561734 research-article2014
RSH0010.1177/1757913914561734In practiceIn practice
In Practice
In Practice Mind, the mental health charity: improving maternal mental wellbeing With suicide being the main cause of death of women during pregnancy and the first year after the birth of a child,1 and a recent report showing the long-term economic impact of failing to address mental wellbeing during the perinatal period,2 there has probably never been more focus on maternal mental wellbeing. Pregnancy and early motherhood are times during which women are bombarded with positive images, glossy magazines, endless online forums and well-wishers all pointing towards the perfect pregnancy, supportive home environment and ‘the best time of your life’. But how much of the perinatal period is spent considering the potential for post-natal depression? Or explaining post-partum psychosis? Or considering what expectant mums might be able to do to keep themselves mentally, as well as physically, healthy? In 2012, the United Kingdom’s leading mental health charity, Mind, identified 12 ‘at risk’ groups who posed a greater chance of developing a mental illness due to social circumstances, physical health problems or major life events. Women in the perinatal period featured highly in this list, with mental health problems affecting as many as one in five women2 at some point during this time. With funding secured from the People’s Health Trust, and a model of resilience3 to test, Mind funded nine pilot projects – five working with unemployed men and four with women during pregnancy and the first year after birth.
Pilot Projects To Reduce The Likelihood of Maternal Mental Health Problems The Mind model of resilience recognises the importance of three key elements in reducing the likelihood of mental health problems: •• Positive activities that are known to improve wellbeing as a basis for good mental health; •• Developing psychological coping strategies, based around insight,
awareness and realistic optimism, driven by the principles of Cognitive Behavioural Therapy (CBT) and mindfulness; •• Building good social networks and social capital – good quality human relationships that are key to our capacity to respond to adversity and challenge.
project with pregnant women and new mothers in the Ulverston area of the Each of the four pilot areas (Ulverston, Lake District is a rural environment Dudley, Coventry, Peterborough), affecting the women’s social managed by a local Mind branch, aimed experiences, connections and access to work with 40 women over a period of to services, compared with the more a year ranging from a six-week urban Dudley and Coventry projects. intervention to a year-long ongoing The projects had to show context programme of support offering a range of sensitivity in both planning and activities within the Mind resilience model implementation. Sensitivity in planning which included befriending, a ‘coping involved, for example, developing strategies’ course, planned wellbeing appropriate partnerships in advance, activities and a concentration on based on an understanding of the developing social networks within the environment for recruitment, and groups. Some of the courses ran planning appropriate activities, course alongside already established groups in design and accessible attractive children’s centres and the workers and locations and timings based on their befriending volunteers likely appeal to the women. had to be prepared to Flexibility in implementation work in flexible ways, meant, for example, being courses were often initially in the prepared to change structured home, with particularly around the Five direction if the original plan vulnerable or isolated was not working, on the Ways to women. basis of ongoing Wellbeing4 or The way the projects conversations between basic CBT developed depended course leads, partners, techniques partly on their contexts. national Mind and especially Two overarching participants to take account dimensions of context of their reasoning around are important: the environmental and being supported to make different social contexts where recruitment and choices. delivery took place, and the individual, A lot of the coping strategies courses personal contexts (the women’s life were structured around the Five Ways to histories and aspirations). The two Wellbeing4 or basic CBT techniques, dimensions intersect: for example, while the wellbeing activities were often variation in the social environment ‘baby or pregnancy oriented’ using yoga, affects people’s life histories. The mindfulness, massage, baby signing,
10 Perspectives in Public Health l January 2015 Vol 135 No 1 Downloaded from rsh.sagepub.com at PENNSYLVANIA STATE UNIV on May 26, 2015
In Practice parenting courses and so on. The social networks were built around the principles of peer support, such as group walks. The flexibility of the model was also tested through the order in which the different elements were introduced; in some cases, befrienders were deployed to encourage those most isolated to attend groups and begin to build social networks, whereas in other areas, the groups happened first and befrienders were employed to mentor the women in using the skills they learned and to access the services available locally.
