Welcome to NSPCC Learning, a series of podcasts that cover a range of child protection issues to inform, create debate, and tell you all about the work we do to keep children safe. At the heart of every podcast is the child's voice, and how what they tell us, informs the work we do.
Hi and welcome to the NSPCC Learning Podcast. Over the next few weeks, we are releasing episodes related to how professionals from education, social care and health have adapted their services in order to safeguard children and young people during the COVID-19 pandemic.
The NSPCC knows that families across the UK are facing unprecedented pressures, coping with the implications of the COVID-19 pandemic, and this includes expectant and new parents. We know that the mental health of parents in the perinatal period can have long-term effects on infants, especially in relation to their later emotional and behavioural development.
It’s therefore vital that families receive consistent and appropriate support. The NSPCC has considerable interest and expertise in this area through its policy and research activity, including our Fight for a Fair Start campaign, where we’re calling for all families to get the support they need if they’re struggling with their mental health during the perinatal period.
We’ve also developed and deliver evidence-based services that support parents during the perinatal period, including Baby Steps and Pregnancy in Mind. And if you listen to episode five from April last year, you’ll hear our podcast about these services.
In light of all this, the NPSCC put together a panel of professionals to discuss the impact of the pandemic on pregnant women, new mums, their families and babies. The panel consisted of: Penny Dougan, a health visitor; Katie Worley, a health visiting and school nursing service manager; Eileen O'Sullivan, a specialist health visitor; Claire Spencer, who is a midwife; Dr. Jo Black, a consultant perinatal psychiatrist; and Dr Alain Gregoire, a consultant and senior lecturer in perinatal psychiatry and the chair of the Maternal Mental Health Alliance UK.
The panel began by discussing what impact the coronavirus pandemic and lockdown has had on their service.
So it all happened so quickly. We were absolutely on the back foot, weren't we? But we reacted really quickly and now really are managing to deliver a service, be it mainly over the telephone. So, we're still doing telephone assessments. We're still trying to offer the main key, mandated visits over the telephone, undertaking telephone assessments, but then offering some home visits where there is a compelling reason.
But what we have found is that the compelling reasons have tended to be more physical, so premature babies or where there's been a safeguarding concern. And we've all got concerns about our ability to assess maternal mental health over the telephone. And what exactly are we missing?
I have some interesting figures back from our referral and advice service at Birmingham Children's Trust. So, what they have said is that the week commencing the 23rd of March, that referrals into CAS, so into Children's Services, which would include referrals where there was concern about mental health, a significant concern, dropped by 50 percent. The referrals into Children's Services in Birmingham, a huge city, dropped by 50 percent in a week.
What we've now seen is that those referrals are picking back up. For example, domestic abuse referrals, doubled last week - in a week. But what they're now seeing is an overall increase in the referrals, again, concerning maternal mental health, parents support requests, substance misuse and concerns about neglect. So, the cracks are really beginning to show. The novelty, if there ever was a novelty, has definitely worn off.
I think from South Warwickshire, we probably echo that Penny. I think we had to mobilise really, really quickly and think quite innovatively and try and really get technologically advanced quite quickly. For us, this was all incredibly new.
We have offered, predominately in my role as a specialist health visitor, we're offering video conferencing. So, using online platforms to try, as best we can, to still have that eye-to-eye contact and trying to assess...
I understand your worries, Penny, on the phone it can feel like we are missing something. From our perspective, we've seen an increase in referrals, and that's two-fold really… We've identified there are more parents who are struggling, but equally, we're also finding that health visitors are undertaking less face-to-face contact and they're not quite so sure that they're picking everything up. And so, we're referring to the specialist services for that extra layer of reassurance and support.
I think we can shadow that experience in Slough as well, as Eileen and Penny have pointed out. We had to mobilise very quickly and we were also offering telephone and video consultations.
Health visitors have a huge range of skills around communication and assessment. And what they're having to do is they're having to utilise the skills they got and really expand on those because there is a big difference between being face-to-face with somebody and then having those conversations over the telephone or via video consultation.
Very similarly as well, we've also had to triple the number of staff that we've got health visitor-wise manning the duty lines just to deal with the volume of calls we've got coming through and also to act as a front door service to assess and triage all new referrals coming in. So, it's really been a very, very busy couple of weeks now.
We were asked very quickly to - like everybody else - to kind of reorganise our services. One of the things that we've been asked is to prepare our staff to be redeployed to cover the inpatient mother and baby unit. So that's a service that has to run twenty-four seven. Very highly risky kind of situations can emerge in the wards, so we absolutely couldn't leave the mother and baby unit uncovered.
