Perinatal and Infant Mental Health (PIMH) Network for England

 

1. Background

The National CAMHS Implementation Lead National CAMHS Support Service (NCSS) in the Care Services Improvement Partnership (CSIP) and the National Clinical Director for Children and Young People agreed that a national Perinatal and Infant Mental Health (PIMH) network for England would be created 2007-8.

The rationale was the need to improve local delivery of services to mothers and very young children, in the context of major policy initiatives aimed at improving maternity services, the development of a national child health promotion programme, and other policy drivers listed below.

From the NCSS national Infant Mental Health conference in 2005 it was clear there were many examples of good practice in different parts of the country, but very variable local networking with key other stakeholders in adult and childrens services, little consensus about the most effective approaches to infant, as opposed to maternal mental health, and that there was, in particular, the need to support the strengthening of knowledge in commissioning of both sets of services conjointly.

Many of the symptoms listed in the Guide to Locally Managed Networks (LMN) as indicators of potential benefits of developing Locally Managed Networks also applied to the national scene:

  • Widespread delivery of services to different standards and models of care even within local (i.e. neighbourhood) contexts (Click here)
  • Problems discharging from care due to mother baby relational problems
  • Poor outcomes for many babies – developing conduct disorder and ADH
  • Poor information about what is available
  • Complaints from (especially) mothers about services
  • Absence of performance management in many places or of standards to manage performance against
  • Difficulties in achieving more joined up commissioning or re-commissioning of existing services
  • Lack of clear guidance about best methods of diagnosis and treatment of infant mental health problems – a range of approaches some of which suit different situations, some for different clinical presentations, are available.
  • Routine outcome measurement is infrequent. There is no generally accepted measure. Assessment tools are similarly diverse.

Potential advantages / improvements identified by setting up a national network included the following:

  • Improved focus on high level aims of the system – policy, and buy in by stakeholders at national and regional level
  • Reduction of variation in service standards by promoting a set of service standards in the context of a care pathway exemplar
  • Benchmarking standards for services against a care pathway exemplar
  • Potential involvement of users in advising on policy and delivery standards
  • Improvement of safety of children and their parents by improving knowledge of the best clinical approaches, governance and commissioning arrangements
  • Improved service reach and access to socially excluded families
  • Improved equality of service provision – more consistent commissioning and provision across localities and regions
  • Identification of problems in relation to development and delivery of these services by clinicians, commissioners and regional and national stakeholders, and knowledge sharing about solutions
  • Facilitation of sharing of good practice
  • Potential to influence new funding by commissioners by providing the knowledge and evidence base against which to commission
  • Influences commissioning and service design and reconfiguration
  • Impact on workforce by supporting training and enabling training
  • Bringing together key partners from across policy and service delivery organisations

2. Purpose of a perinatal and infant mental health network

A national perinatal and infant mental health network will:

  • Develop simple mechanisms to enable a networked approach to knowledge sharing, the basis of which would benefit inter and intra regional training and development of services
  • Develop perinatal and infant mental health pages on the CSIP website to make accessible/share knowledge about the field of perinatal and infant mental health including
    • Provide examples of emerging practice and service design
    • Support to the improved commissioning of Perinatal and Infant Mental Health services through shared examples of service level and commissioning agreements
    • Identify sites which are in a position to share their practice, who have agreed policies
    • Identify sites which demonstrate good liaison between maternity, perinatal services, adult mental health and CAMHS
    • Identify the evidence base for early intervention in infancy
    • The website will make explicit the links relating to a public health perspective, commissioning, parenting strategies in DCFS and DH.

3. Potential users of a PIMH network and website

The network aims to support and provide information to the following groups:

  • Commissioners of local authority childrens services, and health/mental health services to adults and children
  • Providers of childrens services in local authorities and health services, and adult mental health services, both individually, and on behalf of service
  • Members of the general public, particularly those who have experienced perinatal or infant mental health services and want to discuss their experience or pass on learning about it
  • Central policy teams in need of advice, examples of good practice, identification of problem areas from the groups above


4. Network funding and leadership

Scoping work and a survey of perinatal and infant mental health services was carried out in the summer and autumn of 2007, with a view to getting a clearer view of what services were being provided, and establishing links with significant stakeholders in DH, DCSF, adult and childrens service providers, the third sector, and within CSIP. The broad consensus supported the establishment of a perinatal and infant mental health network in England, that there should be an email network, and that this should be supported by a website. It was agreed that CSIP would set up the network, subcontracting its running to a network provider and funding it for a year from April 2008 in the first instance. Leadership for the network development will come from a national steering group formed and chaired by the CSIP lead.

5. Relevant Contexts

National Policy, Guidance and Activity

There is a large range of policies, guidance and activity across government relating to the delivery of perinatal and infant mental health services. They illustrate a growing interest in the importance of early attachment and the significant of early relationship in the development of the brain. Some of the more significant ones, mainly in the childrens policy field, are listed below.


It is vital that practitioners in the field of perinatal and infant mental health have a good understanding of this context and the expectations which it places upon them. The network and website have the potential to make these expectations specific to their activity, by highlighting relevant policy and guidance.

The Public Health context

This includes:

  • Changing needs of pregnant women
  • Changing patterns of work and work life balance
  • Changing birth-rates (by 2021 number of young people will have fallen by 20%, but is then set to rise again)
  • Changing ethnicities: the fastest growing birth-rates are in ethnic minority populations who form some of the most socially excluded sectors of the population and pose challenges to services to deliver effective health care differently

Resource constraints

There are current resource constraints for commissioners and service providers – in particular

  • The current financial settlement for the NHS poses a significant challenges to the NHS with a reduction in the new spending round from the level of 7% annual increases. Improved advice to commissioners and identification of the longer term cost benefits of investment in infant mental health enable a case to be made for further investment in these services through the network
  • Staff and skill shortages. The new role for Health Visiting (Face the Future and CHPPDS), whilst acknowledging their centrality in delivery of perinatal and infant mental health services, is being developed in the context of a workforce which is aging in many parts of the country. There is likely to be an increased need for specialist support to this primary care role, which a network should enhance.

Changes in public expectations

  • There are increased expectations from central government and the public about the quality of health care and advice, its timeliness and patient choice in when and where it is delivered. The implications are that PIMH services will have to be commissioned and delivered to consistently high quality, and integrated with other service delivery, if these expectations are to be met. A network can potentially support this.

Changes in commissioning

There are opportunities but also challenges in the following:

  • The development of practice based commissioning
  • The development of foundation trusts
  • The increasingly influential role of PCT commissioning and local performance management; the priority accorded to childrens services commissioning within this structure;
  • The development of childrens trusts and extended schools – the push to deliver commissioning of childrens services coterminous with excellence clusters or school communities, conjointly with primary health and local authority budgets
  • The development of LAA’s as mechanisms for local target setting and service delivery

Sidebar

Last updated: 4 Jun 08