Evaluation and Forward Planning Evaluation of the projects was key for Mind, and this was managed by the Faculty of Health and Social Sciences at Leeds Metropolitan University and the Faculty of Midwifery at the University of Chester. The final report5 was published in July 2014 with results strongly indicating that the model was effective and participants reported significant gains in their emotional resilience. The evaluation design was one of mixed quantitative and qualitative approaches to address the evaluation aims. A pre-phase involved collection of project management and self-evaluation data, including, for example, project plans and marketing materials. During this pre-phase, the evaluation team also compiled a highly focused brief review of related resilience programmes to provide context and comparison. Phase 1 included (1) a survey of participants at the start of the first projects, and (2) interviews with stakeholders with particular involvement in the campaign. During Phase 2, the evaluation team conducted a follow-up survey of first cohort participants, and a start and
follow-up survey of all participants in later in social support. As the primary focus of cohorts. The team also conducted the programme was to work with women interviews with further who had no previous stakeholders – and with significant mental health the results participants on all the issues or use of services, showed that projects. maintenance of resilience over seven out The aim of the was considered favourably. of ten women qualitative stakeholder However, the results showed reported an interviews was to that over seven out of ten increase in their women reported an increase explore those wellbeing stakeholders’ views and in their wellbeing, almost experiences of the eight out of ten an increase projects, focusing in self-efficacy and coping specifically on issues such as referral, skills and over seven out of ten an expectations of the project, needs of the increase in social networks and support. target groups, views on how the projects Overall, 79.1% of women showed an could and did benefit the participants, increase in emotional resilience, with just factors underlying success, challenges over 2% reporting no change. and enablers, progression and The final evaluation not only asks ‘did sustainability. The aim of the survey was the resilience programme work’ but to gather data about project participants’ explores insights about ‘what works, for self-perceived resilience at the start and whom, in what contexts, and how’. While at the end of participation. the results of a ‘before-and-after’ Mind proposed to use three scales to resilience survey demonstrate consistent cover wellbeing, self-efficacy and social gains in resilience for participants across capital, because this maps onto the Mind all projects, delivery mechanisms, resilience model. The Warwick-Edinburgh including participants’ own reasoning Mental Wellbeing scale was included. underpinning their choices, showed both Through a consultation process, some similarity and difference across projects. adaptations were made to the SchwarzerMind are now looking to further Jerusalem General Self-Efficacy Scale. develop work with women in the perinatal Concerning the third area, social support, period and also look to continue testing the Lubben Social Network Scale was felt and using the resilience model with other to be not fully fit for purpose. Some items groups considered ‘at risk’. A programme were constructed, modelled on but not delivered in partnership with Diabetes UK identical to the ‘multidimensional scale of and the British Heart Foundation is perceived social support’6. Further currently being delivered by local Mind branches in Manchester and Birmingham, individual items were constructed after and discussions are underway to develop consultation between the evaluation team partnerships with organisations engaged and Mind. in delivering community based services The results for the wellbeing element with other groups. of the model reported a statistically significant improvement in wellbeing scores from baseline to post stage, the Stuart Reid same with improvement in problem Community Programmes & Grants solving and achieving goals and similarly Projects Manager, Mind
References 1. Oates M. Suicide: The leading cause of maternal death. 2003. Available online at: http://bjp.rcpsych.org/content/183/4/279.full (Last accessed 7th November 2014). 2. Centre for Mental Health, London School of Economics. The Costs of Perinatal Mental Health Problems. p. 6. 2014. Available online at: http://everyonesbusiness.org.uk/ wp-content/uploads/2014/10/Embargoed20th-Oct-Final-Economic-Report-costs-of-
3 .
4.
perinatal-mental-health-problems.pdf (Last accessed 7th November 2014). Holloway S. Scoping report on Mind’s approach to resilience building. September 2012. London: Mind. New Economic Foundation. Five ways to wellbeing. Available online at: http://www. neweconomics.org/projects/entry/five-waysto-well-being (Last accessed 7th November 2014).
5.
6.
Robinson M, Steen M, Robertson S, Raine G. Evaluation of the local Mind resilience programme. Final report, July 2014. London: Mind. Zimet GD, Dahlem NW, Zimet SG, Farley GK. The Multidimensional Scale of Perceived Social Support. Journal of Personality Assessment, 1988, 52, 30–41.
