma and limit the long term impact it has on the baby’s development. Specialist support can help to strengthen these relationships and reduce the harms to babies.” Parent-Infant Foundation

Tell us about your role as a Specialist Perinatal Mental Health Team Lead 

The Specialist Perinatal Mental Health Service is a multi-disciplinary service that provides joint assessment, support and advice to professionals working with women who are experiencing, or are at an increased chance of experiencing, a moderate to severe mental health condition during pregnancy and up to 12 months after having a baby.

The service works with women across Powys who are planning a pregnancy, currently pregnant or have recently given birth and have moderate to severe mental health conditions including bipolar disorder, psychosis, depression, anxiety and maternal Obsessive Compulsive Disorder (OCD).

The team currently comprises of two perinatal mental health practitioners, a specialist midwife two days a week and a consultant psychiatrist for half a day. We also have our team administrator three days a week who does an excellent job supporting us all.

What led you to this role?

I have had a special interest in maternal mental health since 2012 when I found myself supporting a mother through an episode of postpartum psychosis on an acute mental health ward and realised how little knowledge of the illness I had and was shocked at the lack of support and provision available to her, her new-born child and her partner. It was a steep learning curve, and from then I took every opportunity to further my knowledge and champion the needs of women in the perinatal period with mental health illness.

After gaining employment in Powys I was fortunate enough to be invited to, and was one of the founding members, of the Perinatal Mental Health steering group and my passion for improving perinatal mental health services continued, resulting in my successful appointment to Specialist Perinatal Team Lead post last April.

What does the ‘best start in life’ look like for an infant (0 – 3 years)?

The first 1001 days include pregnancy and the first two years of a child's life. There is clear evidence that this is a significant and influential phase in development. What happens during this period lays the foundation for every child’s future health, wellbeing, learning and earnings potential. It sets the groundwork for children developing emotional wellbeing, resilience and adaptability and the competencies they need to thrive. This period is a time of opportunity for services and interventions to support parents and primary care givers to help lay a foundation of health and wellbeing whose benefits can last a lifetime and carry into the next generation.

How is infant mental health supported across Powys?

Infant mental health is supported by many agencies and support services across Powys and is at the forefront of consideration with all professionals who work with families but, as a newly established team, the Specialist Perinatal Mental Health service have recently been undertaking further training to improve our knowledge and skills in relationship parent infant assessment. In the future we will be looking to provide parent-infant therapies for parents who experience moderate-severe mental health illness in the perinatal period.

Who is eligible to receive support and how do they access it?

The Specialist Community Perinatal Mental Health Service is a multi-disciplinary service that provides joint assessment, support and advice to professionals working with women from across Powys who are experiencing, or are at an increased chance of experiencing, a moderate to severe mental health condition including bipolar disorder, psychosis, depression, anxiety and maternal OCD during pregnancy and up to 12 months after having a baby

The Perinatal Service runs alongside the Community Mental Health teams' core hours Monday to Friday, 9am to 5pm.

Referrals can be made by any professional working with an individual including social workers, midwives, health visitors, GPs, hospital-based teams, local authority services and mental health services.

Photo by Omar Lopez on Unsplash

Tell us more about Early Trauma and its impact on babies’ mental health

It is widely now recognised by professionals throughout the world that what happens in the first 1001 days of life are incredibly important. Children’s brains develop fastest, and are at their most ‘plastic’ or adaptable, in the womb and early years of life. A baby’s development is strongly influenced by their experiences of the world and these are shaped by their primary caregivers which are usually their parents. A parent’s response to a baby’s needs shapes how they experience their emotions and how they learn to regulate and express these emotions.

It is also important to remember that nurturing relationships begin before birth. The baby’s brain is developing rapidly during pregnancy and is influenced by the physical environment of the mother’s womb, and the environment beyond it. Babies can experience adversity in the womb. For example, where domestic abuse is occurring, research shows that babies’ stress regulation systems adapt accordingly, leaving them more responsive to threat but consequently more irritable and difficult to settle once they are born.

