In 2019, the Scottish Government made a commitment to develop perinatal and infant mental health services. A Programme Board was set up to do this and was asked to oversee the development of infant mental health services in line with the Programme for Government (2019-20):
‘Implement and fund a Scotland wide model of infant mental health provision. These infant mental health services aim to meet the needs of families experiencing significant adversity, including infant developmental difficulties, parental mental illness, parental substance misuse, domestic abuse and trauma.’
We aim to develop services for infants from conception to three years of age which address the needs of families whose parents may not have access to formal mental health services. Many are supported by third sector organisations, but some have no supports at all.
This challenge has been in the context of the COVID-19 pandemic which has impacted on all services, making service delivery, and recruitment and planning for service development difficult. However, the wellbeing of young children and their families has been adversely affected by the social restrictions imposed and if anything is a more urgent concern at the present time.
Health promotion and the prevention of individual and relationship problems should be universal, with early intervention being offered to those identified as in need. Well targeted prevention and early intervention programmes can substantially reduce the risk of future mental health difficulties, and ultimately improve the health and wellbeing of Scotland’s children and young people, and parents. Infant mental health systems must involve all agencies both statutory services (health and local authority) and third sector, and must include parents in thinking about their design and delivery. Getting it right for every child (GIRFEC) principles will be at the heart of their development. Specialist teams will be a part of these systems and offer consultation and training as well as direct services to some infants and their carers.
The Infant Mental Health Delivery Plan 2020-21 was launched on 3 July 2020. It has 10 action points including leadership and coproduction, raising awareness and promoting understanding, training and workforce development and retention, evaluation and innovation. A plan for service development was proposed and health boards were asked to identify their state of readiness and bid for funds. A three-wave approach has seen a small number of areas moving forward with service development, with Fife and Lanarkshire leading the way. Wave 2 boards have had funds to begin planning and will move into a more active development phase next financial year. These are Greater Glasgow and Clyde, Highland and Lothian. Other boards are expected to develop plans in the next few months.
Importantly, IMH is also part of the delivery of perinatal mental health services with parent –infant therapists being appointed in larger services. A third workstream is the development of Maternal and Neonatal Psychological Intervention Services (MNPI). These should also address infant’s wellbeing and include the development of services to support neonates with complex needs in the context of prematurity, congenital abnormalities or other health challenges. Integration with local IMH services is essential in order to attend to babies who are returning to their home area after a period of inpatient specialist interventions.
An integrated systems approach to the development of services is crucial and at this point most health board areas have set up implementation groups. These should ensure that there are good links between these three workstreams, and those working in universal and specialist services in all agencies.
IMH Lead, Perinatal Mental Health Network Scotland and Chair of SG IMH Implementation and Advisory Group. Anne.McFadyen @ lanarkshire.scot.nhs.uk