January 2015 Vol 135 No 1 l Perspectives in Public Health 11 Downloaded from rsh.sagepub.com at PENNSYLVANIA STATE UNIV on May 26, 2015
RSH0010.1177/1757913914561734In practiceIn practice
In Practice
In Practice Mind, the mental health charity: improving maternal mental wellbeing With suicide being the main cause of death of women during pregnancy and the first year after the birth of a child,1 and a recent report showing the long-term economic impact of failing to address mental wellbeing during the perinatal period,2 there has probably never been more focus on maternal mental wellbeing. Pregnancy and early motherhood are times during which women are bombarded with positive images, glossy magazines, endless online forums and well-wishers all pointing towards the perfect pregnancy, supportive home environment and ‘the best time of your life’. But how much of the perinatal period is spent considering the potential for post-natal depression? Or explaining post-partum psychosis? Or considering what expectant mums might be able to do to keep themselves mentally, as well as physically, healthy? In 2012, the United Kingdom’s leading mental health charity, Mind, identified 12 ‘at risk’ groups who posed a greater chance of developing a mental illness due to social circumstances, physical health problems or major life events. Women in the perinatal period featured highly in this list, with mental health problems affecting as many as one in five women2 at some point during this time. With funding secured from the People’s Health Trust, and a model of resilience3 to test, Mind funded nine pilot projects – five working with unemployed men and four with women during pregnancy and the first year after birth.
Pilot Projects To Reduce The Likelihood of Maternal Mental Health Problems The Mind model of resilience recognises the importance of three key elements in reducing the likelihood of mental health problems: •• Positive activities that are known to improve wellbeing as a basis for good mental health; •• Developing psychological coping strategies, based around insight,
awareness and realistic optimism, driven by the principles of Cognitive Behavioural Therapy (CBT) and mindfulness; •• Building good social networks and social capital – good quality human relationships that are key to our capacity to respond to adversity and challenge.
project with pregnant women and new mothers in the Ulverston area of the Each of the four pilot areas (Ulverston, Lake District is a rural environment Dudley, Coventry, Peterborough), affecting the women’s social managed by a local Mind branch, aimed experiences, connections and access to work with 40 women over a period of to services, compared with the more a year ranging from a six-week urban Dudley and Coventry projects. intervention to a year-long ongoing The projects had to show context programme of support offering a range of sensitivity in both planning and activities within the Mind resilience model implementation. Sensitivity in planning which included befriending, a ‘coping involved, for example, developing strategies’ course, planned wellbeing appropriate partnerships in advance, activities and a concentration on based on an understanding of the developing social networks within the environment for recruitment, and groups. Some of the courses ran planning appropriate activities, course alongside already established groups in design and accessible attractive children’s centres and the workers and locations and timings based on their befriending volunteers likely appeal to the women. had to be prepared to Flexibility in implementation work in flexible ways, meant, for example, being courses were often initially in the prepared to change structured home, with particularly around the Five direction if the original plan vulnerable or isolated was not working, on the Ways to women. basis of ongoing Wellbeing4 or The way the projects conversations between basic CBT developed depended course leads, partners, techniques partly on their contexts. national Mind and especially Two overarching participants to take account dimensions of context of their reasoning around are important: the environmental and being supported to make different social contexts where recruitment and choices. delivery took place, and the individual, A lot of the coping strategies courses personal contexts (the women’s life were structured around the Five Ways to histories and aspirations). The two Wellbeing4 or basic CBT techniques, dimensions intersect: for example, while the wellbeing activities were often variation in the social environment ‘baby or pregnancy oriented’ using yoga, affects people’s life histories. The mindfulness, massage, baby signing,
10 Perspectives in Public Health l January 2015 Vol 135 No 1 Downloaded from rsh.sagepub.com at PENNSYLVANIA STATE UNIV on May 26, 2015
In Practice parenting courses and so on. The social networks were built around the principles of peer support, such as group walks. The flexibility of the model was also tested through the order in which the different elements were introduced; in some cases, befrienders were deployed to encourage those most isolated to attend groups and begin to build social networks, whereas in other areas, the groups happened first and befrienders were employed to mentor the women in using the skills they learned and to access the services available locally.