What that meant for the community service though, was that we were having to think about reducing our caseloads so that we could manage some of our staff redeploying if that became necessary. And also, so that our staff could pick up one another's workload if any of them became unwell or if one of them was redeployed into the mother and baby unit.
I was heartened that we were classified as an essential service. We weren't being asked to be redeployed anywhere else within mental health services which we were thankful about. And it felt reasonable for us to be prepared to redeploy within perinatal mental health to make sure that we could do the work that absolutely needed to be done.
I have some concerns about the way that we're working online, and I don't want that to become our new normal. I think there's some alley to mums and babies for us to be able to be in the same space and get to know her. But yes, like everybody else, we're doing a lot of our work by video consultation and by telephone at the moment. But we will do face-to-face visits if needed.
I suppose the Maternal Mental Health Alliance's perspective, so as a coalition of nearly a hundred professional bodies and charitable organisations, everything that everybody does has been kind of turned on its head and everything has become focused, like it has for everybody else, on the immediate crisis.
But we have also had our eye to the aftermath. There's been a lot of work within these organisations - behind the scenes. So just taking one example of something that's been an issue that's been ongoing, and my latest exchange about it was this morning - pregnant women who are employed in high risk, high exposure, high stress circumstances. So you guys, for example, at the frontline of health and social care who are pregnant, the guidance has been entirely infection-with-the-virus focused, totally ignoring the stress of the circumstances that we all on this call know is incredibly important in pregnancy, it's important anyway, but we can kind of do what we can as adults to protect ourselves, but we can't always protect our babies from the risk that the stress brings.
And we know that major disasters increase stress in pregnancy and that that has a measurable impact on risk to the baby. Of course, most babies are actually fine, but this hasn't been taken into account by employers. And we've had lots of reports from extremely stressed pregnant workers who we all know the PPE story and the stresses around that, but the stresses of dealing with families who can't be with each other at really difficult times and so on.
The workplace has become incredibly stressful and really only the risk of COVID exposure and the virus has been taken into account. So, we've been working behind the scenes with the RCOG (Royal College of Obstetricians and Gynaecologists), which has now changed its advice, which is that employers have a duty of care to take into account the mental health of their pregnant employees as well as their physical health. So that's just been changed last week.
You know, it seems obvious, but when everybody's in a rush writing documents, it's understandable these things are left out. And we're now in discussion with Occupational Health Physicians Faculty to make sure that they understand that the stress is a risk in itself.
The panel then went on to discuss how vulnerable families are being supported during lockdown.
How we're reaching vulnerable people, Louise, is that we're trying to catch everybody on the postnatal wards so that nobody gets lost, so that they get into the service very quickly, especially for feeding postnatally.
And antenatally, I think the midwives are just trying their hardest to pick up those subtle nuances and cues on the telephone if they're doing consultations at the beginning of pregnancy and trying to link into services and contact the health visitors and GPs much earlier in pregnancy than maybe they would have done otherwise so that there's a network of people around them.
We've got a system where we identify the most vulnerable families that have above the universal service. So those families that are known to us, we are having regular contact with over the telephone and visiting if we need to, if there's a real reason.
But I think there will be families that will slip through the cracks during this. Because it's so difficult for them to kind of raise their heads above the parapet and ask for help. They won't be attending Well Baby Clinics, for example, they won't then be accessing any groups.
Next up for discussion was how postnatal assessments are being carried out in the current climate.
So, in Birmingham, we've continued to offer a six-week assessment, which I know hasn't been the picture nationally. But again, it's mainly over the phone so, it's a telephone assessment that does include some screening questions regarding mental health. And then I will follow that up with the home visit, if I've picked up an area of concern or the mum wants it.
Now, the family may not want you in the house. So even if you've picked up a concern, some family's level of anxiety is such that they really do not want you to visit. I have got families that are going to take a newborn visit over the phone and a six week contact over the phone and I’ve never met the mum or seen the baby.
It leaves me feeling anxious and uncomfortable about what we might potentially miss. And then if we do a home visit, we're obviously thinking of their safety as well as our own. So, the temptation is that you literally fly in with your mask on, and weigh a baby and leave quickly because you do want to be in a house for longer than 15 minutes, because you're very aware of what you're bringing into that house potentially. So, it just makes a holistic, in-depth assessment very difficult.
Where I work, what we've done is ask women to come to us. So, we have community hubs. They get two phone calls and then two visits. It's kind of a compromise. It's not ideal.
