Background
Ealing SAB carried out a joint practitioner workshop with Ealing Safeguarding Children Partnership, with input from Essex Partnership University Trust’s Service Manager peri-natal MH Community Services and the Assoc Dir Safeguarding. The workshop looked at the case of a 31-year-old mother of a 4-month-old baby, who jumped from a 3rd floor block of flats in 2020. The mother had a number of interactions with her GP, health visitor and breast-feeding advisor, on each occasion reporting her concerns relating to her daughter's feeding, whether she was feeding well and getting enough milk. During an appointment with the health visitor the mother reported sleep difficulties advising that it had been 10 days since she had slept properly. In the last appointment at the UTC with a GP the mother’s presentation was tired and anxious, she may have played down her issues because of concerns regarding the stigma of mental health in her culture.
Safeguarding concerns
- Peri natal mental health and the prevalence of difficulties
- Understanding risk
- Understanding the link to suicide
- Themes from national learning
- Assessment and red flags in a woman’s history
- Understanding urgency vs routine presentations
- The importance of understanding culture and circumstance
- Practice themes in clinical care
Key lines of enquiry
- GP
- The role of primary care Peri natal MH - understanding the pathway
- The interplay between adult and children's services
- Professional hierarchy
- Listening to each other
Findings / emerging themes
- The cultural issues and stigma associated with mental health concerns. Mental health difficulties carry with it a stigma, exacerbated in some instances by culture and ethnicity. This may in turn lead to concerns being minimised or played down, which compounds the challenge in assessing risk appropriately.
- Understanding fully the role of past history and its current impact. The impact of adverse past experience is important to understand, in relation to the impact on current circumstances.
- Use of interpreters , the challenges of using family members. Using interpreters to understand the real experience of individuals is important. Availability & accessibility can sometimes be an issue in urgent situations.
- Understanding the significance of multiple interactions with professionals. Effective collaboration is key to effective safeguarding, particularly in sharing information to assess risk and need. In this case the interface between perinatal, midwifery and primary care was explored.
- The impact of sleep deprivation on functioning. The absence of disturbed sleep on functioning is significant. It distorts reality and perception and adversely impacts mental health.
- Effective communication between professionals. The use of formalised strategy discussions to understand presenting risk. Think Family and cross boundary work needs to be undertaken.
- Access to specialist advice for professionals. The importance of specialist advice on issues of peri natal mental health, recognising that understanding risk in this area requires expertise.
- Professional curiosity. Piecing together episodes of concern and asking critical and challenging questions of ourselves and each other is critical.
- The role of fathers. The importance of focusing beyond mother and child and examining the role of father is important. When is it a safeguarding concern?
Practice implications/ practice development
- Adopting a Think Family policy that unifies adult and children’s services.
- Developing shared clarity regarding the pathways for peri natal care.
- Consideration of thresholds of concern : Apply lower threshold for concern in perinatal mental health and especially where culture /language is the context.
Implementing change
Reflect on the findings with your team or service and discuss how this might impact on your practice. Identify what you or your team might do to act on the findings and to implement any change.