Evaluation and Forward Planning Evaluation of the projects was key for Mind, and this was managed by the Faculty of Health and Social Sciences at Leeds Metropolitan University and the Faculty of Midwifery at the University of Chester. The final report5 was published in July 2014 with results strongly indicating that the model was effective and participants reported significant gains in their emotional resilience. The evaluation design was one of mixed quantitative and qualitative approaches to address the evaluation aims. A pre-phase involved collection of project management and self-evaluation data, including, for example, project plans and marketing materials. During this pre-phase, the evaluation team also compiled a highly focused brief review of related resilience programmes to provide context and comparison. Phase 1 included (1) a survey of participants at the start of the first projects, and (2) interviews with stakeholders with particular involvement in the campaign. During Phase 2, the evaluation team conducted a follow-up survey of first cohort participants, and a start and
follow-up survey of all participants in later in social support. As the primary focus of cohorts. The team also conducted the programme was to work with women interviews with further who had no previous stakeholders – and with significant mental health the results participants on all the issues or use of services, showed that projects. maintenance of resilience over seven out The aim of the was considered favourably. of ten women qualitative stakeholder However, the results showed reported an interviews was to that over seven out of ten increase in their women reported an increase explore those wellbeing stakeholders’ views and in their wellbeing, almost experiences of the eight out of ten an increase projects, focusing in self-efficacy and coping specifically on issues such as referral, skills and over seven out of ten an expectations of the project, needs of the increase in social networks and support. target groups, views on how the projects Overall, 79.1% of women showed an could and did benefit the participants, increase in emotional resilience, with just factors underlying success, challenges over 2% reporting no change. and enablers, progression and The final evaluation not only asks ‘did sustainability. The aim of the survey was the resilience programme work’ but to gather data about project participants’ explores insights about ‘what works, for self-perceived resilience at the start and whom, in what contexts, and how’. While at the end of participation. the results of a ‘before-and-after’ Mind proposed to use three scales to resilience survey demonstrate consistent cover wellbeing, self-efficacy and social gains in resilience for participants across capital, because this maps onto the Mind all projects, delivery mechanisms, resilience model. The Warwick-Edinburgh including participants’ own reasoning Mental Wellbeing scale was included. underpinning their choices, showed both Through a consultation process, some similarity and difference across projects. adaptations were made to the SchwarzerMind are now looking to further Jerusalem General Self-Efficacy Scale. develop work with women in the perinatal Concerning the third area, social support, period and also look to continue testing the Lubben Social Network Scale was felt and using the resilience model with other to be not fully fit for purpose. Some items groups considered ‘at risk’. A programme were constructed, modelled on but not delivered in partnership with Diabetes UK identical to the ‘multidimensional scale of and the British Heart Foundation is perceived social support’6. Further currently being delivered by local Mind branches in Manchester and Birmingham, individual items were constructed after and discussions are underway to develop consultation between the evaluation team partnerships with organisations engaged and Mind. in delivering community based services The results for the wellbeing element with other groups. of the model reported a statistically significant improvement in wellbeing scores from baseline to post stage, the Stuart Reid same with improvement in problem Community Programmes & Grants solving and achieving goals and similarly Projects Manager, Mind
References 1. Oates M. Suicide: The leading cause of maternal death. 2003. Available online at: http://bjp.rcpsych.org/content/183/4/279.full (Last accessed 7th November 2014). 2. Centre for Mental Health, London School of Economics. The Costs of Perinatal Mental Health Problems. p. 6. 2014. Available online at: http://everyonesbusiness.org.uk/ wp-content/uploads/2014/10/Embargoed20th-Oct-Final-Economic-Report-costs-of-
3 .
4.
perinatal-mental-health-problems.pdf (Last accessed 7th November 2014). Holloway S. Scoping report on Mind’s approach to resilience building. September 2012. London: Mind. New Economic Foundation. Five ways to wellbeing. Available online at: http://www. neweconomics.org/projects/entry/five-waysto-well-being (Last accessed 7th November 2014).
5.
6.
Robinson M, Steen M, Robertson S, Raine G. Evaluation of the local Mind resilience programme. Final report, July 2014. London: Mind. Zimet GD, Dahlem NW, Zimet SG, Farley GK. The Multidimensional Scale of Perceived Social Support. Journal of Personality Assessment, 1988, 52, 30–41.
January 2015 Vol 135 No 1 l Perspectives in Public Health 11 Downloaded from rsh.sagepub.com at PENNSYLVANIA STATE UNIV on May 26, 2015
