Dr Lynn Prendergast, Holistic Reach Consultancy Ltd

Jo Shead, Senior Practitioner, Essex Perinatal Mental Health Service

Supporting an amazing, award-winning service, namely Adult Mental Health FGC service in EPUT, is an honour and a challenge. It’s an honour to work with a service that has been operational since 2002 and provides a service in secondary mental health care helping over 120 families a year.

The challenge in the ever-changing landscape of health and social care delivery is how do you develop and expand such a consistent and effective service?

The response of many commissioners and leaders when you discuss such expansion is “we do that anyway” or “services must do that as part of their core offer”. Is it that simple?

For many who have worked in secondary health and social care there has been an ever-increasing agenda and often very little time for new ways of working to be truly established before services change again. Services embrace an increase in statutory work, increasing specialist services with their incumbent interfaces, a decrease in the third sector service provision, changing communities and the aftermath of Covid 19. In addition to staff recruitment and retention challenges and this is by no means an exhaustive list.  So, my answer is the workforce need to keep pace with many developments and operationalising a service that shakes the power dynamics of traditional service delivery to the core at such an inherently busy time is a big ask.  Often what is required are dedicated roles to enable the changes to practice to occur.

In health and social care solutions are sought from within services but effective solutions are often found outside of services in the families and networks of the individual. Individuals and families have strengths and knowledge that professionals are not party to.  Engagement with individuals who use services, and their families/networks must happen if the negative trajectory of service delivery is to change.

Successfully across EPUT we are embracing this different way of working in family and group conferencing and have agreed expansion into the Urgent Care Pathway/assessment centre to work alongside the Adult MHFGC and newly established FGC perinatal service.

Why do we want to expand in these key areas?

Inpatient

Admission to any hospital setting can result in neglect of an individual’s social context and inform a process of disengagement from community resources. I would argue that admission to a psychiatric hospital compounds such disengagement even further. Perhaps due to stigma and fear. The individual and family can become isolated from each other and disconnected from their own problem-solving abilities.

The family and group conference model challenges this process and will work towards true partnership with families and support networks, mitigating against a trajectory of poor involvement and missed opportunities.

To improve the effectiveness of care and treatment delivered and the safety of patients there needs to be increased emotional involvement of a person’s family/close network during hospital admission as this leads to better clinical outcomes (fewer hospitalisations).

FGC is an effective and proven model that puts the individual and their close network at the centre of making plans and decisions and addresses what matters to them. There are open discussions and psycho education and guidance, honest talk that enables networks to collaboratively work together with professionals improving the trajectory of good recovery and the assessment/management of risk.

EPUT are currently recruiting to newly established FGC coordinator posts based in the inpatient units to provide FGC initially to patients, who have first admissions and are informally admitted. It is expected that a more open, proactive culture of engagement between inpatient and families will be an outcome from this exciting development.

Perinatal

The Introduction of Adult FGC within Perinatal care is the first as we know in the country, this introduction took place in 2023 during the transformation and expansion of the Pan Essex Perinatal service as part of the NHS Long term plan.

When a mother experiences moderate to severe perinatal conditions, the whole family and support network can be affected. The NHS Guide released in 2021, “Involving and supporting partners and other family members in specialist perinatal mental health services: good practice guide” encompasses the whole model of the Adult FGC process.

As the MHFGC model was introduced into the Perinatal service, the priority was initially to ensure we had staff trained in the theory of the FGC model and also the practicalities of observing and then taking the lead under supervision of the MHFGC process in 2 areas of focus of a “recovery and adult safeguarding”.

The next step was to introduce and embed the model within the perinatal service, by offering consultation slots and discussing the potential use of MHFGC within the MDT discussions. The implementation also included in-reach work into the Mother and Baby Unit inpatient facility to support discharge planning, holding the voice of the mum and their support worker central. The staff are trained through the perinatal competency framework to ensure they have knowledge to deal with the perinatal sensitive issues the families are dealing with, both within a safeguarding or recovery context. Central to all was to ensure that we had lived experience involvement in the implementation process and so a Lived Experience Ambassador (LEA) was involved in the training of staff, and they were consulted in the development of the leaflets and video development.

Individualised person-centred care planning from the FGC model, allows Mums to consider the issues important to them involving their own chosen support network within the MHFGC process.  It has helped to promote relationships, also the understanding of mental health issues that at a time can feel particularly unfamiliar and alienating to network support members. The perinatal service embraces a trauma informed, safe and compassionate approach to their work which includes psychological interventions and treatments. Trauma Informed care is at the heart of the perinatal approach which encompasses the true ethos of FGC.

Current case studies examples have demonstrated complex needs such as suicide attempts and the implications on the individual and support network, as well as understanding mental health diagnoses. Integral has been post-traumatic stress, specific perinatal concerns, Local Authority involvement in child/adult safeguarding and a need for psychological intervention. The service enables links with community organisations that can support with relationship difficulties, family support needs/ plans and other children’s needs in the family.

Evaluation and FGC feedback forms have been finalised to collate both quantitative and qualitative data to enable analysis and development across the services.