Perinatal mental health

There are a wide range of conditions associated with perinatal mental health, this list is not exhaustive and new conditions may be recognised/included in the future. They can affect anyone, regardless of their gender and can occur both during pregnancy and after childbirth. Some people experience these even years after the birth of their child and can also be triggered by other events such as other people becoming pregnant.

• Tokophobia – the fear of pregnancy and childbirth, those with this phobia have a pathological fear of giving birth and will often avoid becoming pregnant or giving birth altogether.
• OCD (obsessive compulsive disorder) – a common mental health condition where a person has obsessive thoughts and compulsive behaviours.
• PTSD (Post-Traumatic Stress Disorder)/Birth Trauma – an anxiety disorder caused by very stressful, frightening, or distressing events.
• Bipolar Affective Disorder – a mental health problem that mainly affects your mood, giving someone extreme highs and extreme lows.
• Postpartum Psychosis – a severe mental illness which developed acutely in the early postnatal period, usually within the first month following delivery, psychotic features are present, closely linked with bipolar.
• Eating Disorders – a mental health condition where you use the control of food to cope with feelings and other situations.
• Personality Disorders – a person with a personality disorder thinks, feels, behaves or relates to others very differently form the average person.
• Depression – a low mood that can last a long time, or keep returning, affecting your everyday life.
• Dermatillomania – also known as an excoriation disorder or skin-picking disorder, it’s a psychological condition that manifests as repetitive, compulsive skin picking.

Following consultation across forces, officers and staff who have been through perinatal mental health illness whilst at work, the Federation and UNISON, the following recommendations are made in relation to internal support networks. These recommendations are made as a minimum standard and are not exhaustive.

Peer Support Network

Forces should look to create some form of peer support network that is well advertised and accessible for all to join (without the need for management referrals) on their intranet pages. For some forces this may be part of their family support network, others may have sufficient demand for a standalone group. The Maternal Mental Health Alliance in its Five Principles of Perinatal Peer Support paper states that ‘good peer support involves people with relevant lived experience in its design and delivery’ and suggests that ‘at a minimum this includes experiences of maternity and mental health difficulties or struggling with emotional wellbeing’. Ideally therefore the group should consist of officers and staff who themselves have experienced perinatal mental health issues (including having supported a family member experiencing such illness). It is also recommended that as a minimum at least one member, typically the person leading the group, should receive some form of formal training (for example through an external training course) and, if possible, develop a relationship with a local perinatal mental health team. Options include having regular catch-up session in the form of informal coffee morning style meetings as well as having Zoom/ MS Teams style meetings enabling everyone to attend if they are unable to travel or other restrictions are in place, and being available for one-to-one support if requested.

An example of this can be found in Cleveland Police who through the Raindrops to Rainbows charity have developed the Blue Light Parenting scheme which delivers ‘peer support and ensures the correct support is provided to all Mum’s and Dad’s from pregnancy through to returning to work within the Emergency Services following Maternity, Maternity Support and Adoption/Fostering Leave and beyond’.

A ‘Buddy’ system should be established

In addition to a peer support network every person who goes on any form of family related leave should be offered the option of being assigned a ‘Buddy’. The Buddy will be an informal source of support and advice relating to all matters maternity, paternity, adoption, or shared parental leave and subsequently returning to work. Their main objective is to keep the person on leave in the loop about things happening at work as well as any developments that may directly affect them. This is most effective when it is someone that has been through the situation themselves thus enabling them to provide advice and support in relation to the practicalities of things such as form filling, applying for flexible working, as well as the more emotional support about returning to work and leaving your child, often for the first time. This can greatly reduce the anxiety and stress faced by those on related leave and smooth the transition back to work; the impact on mental health is not to be understated.

Force Occupational Health Departments/National Rehabilitation Centers

More awareness in forces of the signs and symptoms surrounding perinatal mental health illness will help foster a supportive environment for individuals experiencing difficulties. Once a manager is approached by someone who discloses they are struggling, a referral should be made to the Occupational Health Department, with the individual’s consent. Forces should also offer the ability for a person to self-refer to OH without the need to go through a line manager. Further support can then be offered by OH such as access to internal or external counselling services. If after assessment OH believe that it is suitable/ would be beneficial a stay at one of the national rehabilitation centers should be offered where they are a member and practicable for the individual. Employee Assistance Programmes may also be available.

The negative impact of mental health problems during the perinatal period is enormous and can have long lasting consequences, not only on individuals and their partners but children too. As a line manager, one of the main priorities is to create a workplace which is supportive and understanding for everyone who is suffering or living with someone who is experiencing perinatal mental health problems.

Pregnancy, childbirth and beyond is a time when there are many changes mentally and physically and everyone`s experience is different. As a line manager, you have a duty of care in relation to the health, safety, and wellbeing of your staff, creating a culture of trust and empathy.

Engaging with our staff and creating a positive workplace is key, as stigma attached to perinatal mental health, including a lack of understanding and negativity, can have an adverse effect on recovery, absence management and performance.

Suggested best practice

To begin

• As a line manager, you will typically be the first point of contact. The overriding ethos is to build a relationship with your staff based on trust, so they feel comfortable and empowered to discuss their condition or situation, thus enabling them to receive the support they need. In circumstances where the relationship has broken down, consideration should be made to assign a more suitable replacement.
• Reinforce that anything they disclose will be treated in confidence, fairly and they won`t be disadvantaged by disclosing. An open and inclusive approach with regular communication, being comfortable having sensitive conversations and acknowledging that the smallest things can make a big difference to how someone feels and will encourage staff to approach and engage in conversations.

Going forward

• Risk assessing the current role and being confident with balancing the needs of the staff and the team, with regular reviews and one to one meetings. Every individual and situation is unique and has the potential to change regularly
• Reasonable adjustments to working conditions for both the individual and a carer: do working hours/shifts need modification? flexible working requests, adjustments to working hours so they can still perform their role (to full potential)
• Can they still be effective in their role? (Consider impact of changing roles could cause extra stress and additional training required). Look at what reasonable adjustments can made, to support and assist the individual to work to the best of their ability. Consider responsibilities under the Equality Act 2010.
• Always consider the individual and their circumstances, not the condition. Everyone is affected in different ways, so a bespoke approach is required, not a one size fits all.
• Look for opportunities to expand your knowledge about managing people with a disability or health condition and understand your role within that.
• Disability and carer passports are widely used – this gives people the ability to share their position without the need for long conversations or explanations.
• Take into consideration the different and unique working environments
• Some take longer to recover – regular longer breaks may be required, and an open and honest conversation about when they are ready for a withdrawal of additional support.
• Leave entitlements – dependents and parental leave
• Pressures at work/home
• Recording any sickness absences that are related to perinatal mental health as an ongoing health issue instead of a series of short-term absences.
• Colleagues –Do they need to be made aware? Always seek consent from the individual before discussing with others
• Liaise with HR/Occupational Health – familiarisation with each force policy