Abstract
The perinatal period is the most vulnerable period in women’s lives for relapse or the onset of mental illness. Increasing evidence demonstrates that men too experience significant vulnerabilities that may exacerbate existing mental illness or precipitate the onset of an illness in their transition to fatherhood.
The Victorian FaPMI Program (Families where a Parent has a Mental Illness) in Australia, supports the capacity of mental health services and other health and community services to provide family-focused care, that proactively supports parents with pre-existing and current mental illness, their infants and children, and other family members, alongside mental health recovery.
This paper reviews four key policy and review documents to consider the current context of Victorian (Australia) perinatal mental health policy, practice, and service planning. It explores how these policy documents provide for the particular challenges of those with pre-existing mental illness as they become parents and for their infants and families.
Introduction
Families, where a parent has a mental illness, are a statistically vulnerable group whose needs are not always well met by mental health, health, and community services. Their children are also more likely to experience adverse outcomes in development, education, social and emotional well-being, and to experience mental health concerns of their own in infancy, childhood, adolescence, or adulthood (Rupert et al., 2013).
Research is producing a strong evidence base for a range of services and programs for parents and infants from conception to three years to support significant improvements to infant and family wellbeing and whole of life outcomes. It is here in the transition to parenthood and the first years of life, that parents with a pre-existing mental illness, with their infants and families, will benefit most significantly from universal and targeted support. Support that focuses on family wellbeing, parent-infant relationships, and mental health recovery, while reducing the likelihood of intergenerational transmission of adversity.
This paper considers four key documents that shape and influence Victorian perinatal mental health policy, practice, and service planning:
- FaPMI Standards of Practice for the adult mental health workforce (Goodyear et al., 2015)
- Inquiry into Perinatal services: final report (Family Community Development Committee, 2018)
- Mental Health Care in the Perinatal Period: Australian Clinical Practice Guideline (Austin et al., 2017)
- Royal Commission into Victoria’s Mental Health System, Final Report (2021 a, b)
The documents are considered in how they speak to the identification of pre-existing mental illness, prevention, early intervention, mental health recovery, quality of family life, a strengths approach, and how they focus on parent-infant relationships.
Background – the family context and pre-existing mental illness
The transition through pregnancy to birth and parenthood is mediated by the cultural, social, emotional, and economic circumstances that families find themselves in and the hopes and aspirations they have for themselves as parents and their infants and children. Where a serious mental illness is also a feature, additional challenges are likely to be present.
Understanding the individual and family story around the onset and course of a mental illness, and how it may have influenced their developmental trajectory, including social competence, relationships, and capacity for resilience, is the starting point for working with families. How people experience mental health treatment and recovery, develop an understanding of the mental illness, early warning signs, and management, all make a difference to the quality of family relationships, transition to parenting and mental health recovery. Social and emotional wellbeing and mental health recovery occur in and through relationships (Price-Robertson et al., 2017).
Mayberry et al. (2005) in a report for Victoria Health, identifies key risk factors associated with serious mental illness influencing outcomes for children as: the severity of the parental mental illness; conflict and disruption in family relationships including separation and divorce, family violence; and social isolation. These psychosocial circumstances and stressors around the transition to parenthood can also influence the mental health of parents. If these vulnerabilities are identified and considered in practice, it allows for all services to attend to them. In turn, it is more likely that appropriate interventions can be offered to parents, with their infants and children, to improve outcomes.
COVID-19 highlights the impact of social isolation and fewer connections on the wellbeing of all new parents and their infants. Parents living with a serious mental illness experience additional barriers to joining mainstream parent groups or playgroups. Where groups specific to the needs of parents with mental illness are available, the benefits are considerable (Northern Area Mental Health, Anglicare, 2013).
Services have different roles and tasks in the perinatal period and work best when there is clear communication, secondary consultation, knowledge of resources available, and referral pathways. The Healthy babies for mothers with a serious mental illness: a case management framework, developed in Western Australia, recommends the creation of a ‘small known team’ approach to the management of a pregnant client with a serious mental illness (Hauck et al., 2008). This enables a collaborative approach with the family and supports practitioners to share knowledge and expertise across all aspects of perinatal care in complex circumstances.
