Perinatal mental health - peer support: action plan – 2020 to 2023

Summary of Peer Support Review and links to Delivery Plan and Peer Support Action Plan

Background

In March 2019, the Perinatal and Infant Mental Health Programme Board was launched by the First Minister to oversee, provide strategic leadership and have overall management of the delivery of improved perinatal and infant mental health services. This includes establishing improved provision at national, regional and local level in line with the recommendations in the Perinatal and Infant Mental Health Managed Clinical Network’s ‘Delivering Effective Services’ report published in March 2019. This commitment is supported by £50 million of investment in perinatal and infant mental health services over the next 4 years.

The Delivering Effective Services Report on perinatal and infant mental health services across Scotland made the recommendation to enhance access to peer support as part of a wider range of services for women, infants, partners and families in the perinatal period. Peer support ranges from support groups with other parents, to volunteer befriending and peer workers in inpatient settings. Ministers have accepted the recommendations from the Report and are working towards enhancing peer support for women and families during pregnancy and after birth.

Women and Families Maternal Mental Health Pledge

The Perinatal and Infant Mental Health Programme Board Delivery Plan 2020/21 sets out key actions in delivering upon these commitments. This includes the action to meet the pledge expectation of: "My family are given information and support for themselves and to support me." This action seeks to develop peer support provision by implementing the recommendations in the peer support review and the associated action plan to:

• Identify and support existing good practice
• Ensure safety and quality
• Prioritise accessibility and inclusivity
• Respect the unique value of peer work
• Integrate robust evaluation

Peer support ranges from support groups with other parents, to volunteer befriending and peer workers in inpatient settings.

Action 7 in the Perinatal and Infant Mental Health Programme Board’s Delivery Plan for 2020/21 commits us to:

Developing Peer support provision: Implement the recommendations and associated action plan from the ‘Review of the evidence for Peer Support in Perinatal Mental Health’ report.

Research in the UK and internationally suggests that peer support can be beneficial for supporting women’s mental health in the perinatal period.

Review of the evidence for Peer Support in Perinatal Mental Health

The aims in the report were to review the evidence base for peer support in perinatal mental health by responding to the following questions:

• What evidence is there on the effectiveness of peer support in the perinatal period?
• In Scotland, what models of perinatal peer support can be identified using currently available evidence?
• What evaluation evidence exists on the effectiveness of current models of peer support in Scotland?

Summary

The main findings from the literature and responses from stakeholders demonstrate the benefits of a range of peer support models.

• Quantitative evidence shows that peer support can significantly reduce depressive symptoms for women experiencing postnatal depression.
• Qualitative evidence makes it clear that women experience improved self-efficacy, self-esteem and parenting confidence through peer support.
• Peer support directly reduces social isolation and can increase social activities outside the home for women experiencing perinatal mental health difficulties.
• There is also evidence that peer support can act as a bridge to build trust with clinical services.

It is clear that peer support in the form of peer workers, peer befrienders, peer groups or informal and online support, can be highly effective in supporting parents with perinatal mental health difficulties. Research evidence suggests that peer support:

• Builds parenting confidence and improves parenting self-efficacy for mothers/carers
• Reduces social isolation for mothers/carers and encourages them to form further social bonds
• Builds links between parent and other services, helping to develop trusting relationships
• Can reduce depressive symptoms
• Can be highly rewarding for both peer supporter and mother/carer when safe and appropriate

The report is hugely helpful in influencing the work of the Perinatal and Infant Mental Health Programme Board. Developing peer support provision is a key priority for the Programme Board, which will provide the overall oversight and strategic input.

Peer support will feature in our Perinatal and Infant Mental Health Raising Awareness and Reducing Stigma Strategy and will be a key focus of the Perinatal and Infant Mental Health Equalities Working Group.

The report gave us the below recommendations, which are aligned with the actions within the plan.

Recommendations:

1. Identify and Support Existing Good Practice

1.1 Where there are examples of good practice, with evidence of appropriate training and support for peer volunteers, these should be championed, supported and built upon.

1.2 A range of peer support models should be available, with improved access to services across geographical areas throughout Scotland.

1.3 Regional perinatal mental health networks with statutory and third sector services should be facilitated to share best practice and aid appropriate referrals.

2. Ensure Safety and Quality

2.1 Specialised approaches to recruitment, robust and ongoing training, appropriate and timely clinical supervision and support for ongoing good practice are essential elements in ensuring quality and safety.

Peer supporters need robust support systems and additional flexibility in their roles to enable them to maintain their own recovery and wellbeing.

Existing evidence based and quality assured resources should be utilised when creating peer support services to ensure high quality practice from the start.

All peer support services should have their own policy around safe-guarding peer support workers, volunteers and service users.

3. Prioritise Accessibility and Inclusivity

3.1 Peer support should be available in a variety of formats, for example, one-to-one, in-person, telephone and group support. This will ensure that the support meets the needs of a wide range of mothers/carers.

3.2 Targeted peer support services should be designed to meet the particular needs of groups who are currently underserved by services, for example: Mothers/carers living in poverty, ethnic minority groups, geographically isolated communities, families affected by domestic abuse or substance abuse, parents who experience the loss of a baby, in addition to considering the impact of religious and cultural beliefs, disability, health problems and any other pertinent factors.

3.3 Specific peer support for men should be widely supported and become more widely available. This will help to ensure this underserved group have a range of peer support services in place to support them.

4. Respect the Unique Value of Peer Work

4.1 Peer support services should recognise and celebrate the benefits of peer experience and peer workers or peer volunteers should not replace clinical staff or be asked to do their work.

4.2 Peer support worker and volunteer roles should provide clear boundaries of the role for peers, the people they support and the wider team.

5. Integrate Robust Evaluation

5.1 Evaluation should be built into peer support services to ensure they are meeting needs of clients and peer supporters and providing safe, appropriate and effective services.

5.2 To build the evidence base for peer support, new services should measure their effectiveness using a validated measures, to reinforce a commitment to a robust evaluation.

Development of Action Plan

The Actions within this plan have been derived from the recommendations within the Peer Support in Perinatal Mental Health: Review of Evidence and Provision in Scotland paper. This has helped us to ensure that the actions we propose are based on evidence with a clear methodology and rationale. However, we cannot rely solely on the evidence when considering the delivery of the Action Plan. We need to understand which actions are most urgent, which may require longer term planning and which may need to be adapted as time progresses.

On 30 October 2020, the Scottish Government hosted a Roundtable Event with peer supporters and women with lived experience from around Scotland. Discussion and feedback from this event has helped to inform the progression of this action plan. The event was co-designed and Chaired by Maternal Mental Health Scotland’s Participation Officer.

A total of 64 stakeholders attended the launch event, including the Minister for Mental Health. 33 Third Sector organisations were represented and we received a total of 115 total comments during event, which has helped to co-produce this Action Plan.

The actions will be subject to the Scottish Budget and will be delivered over the course of the Programme Board.