I specialise in infant feeding, so we’re seeing… obviously breastfeeding right now is really important because the babies need the anti-bodies more than ever. And women really do want to breastfeed, but obviously it’s not the easiest of tasks, so we are able to offer them face-to-face support for that. But the fact that we can offer a really good feeding service alongside postnatal care hopefully means that with breast feeding and mental health being inextricably linked, that we can kind of support women in those early days and lead them on to services. But there's definitely been a mix of experiences for women and this cohort of women, the starts of their journeys in parenting. We're just going to have to watch how it goes but I think we need to be very mindful.
To echo you Penny, we are still delivering all the mandated contact, whether that's through telephone calls or whether it's through video conferencing.
We've found probably that we had an added influx in the sense that some of those universal development assessments, we're finding a lot of mums' conversations are mourning a lost maternity leave. So whereas some of those routine postnatal contact that we would have done where we would have thought it was fairly universal, on exploration and asking those routine questions that we ask at all contact, it's uncovering a later episode of kind of feeling low or COVID-related anxiety or a lost maternity leave and being furloughed, but returning to work and being anxious about that.
There's so many added layers of challenge for mums that we're seeing. So that postnatal care is probably more intense for a longer period for our service.
The panel then moved on to discuss how restrictions during lockdown have affected fathers, wider family members and how this is also highlighted inequalities in our society faced by many families. And they finished by discussing how we can shape services moving forward.
It must just be horrendous. And I don't think we can begin to understand the impact that's going to have. The anxiety that the father must be so worried about his partner but so worried about his child, unable to see his child and bond and attach with his child. I think we're going to be dealing with the fallout from this long term.
There's the pressure cooker as well, isn't it, now for dads postnatally, where the expectation is that they are perhaps working from home, which is wonderful from a bonding perspective perhaps, that they might get to spend more time with their child than they ordinarily would. But then they might also be spending time also trying to home school some older children, while supporting their partner.
Spinning so many plates in a very small world can feel quite pressurised. And we know already that so many dads feel the weight and the burden. There might be the financial burden, an added layer of financial burden because of COVID-19, due to a lack of salaries or 80 percent furloughs, that all of these added layers are going to impact on father's mental health. And dads, we know from our professional experiences, are often really reluctant to come forward and speak about their feelings. They feel that their feelings are normal and they just have to be the rock that carries on.
So within this, I anticipate that that's going to have increased the likelihood of a father's experience in mental health, but still not quite feeling that there's the services available there for them to come forward and get that support.
And there's also a risk that we design services based on that very traditional idea of family, which is lots of people's normal, but it's not everyone’s.
So from a culture where it's the grandma and the aunties who wrap around a mum at this particular time, we talk about how to engage with other communities, the impact on those communities of not meeting their new grandchild, and the impact on mum of not having her sisters or her mother or whatever their normal birth experience expectations were.
Whether that was having dad at the birth or whether it was having grandma fly in from Pakistan. You know, we can't I think begin to unpick the layers and layers of this. It's really interesting from an anthropological point of view and it's happening right now and seems to be happening very quickly. But I think there are a lot of family stories here. Dads are one of them and a really, really vital one of them, but I think those wider matriarchal societies are really also struggling with some of this.
When I was leaving the postnatal ward the other day, there was just a group of dads pacing up and down because they're waiting to know, and leaving a postnatal ward is not kind of done in a timely fashion. So, I didn't know how long they've been there for but they weren't talking to each other. They were just pacing. And it just reminded me of that 'call the midwife' stages where they want to be there, but they can't be there. And, you know, taking on that burden of information is just so much harder for women.
The only thing that I've tried is emailing the family. So therefore, information can be shared through email but it's not the same. It definitely isn’t. And it's something that maybe postnatal groups in the future needs to take on board - this cohort will need something different. There'll be women coming up and families coming up in the future that will require what we used to do, but then this cohort will need something very different.
What's happened has thrown into focus as well, the inequalities in our society. And I think we are going to have to consider carefully the different needs of different groups of people. And we know the huge differences between the privileged in our society.
I've got a garden and I've got books, and you know, I can keep myself actually very happily entertained. And I haven't got young children to look after any more.
Stuck on the tenth floor flat with one bedroom and six children and a new baby in a stressful situation, completely different needs for a very, very long time to come. And we are going to need to consider all of those and adapt our services.
Absolutely. I think the key as well as moving forward is remembering, we've touched on it, is to have those conversations with those families to explore what they would find useful, because we know that services work well when we ask the people who will be accessing them what they need and how they should look.
So, I think it's really important to take sort of pregnant women and new mums and mums with older children on this journey with us in shaping how we move forward and make sure that the support is adequate.
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