REVIEW – POLICY IN PRACTICE
The following section outlines four policy documents relevant to Mental Health Care in the Perinatal Period:
- The FaPMI Practice Standards. These standards describe the capacity-building priorities and practices that are most likely to support good outcomes for consumer parents, their children and families (Goodyear et al., 2015).
- The Australian Clinical Practice Guidelines (COPE) (Austin et al., 2017) address women with a pre-existing mental illness during the perinatal period and allows a clear view of the guidance provided to professionals for the care of this group, their partners, and infants.
- The Victorian Perinatal Inquiry (Family Community Development Committee, 2018) examines a wide range of concerns and highlights gaps and practitioner concerns around supporting perinatal and infant mental health.
The Royal Commission into Victoria’s Mental Health System (2021a, b). This report makes extensive recommendations to improve mental health service provision and this includes for pre-existing mental illness, perinatal, and infant mental health.
FaPMI Practice Standards
The Victorian Families where a Parent has a Mental Illness (FaPMI) program’s central purpose is to build capacity in State run adult mental health services to proactively support parents with pre-existing and current mental illness, with their infants and children and other family members. The program has four strategic priorities:
- To collect and improve data to inform program priorities,
- To enhance the clinical practice of the mental health workforce,
- To strengthen partnerships with services relevant to FaPMI, and
- To flexibly respond across the state to diverse FaPMI local needs (FaPMI Strategic Priorities, 2019-2022).
The programs focus on family-inclusive practice and encourages a whole of life and whole of family approach.
The program operationalises FaPMI Standards of Practice (Goodyear et al., 2015) using them as a benchmark for service delivery, as a guide to prioritising areas for service improvement, and as a tool for data collection to understand the level of family-inclusive practice that operates in Adult Mental Health Services.
The FaPMI Standards of Practice for the adult mental health workforce (Goodyear et al., 2015) provides a measurable and well-articulated whole of service delivery platform for family-focused clinical practice. This platform focusses on enhancing current adult mental health services practice with the aim of achieving better outcomes for FaPMI. The practice standards offer a six-stage system which looks at screening and referral, entry into the service, negotiating a recovery plan, implementing treatment, monitoring care and discharge, or the transfer of care. The standards are intended to support families where a parent has a mental illness with children of all ages, including but not exclusively, perinatal mental health.
The FaPMI Practice Standards are consistent and supported by the Royal Australian and New Zealand College of Psychiatry (position statement 57, 2021) and the Working with Families and Carers Guidelines for Adult Mental Health Services (Office of the Chief Psychiatrist, 2018). The Practice Standards also align with family-inclusive practice recommendations of the Victorian Royal Commission into Victoria’s Mental Health System (2021).
Attention to perinatal family-inclusive practice is an important component of the FaPMI Standards for the mental health workforce by identifying adult mental health consumers’ (or partners) planning to become pregnant. It also identifies and records pregnancy status, identifies information on current supports and family relationships, and sets the scene for parenting and children’s needs to be included in any ongoing service provision. Identifying parents within an adult mental health service occurs through state-wide documentation procedures at admission, a very important first step to building family-inclusive practice.
More broadly it encourages attention to child wellbeing, family vulnerabilities, and strengths (including impact of trauma, family violence, recovery plans and family care plans). The Standards expect that a family’s needs and plans (including infants /children) are included in regular mental health treatment reviews. Although the FaPMI Standards do not provide detailed guidance in relation to perinatal mental health practices, they encourage coordinated and collaborative practice across different parts of mental health service delivery and offer a base from which other specialist programs and interventions can occur. This guidance is helpful in not only addressing service system organisation, policy, and planning but is aimed at providing a mechanism to drive practitioner competency and skills (Fixen et al., 2009; Goodyear et al., 2015).
The FaPMI program is designed to support practice improvement through capacity building and professional development. However, there are challenges in implementing the Practice Standards in Victorian mental health services. The Standards challenge a culture of individualised focus of care. “Evidence suggests that Victoria’s adult mental health system primarily takes an individualist approach to treatment, care and support without consistently considering the social contexts within which most people live in the community” (Royal Commission into Victoria’s Mental Health System Report, 2021b, p. 72). Implementation of models of care that support the whole family needs to be systemically considered by taking into account the family needs as well as the setting and the agency, and how they are integrated.