Therefore, it is vital to consider the parent infant relationship when supporting parents who may be experiencing, or are at an increased risk of developing, moderate to severe mental health problems during the perinatal period.

How are you working alongside other agencies, in particular voluntary groups, to promote good mental health for infants?

Two years ago ten professionals from Powys Teaching Health Board's Mental Health and Women's & Children’s services became the Institute of Health Visiting Champions. The role of the champions is to be ambassadors for perinatal and infant mental health within our local area and take an active role in leading the perinatal and infant mental health agenda.

Despite the obstacles that all of us have faced with COVID-19 the team of champions has successfully delivered perinatal and infant mental health training to over 60 healthcare professionals in Powys who work with families in the perinatal period. Our aim over the next 6 months is to open this up to Third Sector services as well as establishing a Powys perinatal and infant mental health Community of Practice where all agencies and professionals can come and share good practice and knowledge in relation to service development.

Photo by Sharon McCutcheon on Unsplash

Parental / carers’ wellbeing is important too. How do you support parents / carers who might be struggling?

Supporting other primary care givers’ mental health is also a key priority of the specialist mental health team and in our role as perinatal practitioners we take into consideration ‘the whole family’ when assessing needs in relation to perinatal and infant mental health.

Just like mothers, fathers go through a multitude of complex emotional changes during the perinatal period, and it is important when thinking about perinatal mental health that equal consideration is given to the mental wellbeing of fathers’ mental health. Once needs are identified appropriate signposting and or referral to relevant services to support the family’s needs are completed.

What is the most challenging aspect of your job as a Specialist Perinatal Mental Health Team Lead?

On a daily basis the complexities of the perinatal and infant mental health needs that present to our services can be challenging but, as a needs-led service we are equipped to be adaptable to meet those needs and work closely with other agencies and services across the health board to ensure co-ordinated and consistent care are delivered.

The most challenging aspect that I have personally encountered since embarking on this professional journey is that of trying to set up a new service in such a large geographical area which can present a number of barriers and challenges to equitable service provision. That said, I do like a challenge, and it has been very rewarding trying to think creatively about how we can deliver this across Powys.

Tell us about some of the most rewarding work you have done as a Specialist Perinatal Mental Health Team Lead

We have recently undertaken our Perinatal Service peer review by the Royal College of Psychiatrists’ Perinatal Quality Network. It was a great opportunity to reflect on what we have achieved over the last 12 months and felt very rewarding to hear positive feedback in respect of the service being delivered by the team.

What is the most valuable thing you have learnt since starting your role?

Communication and patience are key components needed when setting up a new service. The ability to ‘learn to walk before you can run’ is also fundamental.

If there was one thing you could change in the Infant mental health world, what would it be?

A specialist infant mental health service in every health board across the UK!

When you are not working in the Perinatal mental health team, how do you enjoy spending your time?

I have two boys aged 5 and 2 who keep me busy on a daily basis as well as helping my husband on the family beef and sheep farm where we also have an egg production unit. I am a club leader for my local young farmers’ club and enjoy giving back to an invaluable youth movement that gave me so many opportunities in life! I enjoy walking and spending time with friends and when I get the opportunity, I love to travel to new places both in the UK and abroad.

Many thanks to Jolene for telling us about what is in place to support infant mental health in Powys. If you would like to find out more you can contact Jolene by emailing jolene.duggan@wales.nhs.uk or follow her on Twitter.

North Powys Crisis Resolution Home Treatment Team

I first wrote about the introduction of a Crisis Resolution Home Treatment Team for North Powys (Montgomeryshire) in February 2013 (Home Treatment Team for the North) when Mike Shone unveiled the plans for the new team. Earlier this month I met with the team’s manager, Graham Batha, and asked him for an update about the service.

