Listening Visits to Mothers’ Suffering with Mild to Moderate Peri-Natal Depression; Critical Issues of Clinical Supervision, Training and Health Visiting Capacity to Tackle Health Inequalities

Paul Regan

doi:10.4172/2167-1079.1000107

Abstract

The importance of United Kingdom health visitors' in the detection and treatment of peri-natal depression in primary care services is well documented. Evidence based policy and clinical guidelines make recommendations for the prediction, detection and treatment of women with mild to moderate depression in the postnatal period continuing up to a year after delivery. An inter-professional cross organisational practice development project aimed to assess the provision of antenatal and peri-natal mental health care within one health visiting service in accordance with NICE guidelines (2007). This paper discusses the disparity between guidelines and health visiting practice; a lack of training in listening visits or other psycho therapeutic methods, poor access and availability of clinical supervision, commissioning reforms leading to larger health visiting caseloads suggesting the service is unable to meet NICE recommendations. Lastly, the evidence suggests the scope and practice of community nurses' within health visiting teams should be expanded.

Highlights

Peri-natal depression (PND), previously known as postnatal depression, is a non psychotic depression meeting standardised diagnostic criteria for a minor or major depressive disorder [6]
A number of systematic reviews found little evidence of systematic approaches to PND detection [11,23,13] with National Institute for Health and Clinical Excellence (NICE) (2011) guidelines recommending the use of diverse psychological treatments in the United Kingdom (UK) such as brief cognitive therapy, interpersonal psychotherapy and listening visits
Instead, training focuses on Integrated Care Pathway (ICP) and detection using the Edinburgh postnatal depression score (EPDS) reinforced by NICE stating ‘...staff have supervision and training, covering mental disorders, assessment methods and referral routes, to allow them to follow the care pathways ... (CG 1.2.2.5)

Summary

Background

The United Kingdom (UK) Health visitor implementation plan 2011-2015; a call to action (DH, 2011) suggests improving health visitors’ ability to offer timely, effective interventions to mothers’, children and their families within primary care services [1]. The implementation plan aims to train 4200 more health visitors’ by 2015 [1] in order to counteract the effect of commissioning reforms [2] and numbers falling to 8,017 in 2010 from 10,137 in 2004 [1]. The expansion of commissioning, or outsourcing to private healthcare companies within the National Health Service has led to concerns within community services [5], despite the health visitor implementation plan’s attempts to rectify the errors made [1]

Introduction

Discussion

Conclusion