Practice within the Standards relies on each mental health service developing and implementing local procedures to comply. The Victorian FaPMI File Audit measures adherence to the FaPMI family-focused practice standards. It uses file audit methodology and indicates that ‘…family-focused practice continues to be recorded at moderate to low, rather than high levels…’ (The Bouverie Centre, Latrobe University, 2020, p. 14) reflecting that implementation of FaPMI Practice Standards remains a work in progress.
Adult mental health service ‘practice as usual’ is influenced by an individual focussed approach. This approach might risk seeing the mental health outcomes of mental health consumers during the perinatal period. For example, the absence of a family focus lens risks ignoring the infant’s perspective all together.
Those with pre-existing mental health issues who become parents have additional core challenges of needing the best available information that considers both the risk and benefit of treatments such as medication for both the parent and the infant. They also need to be engaged by mental health services, as a soon-to-be parent, in a respectful, supportive way, recognising the importance of their parenting role. They need to be given an opportunity to discuss how they are approaching their journey to parenthood, including often strongly held guilt, myths, and stigma about parenting with mental illness. This engagement then enables parents to be connected to the strong evidence that is available which looks at ways to prepare for parenthood and manage their mental health, reduce the vulnerability of children, and support positive outcomes (Foster et al., 2019; Goodyear et al., 2018; Hosman et al., 2009; Nicholson et al., 2019; Rupert et al., 2017; Siegenthaler et al., 2012; Thanhauser et al., 2017).
The Practice Standards guide mental health practitioners to provide a balanced approach considering both the strengths and the vulnerabilities of the parents with a pre-existing mental illness and their families. “…treatment is delivered with regular review of protective factors, risk, and vulnerabilities” (Goodyear et al., 2015, p. 174). This is an important balance as families in the perinatal period are often faced with the challenge of a service system that may only consider risks. The practice standards provide adult mental health services with a starting place to make the necessary changes to ‘practice as usual’ by identifying both strengths and risks within a family context and including a focus on parent-infant relationships. To enable this practice, tools or screening resources for the perinatal period to support inquiry and observations similar to the Western Australian Healthy babies for mother’s initiative (Hauck et al., 2008) and available in the Australian Clinical Practice Guideline (Austin et al., 2017), could be incorporated. This then enables a strengths-based approach to identification, early intervention, and mental health recovery, which addresses the parent-infant relationship and supports referrals to specialist community programs, where appropriate.
Victorian Perinatal Inquiry
In 2018, the Victorian Government completed the Inquiry into Perinatal Services (the Inquiry) to examine the healthcare and wellbeing of mothers and babies throughout the entire perinatal period. The report provides a snapshot of the issues across perinatal health and allows a view of how perinatal mental health is located (Family and Community Development Committee, 2018).
The Inquiry devoted specific attention to perinatal mental health and included the voices of families, support groups, and health professionals. All contributors reinforced the need for improvements within the perinatal sector, particularly in mental health. The report notes that the many complexities in the provision of care, often preclude support to the specific needs of more vulnerable women and families. There are few services designated specifically for pregnant women with a pre-existing mental illness and access for them to more generalist services can be difficult.
According to Goodyear et al. (2015), mainstream perinatal services may not be best placed to address the needs of these women, due to difficulties for the women, their families, and the health professionals who are often not trained in mental health (Hauck et al., 2015). Rather, a model of care is required to be formed from the recommendations of the Inquiry, focussing on strengthening early intervention and a plan for integration of perinatal mental health services into broader perinatal services (Family and Community Development Committee, 2018, p. 134). Benefits for outcomes for both women and their infants are prioritised through the recommendation of a Victorian Perinatal Mental Health Plan that builds on the existing 10 Year Mental Health Plan. Whilst this is promising, it is disappointing that there are no specific recommendations that provide for the particular challenges of those with pre-existing mental illness and their infants.