Tell us a bit about your background

I am a registered mental health nurse, and have been registered in this profession for approximately 10 years. I trained at the University of Central Lancashire, and then worked in Preston in an acute inpatient setting before moving to the Preston home treatment team. I later went on to work within the Wrexham home treatment team before moving to this post as the team manager for the Crisis Resolution Home Treatment Team in April 2013. My professional interests include service user involvement in the development of services, and professional education for students.

Tell us more about the service

The CRHT in North Powys opened in May 2013. To date we have received 419 referrals into the team, and our service is open 7 days a week, from 9am to 9pm Monday to Friday, and 11am to 7pm at weekends and Bank Holidays. The objective of the team is to provide an equal alternative to inpatient care, and to facilitate early discharge from hospital when it is safe to do so.

What staff roles do you have on the team?

The team consists of one team manager, one team secretary, one health care support worker and six registered nurses. The team is also having an additional 3 members of staff in the future. The team is also supported by a dedicated Consultant Psychiatrist.

Who can refer people for the CRHT service?

The Community Mental Health Team can refer people into our service, during the hours of 9am to 5pm. Out of hours, the CRHT does accept referrals from ShropDoc, which is the out of hours GP service.

Can people of all ages be referred?

We look after people aged 18 or over with a functional* illness.

What happens if someone experiences a crisis outside of your usual hours?

It can be useful to write a contingency plan with your care coordinator (if you have one), which can be used to highlight what needs to happen in an emergency. I would suggest that you contact your on call GP or in an emergency attend your local Accident and Emergency Department.

What is the nature of the service provided by a Crisis Resolution Home Treatment Team?

The CRHT is a short term but intensive service. The team visits service users on a frequent basis, up to twice a day, providing the same service as you would receive in hospital. When someone is referred into the CRHT team, the team will arrange an assessment as soon as possible. The team will then develop a care and treatment plan with that person, with the aim of supporting and aiding recovery. 

How do you promote a person’s recovery?

Twice a week, the whole team meets in a confidential environment to discuss each person that the CRHT is caring for. This allows the team to do its very best for the people we care for, and to support recovery in a timely manner. People who have used our service have been positive about their experience with us. The team does share the entire CRHT caseload, and people who do use our service can see all members of the team.

As a relatively new service in North Powys, how has the CRHT impacted on provision of mental health services generally?

The CRHT has had huge benefits in supporting those who really don’t want to go into hospital, and would rather stay at home. The team does, however, understand that sometimes hospital is necessary, and the CRHT will try to facilitate an early discharge with our support at the earliest opportunity when it is safe to do so.

Are there any specific needs that can be well-addressed by the CRHT?

The CRHT can help with practical issues such as housing etc, and will do all they can to ensure carers are supported.

Do you refer people on to other services?

When someone has recovered in the CRHT, their care is either referred on to additional mental health services or another appropriate service, or their care is handed back to the GP. In all cases the CRHT writes to the GP to ensure that the GP is aware of our intervention and any changes we may have made to the person’s care or treatment.

What are the challenges for a CRHT in a large rural area like North Powys?

The distance of travel that is required within this area is a challenge for the team, but it does not cause us too many problems once you become familiar with the area.

What are the most rewarding aspects of the work you do?

For me it is rewarding to see people recover at home, within a familiar setting, as opposed to a hospital setting. I feel that you are able to work with people more creatively and independently at home, as hospital can sometimes be restrictive.

How would you like to see mental health services developing in North Powys in the next few years?

From the view of the CRHT we would like to help and support more people to recover at home. We understand that hospital admissions will always be needed at times, but if we can reduce the stress of going into hospital for the client and their family, this may limit the amount of time it takes to recover.

Many thanks to Graham for the update. If you have any queries relating to the Crisis Resolution Home Treatment Team in North Powys, you can comment below.

*This term is defined online on an NHS jargon-busting website: "A term for any mental illness in which there is no evidence of organic disturbance (as there is with dementia) even though physical performance is impaired".