A Social Worker & Postnatal Depression

Adele Boyd,

Northern Ireland Association of Social Workers

“When I was asked to discuss the role of social work in the context of Postnatal Depression (PND) for haveyouseenthatgirl.com, my first reaction was to visit the website and watch Lindsay’s Ted Talk.

It is wonderful to see testimony from women who have been brave enough to share their experiences. Lindsay’s talk at Stormont was a huge step forward in encouraging the conversation about the challenges of PND.

As this site offers a number of qualified sources on PND I will not try to expand or repeat the clinical information. Instead I will focus on the role a social worker might have in supporting a woman and her family when PND occurs. This is not an exhaustive list but I hope it will shed some light on what some mums and families find a new and daunting prospect.

Traditionally your General Practitioner (GP) assigns a Health Visitor to make home visits with new mums once the Midwife’s involvement has ended. Routine visits are provided to monitor how mum is coping and assess the baby’s health and development.

If a woman’s mood fails to settle after the initial days and weeks at home, or she presents with more severe symptoms that suggest possible PND, increased contact is maintained by the Health Visitor and GP. The GP may be satisfied that support such as counselling or medication at this primary care level is sufficient. However, if symptoms emerge in the prenatal or perinatal period (when for example a mum is breast-feeding) the GP may refer onto secondary care to the local Community Mental Health Team for assessment and advice.

At this stage an assessment is undertaken by a member of the Community Mental Health Team and a Consultant Psychiatrist may be involved to ascertain if medication is appropriate, and if it is, which type is best when breast-feeding. If extra support is necessary a Community Mental Health Team keyworker may be allocated. The keyworker is usually a Community Psychiatric Nurse or a Mental Health Social Worker.

Generally an office appointment will take place with the keyworker, followed by pre-arranged home visits. This offers support to mum at home and gives the keyworker the opportunity to observe mum and baby in their own environment, meet a partner, extended family or other children.  If a social worker is appointed as the keyworker their role is to enable mum to consider what supports are available, discuss mood, and monitor symptoms which are hopefully reducing or being adequately managed.

Often people associate social work involvement with statutory Children and Family Services. A social worker may already be involved from Children and Family Services for other support needs. In this case the keyworker might link with the Children and Family Services social worker to support the mum and her baby until the family are able to manage mum and baby’s health and safety.

In addressing PND the Mental Health Social Worker will work with mums and their families to try to find the best solutions to meet the family’s needs. Loneliness and isolation are key problems associated with the condition. However, when supports are put in place stresses often reduce enough for mums to be able to adjust and recover at home with their baby.

There are instances when PND or other symptoms of mental illness develop to an extent that hospital care may need to be considered. Every effort is taken to work with mum and her family or support services to prevent the need for hospitalisation. As with any health condition hospital care is usually a last resort. Professionals work with mums to explore what supports they have with family and friends. Sometimes this is enough to allow mum to get sleep and routine back on track, to be able to cope well enough at home. A Family Hub referral might be made to offer community and voluntary service support options that are already available in the local area.

At every opportunity the social worker will work in partnership to support mum to explore solutions that best meet her and the baby’s needs. If hospital admission is required a plan will be made with mum and any relevant family members to plan for the hospital stay.

The fear and stigma associated with social work input is usually around children being deemed unsafe to stay at home. Thankfully there are a range of supports and options available to families before this need be the case. However, sometimes there may not be anyone else to help care for a child and a placement may need to be considered if mum needs hospital care, dad is not about, or parents cannot manage by themselves right now.

As with hospital admission, a care placement for a baby or child is always the last resort, but it may be a placement with extended family to offer mum the time and opportunity to recover. The aim will always be to reunite a family when health needs and safety measures are back in place.

Unfortunately most people are embarrassed to talk about social work input with their family. The result is we rarely hear the good news stories when families get support to make positive changes, people’s health improves and a baby, or children, return home from a placement with grandparents or other carers. These are the positive outcomes we all want.

As a social worker for many years, I have had the privilege to work with many mums who accessed mental health or children’s services due to postnatal depression or mental health issues. The biggest hurdle is to start the conversation about PND, then tackle the fear and loneliness associated with what remains an often secretive or hidden condition.

There are many resources available now and more women are finding the courage to speak up about their experiences.

My professional experience of talking with mums who have suffered from PND, as well as talking to my friends and relatives who have suffered from the condition, has shown me once we start the conversation we break the silence and discover there is hope.

There are services and supports available, no one has to deal with PND on their own.”

Thank you to Adele and to the Northern Ireland Association of Social Workers for providing this post and helping to break the stigma surrounding PND and reminding us of the support that is available.