Despite well documented increased risks to fathers’ and partners’ mental health during the perinatal period, there are few specific services focusing on their support. Bollard (in Sved-Williams & Cowling, 2008) highlights these issues and discussed the considerations for fathers’ wellbeing, their roles in the dyad, and their caring responsibilities. Support for the mental health of fathers is discussed in the report, noting also the benefits to the health and wellbeing of mothers and their infants (Family and Community Development Committee, 2018, p. 155). Accordingly, recommendation 3.10 addresses the expansion of perinatal mental health programs for fathers. For this to be effective, the authors note that services need to consistently consider the whole of family context and be integrated with a model of care which incorporates support within the family’s community including fathers’ playgroups and parent support. Online information and support are also emerging as accessible supports for parents. However, consideration for those with pre-existing mental health concerns is still required.
The Inquiry and the evidence presented recognise that addressing the needs of women who have a pre-existing mental illness, may prevent the potential exacerbation of symptoms and the impact this can have on their unborn or infant. For these women, the early postnatal period may be challenging. The 2018 Inquiry reinforces concerns about the impact it can have on the relationship with their baby and resulting emotional and developmental concerns (Family and Community Development Committee, 2018, p. 115 – 120). Unaddressed, the long-term consequences for mental health and wellbeing of infants and parents, and quality of family life are obvious.
From professional reflections of clinical practice, the authors offer anecdotal feedback regarding the benefits when dyadic work is identified, that reframes mental health concerns, and highlights the specific needs of the infant. One example comes from a Lactation Consultant who noted that after years of working with unsettled babies and distressed mothers and normalising their experience, the impact of the situation on the mother and infant from a psychological perspective, was often overlooked. Just as concerning, is when a mother’s pre-existing mental illness is blamed as the cause for their perceived inability to cope with parenting demands.
The Inquiry reports on various examples of issues raised regarding perinatal mental health for parents with pre-existing mental illness and their infants. There is a significant focus on the existing guidelines and recommendations for care. In particular the Australian Clinical Practice Guidelines (Austin et al., 2017), with emphasis on early identification and intervention, and integrated, family-focused care. The Inquiry is obviously a Victorian snapshot of a state fortunate to have a variety of services. This picture varies greatly across Australia, where there are many influences within States and nationally, that determine service delivery.
Mental Health Care in the Perinatal Period: Australian Clinical Practice Guideline
The Australian Clinical Practice Guideline’s (Austin et al., 2017) stated intention is to “inform local, state, and national policy surrounding the timely implementation of appropriate tools to ensure early identification of women’s needs and timely, safe (for mother and baby) and effective intervention” (Austin et al., 2017, p. 73). The guidelines specifically address women living with serious mental illnesses including schizophrenia, bipolar disorder, and borderline personality disorder.
It describes the potential complexities and risk factors that may influence pregnancy management, including medications, mental health care, relapse prevention, transition to parenthood and the early postpartum period. Each diagnosis is addressed separately, and fact sheets are available on the accompanying Centre for Perinatal Excellence website. There is a clear intention to support parent-infant relationships alongside the physical and mental health and wellbeing of mother and infant. However, little is mentioned in relation to supporting the transition to parenthood psychologically, or practically, for the mother, father, or parenting partnership. It is these areas of becoming parents that offer the most substantial opportunities to make a difference in the transition to parenthood.
For parents with a pre-existing mental illness, open discussion with partners and family to develop a shared understanding and support plans that include early warning signs and mental health relapse prevention needs to be offered rather than assumed. No attention is given to men with a pre-existing mental illness as they become fathers in these guidelines. Research and practice wisdom acknowledges that depression regularly occurs in the first trimester for men and is also increasingly recognised postpartum. For becoming fathers, with a pre-existing mental illness, any worry may precipitate increased symptoms or relapse. The implications for the start of a new family, or subsequent births, are significant. Any deterioration in mental health could affect relationships and reduce a father’s ability to participate in and support their new family. These impacts within the family could be felt for a long time.
The importance of the infant’s mental health and wellbeing is first raised postnatally with the observation of mother-baby interactions supporting early identification of concerns (Austin et al., 2017, p. 34). The Guidelines suggested follow-up action is a referral to a perinatal and infant specialist. A national guideline cannot provide service details for each state. However, the Centre of Perinatal Excellence website has added a search for services function. Whilst this is very welcome, access to options that are designed to include infants with parents with a pre-existing mental illness are limited. Programs for fathers are increasing and a range of web-based supports for new dads are also a welcome first step towards developing additional guidance for working with men with a pre-existing mental illness.
