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New 'low stigma' perinatal mental health prevention tool

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A new “low stigma” tool to help prevent perinatal mental problems is being developed for potential use by midwives and health visitors in North London.

The tool, called the perinatal emotional health check, combines standard mental health screening questions with a new set of questions asking how the mother balances different parts of her life.

“My rationale for the perinatal emotional health check is to try and create something that is very low stigma”

Mike Scanlan

The extra set of questions ask the mother to score how highly she values different elements of her life such as friends, family, work and interests and then compare how much time, effort and headspace she puts into those.

It has been developed by mental health and wellbeing nurse consultant Dr Mike Scanlan, who noted that most existing perinatal screening tools do not include interventions.

By including the additional questions, midwives and health visitors can help identify how future problems might occur and suggest prevention strategies, said Dr Scanlan in an interview with Nursing Times.

He said the health check was designed so that it could be used with all mothers and, based on their answers, to then develop a personal wellbeing plan.

As the check also includes standard anxiety and depression checks – including the Whooley questions and Generalised Anxiety Disorder 2 (GAD2) and avoidance questions – if the mother scores highly on these scales, actions to address this can also be included in the wellbeing plan, said Dr Scanlan.

“If I were to carry out a perinatal emotional health check on a mum she may score very low on the Whooley questions but when we use the tool that asks if your life is in balance, we might find there are a couple of areas of her life where she has lost her balance,” he noted.

“So, once you’ve completed the check, the mum is then given the option to develop a wellbeing plan which is aimed at sustaining her wellbeing,” he said.

“Or, if at the other level, you do the check and she scores high on something like the anxiety score, you might include in the wellbeing plan something to make sure she gets in touch with her GP or health visitor,” added Dr Scanlan.

The check would ideally be used once during the ante-natal period as a prevention tool, but also during the post-natal period as a follow-up, he said, highlighting that it could also be used by third sector workers.

“Once you’ve completed the check the mum is then given the option to develop a wellbeing plan”

Mike Scanlan

He noted that for the majority of physical conditions, standard non-stigmatised health checks had been developed for women – such as those for ensuring healthy hearts, or gynaecological or breast checks – which was why the new tool was not referred to as “screening”.

“My rationale for the perinatal emotional health check is to try and create something that is very low stigma and that can be delivered with training by a non-specialist workforce as well,” said Dr Scanlan.

He told Nursing Times he was currently in discussion with Barnet Clinical Commissioning Group to explore whether the perinatal emotional health check could be used across the North London borough.

Paula Arnell, joint commissioning manager for mental health (adults) at Barnet CCG, said: “Following the government’s national focus on achieving parity of esteem in mental health, Barnet CCG has engaged in a process to review and explore services to benefit people in the community.

“As part of this focus, Barnet has been proactive in supporting local community and statutory providers to offer well-being support services at the right time and in the right place for individuals. Dr Scanlan is supporting Barnet to explore innovative ways to engage with people in the community around their needs,” she said.

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