Flying Start pilot project: remote perinatal mental health screening

Last year, Sarah Witcombe-Hayes, Everyone’s Business Campaign Coordinator for Wales, spoke to Community Psychiatric Nurse (CPN), Paula Donovan, to find out how the ‘Flying Start’ pilot project improved screening for perinatal mental health problems and women’s access to support in the South Wales Valleys.

Can you tell us a little about your role?

My role as a perinatal CPN is to provide mental health support and intervention to mums and their families during pregnancy and up until the baby’s first birthday. I work alongside health visitors and midwives, providing education and peer support regarding perinatal mental wellbeing.

How has the pandemic affected women and families in your area?

During the first wave of COVID-19, I noticed a marked decrease in referrals as health visitors were not seeing mums face to face due to restrictions. I became concerned that we were not able to identify mums suffering from perinatal mental health issues as robustly as before. The pandemic was posing new working challenges that none of us could have planned for.

I had the idea to remotely assess mums and decided to contact all those in the ‘Flying Start’ area of Blaenau Gwent to screen for perinatal mental health problems by following Nice Guidelines and asking Whooley and GAD questions but also looking for any bonding or attachment difficulties.

Walk us through the screening process and outcomes

Firstly, a Health Visitor would let mum know I would be contacting her – so it felt less like a cold marketing call. I would get all birth notifications through the registration forms, which I used to create a contact list. I then reached out to mums by phone roughly 5-6 weeks postpartum. During this contact, I introduced myself and the service, helped normalise the idea of perinatal mental health, screened for wellbeing problems and attempted to identify any bonding issues.

From this contact there were four possible outcomes:

1. No intervention – mum isn’t in need of any immediate support, but the door remains open should she run into difficulties, and she knows who to contact if that’s the case.
2. Follow-up – listening visits offered for low-level problems and further screening using Edinburgh Postnatal Depression Scale (EPDS).
3. Active intervention – mum is added to the current caseload.
4. Signposting or referral to alternative services, including GP, Parent-Infant Mental Health Service (PIMHS), and Specialist Perinatal Mental Health Service.

Each contact was documented and recorded on a secure database.

What are the successes and learnings from the pilot?

The pilot has been successful in several ways:

• The adaption to new ways of working for me and the wider team has provided new opportunities and flexibility to offer services in a patient-friendly way.
• The pilot was evaluated by an undergraduate psychologist and the screening was well-received both in structure and timing to mums.
• Health visitors gave positive feedback that this supported their role as some felt they did not have adequate skills or training in maternal mental health.

The top three things I’ve learnt through this pilot are:

1. Services can – and should – be delivered in different formats that meet individual patient needs.
2. Consistency is key when it comes to screening mums for mental health issues.
3. Early identification and removal of stigma are vital to the prevention of/intervention for maternal mental health problems.

The patient perspective is hugely important to service evaluation and development and this pilot has been shown to be highly acceptable to patients. Before the pilot project ended in November 2021, I had screened 210 mums with a pickup rate of 17.4%, which is slightly higher than publicised rates. This has felt like a valuable project, and I hope this information will be useful for others.

What now for the project?

The project proved a success with both new mums and health visitors, who felt it complemented their role. I was able to reduce the stigma of asking for help and talking about difficulties. The team felt that perhaps mums were more comfortable talking about any issues there were experiencing with a non-health visitor. The health visitors within the Flying Start team continue to screen using a flowchart I created and refer to me if mums need support. I continue to provide peer supervision and training for the health visiting team, which increases knowledge and confidence.

At this time, the project is not being progressed as there are competing priorities within the service, but I hope that the pilot and model may be taken up in the future within my area or wider.