The Australian Clinical Practice Guideline (Austin et al., 2017) is a substantial contribution to excellent care for women with a pre-existing mental illness in the perinatal period. There is a strong appreciation of the importance of the parent-infant relationship, and attention to good mental health treatment, and care. Key areas for development are: Establishing the most effective way to provide support in the transition to parenthood for both parents, supporting the development of the emerging parenting relationship from pregnancy, the needs of infants, and support to parent-infant relationships throughout the perinatal period.
The expected audience of the Australian Clinical Practice Guidelines (Austin et al., 2017) includes mental health and allied health professionals, consumers, and carers, alongside those delivering antenatal and postnatal care. The guidelines do not address the mechanisms for collaborative practice between these services and do not have a family-inclusive approach that would support collaboration with the whole family in the provision of services. Each of these professions would be well-served by resources and training to support collaborative working relationships. This is consistent with concerns in other reviewed documents calling for an integrated approach to perinatal health and further training of those providing services, calling for professional development, and an integrated approach.
The Royal Commission into Victoria’s Mental Health System
The Royal Commission into Victoria’s Mental Health System (2021a, b) recognises the perinatal period as one of high-risk to mental health and wellbeing. Whilst poor mental health can start, recur, or worsen during the perinatal period, the Commission acknowledged that responses to parents already linked to public mental health remain uncertain in policy. This reinforces a call for action in both policy and practice and the need for models of care appropriate for parents with pre-existing mental illness.
Experiences of psychological distress during the perinatal period vary widely, although prevalence data referred to in the Royal Commission presents perinatal depression in Victoria at 10.7 percent and perinatal anxiety at 20 percent of women in antenatal and postnatal periods. There is generally less research on the prevalence of perinatal mental illness among fathers and non-birth parents, and no clear data on parents with pre-existing serious mental illness.
The Royal Commission Report (The Royal Commission into Victoria’s Mental Health System, 2021 a, b) notes that primary and secondary services including General practitioners (GPs) and maternal-child health services, can screen for and support parents with perinatal mental illness. Perinatal mental health screening is recommended as part of routine antenatal care at public health maternity and newborn care services, and in postnatal depression screening by Victoria’s maternal-child health nurses. GPs, maternity services, and maternal and child health nurses, can connect parents to specialised perinatal mental health and wellbeing services and specialised parent-infant inpatient units when required, provided the services are available.
The experience for parents with existing mental illness can be quite different. As indicated previously, many people with pre-existing mental illnesses do not access mainstream services. Parents with pre-existing mental illness may experience challenges in connecting to mainstream services including GPs, maternity services, and maternal-child health care, due to their experience of illness, stigma, and concerns regarding child protection and other mandated interventions. The capacity of adult mental health services to screen for pregnancy, and support parents during the perinatal period is limited by professional and service capacity. The authors recognise limitations in the current service systems. For example, further capacity-building work is required. This includes training and support of staff and the development of a responsive and integrated model of care. A proposed model of care would ensure all mental health consumers would have access to specialist perinatal mental health assessment and support.
The Royal Commission Report (The Royal Commission into Victoria’s Mental Health System, 2021 a, b) recommends that most prospective and new parents receive treatment, care, and support in their local community from primary and secondary care and related services, with specialised perinatal mental health clinicians and support workers ‘reaching in’ to work directly with services to build their capability to respond to needs. This recognises the important roles of family, carers and supporters, and communities of place, identity, and interest, including facilitated and informal playgroups and parents’ networks. If realised, these models must also consider and respond to the capacity of service systems to support parents with pre-existing mental illness, including targeted supports specific to the needs of these parents and their infants and children. For example, supported playgroups.
