Mark Monahan

There is more to perinatal mental health care than depression: Public health nurses reported engagement and competence in perinatal mental health care

AIMS AND OBJECTIVESnTo explore public health nurses engagement, competence and education needs in relation to perinatal mental health care in Ireland.nnnBACKGROUNDnIt is estimated that 15%-25% of women will experience a mental health problem during or postpregnancy, either as a new problem or a reoccurrence of a pre-existing problem. Public health nurses, or their equivalent, are ideally positioned to support womens mental health and improve health outcomes for the woman and baby, yet little is known about their role and engagement with mental health issues, other than with postnatal depression. The objectives of the study were to identify public health nurses knowledge, skills and current practices in perinatal mental health and establish their education needs.nnnDESIGNnThe research used a descriptive design.nnnMETHODnA total of 186 public health nurses completed an anonymous, online survey, designed by the research team.nnnRESULTSnWhile public health nurses are positive about their role in supporting womens mental health, they lack the knowledge and skills to address all aspects of mental health, including opening a discussion with women on more sensitive or complex issues, such as trauma and psychosis and providing information to women. Those who received education reported statistically significant higher knowledge and confidence scores than those without.nnnCONCLUSIONnPublic health nurses lack the knowledge and skills required to provide comprehensive perinatal mental health care to women. Future education programmes need to move beyond postnatal depression and address the range of mental health problems that may impact on women in the perinatal period.nnnRELEVANCE TO CLINICAL PRACTICEnWithout knowledge and skill among nurses in all aspects of perinatal mental health, women with significant mental health needs may be left to cope alone and lack the necessary prompt evidence-based interventions and supports.

Barriers to midwives and nurses addressing mental health issues with women during the perinatal period: The Mind Mothers study

AIMS AND OBJECTIVESnTo explore barriers to midwives and nurses addressing mental health issues with women during the perinatal period.nnnBACKGROUNDnPerinatal mental health is considered an important public health issue with health policy internationally identifying the importance of psychological support for women in the perinatal period. Midwives and primary care nurses are ideally positioned to detect mental distress early, but evidence suggests that they are reluctant to discuss mental health issues with women during pregnancy or in the postnatal period.nnnDESIGNnThe research used a descriptive design.nnnMETHODSnA total of 809 midwives and nurses completed an anonymous, online or hard copy survey. Designed by the research team, the survey listed 26 potential barriers to the provision of perinatal mental health care.nnnRESULTSnParticipants identified organisational factors as presenting the greatest barriers. Organisational barriers included lack of perinatal mental health services, absence of care pathways, heavy workload, lack of time, lack of privacy and not seeing women regularly enough to build a relationship. Over 50% of participants identified practitioner-related barriers, such as lack of knowledge on perinatal mental health and cultural issues; lack of skill, in particular, skills to respond to a disclosure of a mental health issue; and fears of causing women offence and distress. Findings also indicated that the context of care and education influenced the degree to which participants perceived certain items as barriers.nnnCONCLUSIONSnMidwives and primary care nurses encounter many organisational- and practitioner-related barriers that negatively impact on their ability to incorporate mental health care into their practice.nnnRELEVANCE TO CLINICAL PRACTICEnMidwifery and nursing services need to develop strategies to address system- and practitioner-related barriers, including the development of services and care pathways, and the provision of culturally sensitive education on perinatal mental health in order to support practitioners to address issues with confidence and competence.

A participatory approach to the development of a co-produced and co-delivered information programme for users of services and family members: the EOLAS programme (paper 1)

OBJECTIVEnThe EOLAS programme is a peer and clinician-led mental health information programme on recovery from mental health difficulties, specifically for people with a diagnosis of schizophrenia spectrum or bipolar disorders, their family members and significant others.nnnMETHODnThis article, the first of a two part series, outlines the background to and the rationale behind the EOLAS programme, and traces the participatory process used to inform the development and implementation of the pilot phase of the project. The aims of the programme, and the overarching principles that guided its development, delivery and evaluation, including the set-up of the project steering group are outlined and discussed. Findings Two separate programmes, one for family members and one for service users were designed. In addition, participant and facilitator handbooks were developed for each programme, including a training programme for facilitators.nnnCONCLUSIONnCentral to a recovery oriented service is the involvement of service users and families in the design and delivery of services. EOLAS is one potential model for achieving this aim.

Knowledge, confidence, skills and practices among midwives in the republic of Ireland in relation to perinatal mental health care: The mind mothers study

OBJECTIVEnThe study aimed to identify midwives competency in perinatal mental health care in terms of their knowledge, confidence, skill and educational priorities, and to explore their clinical practices in relation to the assessment and management of perinatal mental health problems.nnnRESEARCH DESIGNnAn exploratory descriptive study design was used on a sample of 438 midwives in the Republic of Ireland. Data were collected over a two-month period in 2016 using an anonymous, self-completed survey designed by the research team.nnnFINDINGSnThe majority of midwives cared for women with perinatal mental health problems in their clinical practice; however, beyond depression and anxiety, their knowledge of perinatal mental health problems was quite limited. Similarly, midwives reported a lack of skill in opening a discussion with women on sensitive issues, such as sexual abuse, intimate partner violence and psychosis, and providing information to womens partners/families. The findings indicated that midwives adopted a selective approach to screening for perinatal mental health problems, with a tendency not to inquire about sensitive topics, or address them only with women deemed at-risk.nnnCONCLUSIONSnTimely and appropriate care is required to ensure the best outcomes for women with perinatal mental health problems and their families. A greater understanding of perinatal mental health among midwives is required to enable them to provide support and information to women and their families, and to identify when specialist intervention is required. Education and other structural supports, such as care pathways and documentation, is required to train and support midwives in their key role of caring for, and collaborating with, women with perinatal mental health problems.

Outcomes of a co-facilitation skills training programme for mental health service users, family members, and clinicians: the EOLAS project

Health policy is increasingly advocating for involvement of service users and family members in service development. In the present study, we evaluated the impact of a 4-day education programme in co-facilitation skills on clinician and peer (service users and family members) knowledge, confidence, and subsequent experience as co-facilitators. The programme was designed to train peers and clinicians as co-facilitators on a clinician and peer-led information programme for people experiencing mental health problems. The study employed a mixed-methods design involving a pre-post survey with 128 participants, and follow-up qualitative interviews with a sample of 17 participants. To examine changes in levels of knowledge and confidence in facilitating from time 1 (T1) to time 2 (T2), paired sample t-tests were conducted, and thematic analysis was conducted on the interviews. The programme had a statistically-significant positive impact on participants knowledge, confidence, and skills, with no significant difference between the facilitator groups (i.e. service user, family member, and clinician) in terms of their improvement at the end of the training, indicating that all groups benefited equally from the training. A majority of participants reported a high level of preparedness as co-facilitators and an open and respectful approach towards each others expertise, and many continued to gain skills and develop their confidence as they co-facilitated the 8-week EOLAS programme (eolas is the Irish word for knowledge). The findings also provide evidence of the acceptability and feasibility of the programme, and appears to be the first detailed study reported on a programme of this nature.