The Commission recommends specialised “Community Perinatal Mental Health and Wellbeing Teams” that provide multidisciplinary treatment, care, and support in the community (The Royal Commission into Victoria’s Mental Health System, 2021 a, b). Lived experience workers (with a lived experience of perinatal mental illness) will be part of the specialist multidisciplinary teams (an addition to existing perinatal services). Models of practice in rural Perinatal Emotional Health Programs (PEHP) could inform these developments as discussed in the Perinatal Inquiry (Family and Community Development, 2018, p. 144). Again, specific attention is required, to ensure the needs of parents with pre-existing mental illnesses are included.
For consumers with more complex mental health support needs and especially in the context of perinatal mental illness, the reforms suggest that bespoke perinatal emotional health programs be extended. For example, with suitably trained and resourced staff, specialised perinatal mental health clinicians, and peer support workers, being embedded in existing models of mental health care. Such programs need consideration in a broader comprehensive model of care, yet to be formulated.
Consistent with FaPMI Practice Standards (Goodyear et al., 2015), the Commission recommends service models that integrate care for parents and their infants into routine Adult Mental Health Service delivery by; recruiting and training specialist perinatal clinicians, establishing shared care and referral pathways, and through a range of parenting supports including evidence-based family practices such as Let’s Talk, Single Session Family Consultation, and specialised parenting programs (The Royal Commission into Victoria’s Mental Health System, 2021 b, p. 104). In these proposed models, care planning and coordination would be delivered consistently with the rest of the adult and older adult mental health and wellbeing services.
If realised, the recommended reforms will strengthen the overall focus on families, integrate treatment, care, and support, that are sensitive to the family’s dynamics, situation, and strengths. These will also focus on attending to the quality of the relationships between infants, children, their parents, family carers and supporters. For parents with pre-existing mental health concerns, the recommendations include features for a model of care which would ensure access to services that are capable of responding to their family’s specific needs.
This includes but should not be limited to trained specialist staff located in services which are accessible to parents with pre-existing mental illness and connection points and processes that link with other services. Services also need to be embedded in the family’s natural communities and be responsive to the developing needs of parents and their infants through the perinatal period and beyond. Co-ordinated care planning, clear referral pathways and a range of specialised parenting programs and community groups will form part of this model.
Implementation & Sustainability of New Practices
“Family-focused practices” encompass approaches, programs, interventions, models, and frameworks that acknowledge the whole family context of the person receiving services (Allchin et al., 2022). These consider the relational family context of recovery and therefore attend also to the person’s parenting role and family relationships. They provide support to the parent in the context of their children and family, while also attending to broader family mental health needs.
Public Mental Health Services are part of wider health and community systems, where various factors impact the implementation and sustainability of family-focused practices (Dixon et al., 2001; Kavanagh et al., 1993; McFarlane et al., 2003). At an individual level, training to build knowledge, skills, and confidence in family-focused practice, enhances the practitioner’s ability to identify and support the parenting role of consumer parents while also holding the children and broader family needs in mind. In addition, organisations must establish systems that routinely identify consumers’ parental status and attend to dependent children and require funding to prioritise working with whole families with a preventive and early intervention approach.
To succeed, government and organisational structures, such as policies and directives, must be mandated to create an authorising environment and leadership support for the promotion of family-focused practices as part of everyday mental health work (Allchin et al., 2022). Directives are needed that clearly articulate effective models of care which identify and respond to the complex needs of specific parenting populations. In this instance, to parents with pre-existing mental illness.
The key features in a model of care that is responsive to parents with pre-existing mental illness and their children and families include:
- A workforce of suitably trained, skilled, and supported practitioners.
- Services that are explicitly whole of family focused.
- Processes and tools to support identification, early intervention, and engagement through strengths-based family-focused practice.
- Collaboration and partnerships between agencies working across the perinatal period.
- Clear and accessible referral pathways.
- Targeted interventions and services including supported playgroups and parenting groups.
- Parent peer support workers and meaningful connection to the community.
This reminds us of the work required at many levels to implement change, particularly family-focused practices. A policy context that provides a framework for workers to engage meaningfully with families and focus on parenting, supports mental health recovery while enabling parents to keep the needs of their infants and children central.
Discussion
Looking through the lens of parents living with a mental illness highlights the missing policy and practice frameworks that are required to support all families in the critical stages of their becoming. The evidence is clear, that a well-considered comprehensive model of care, can minimise the intergenerational transmission of adversity. To achieve this, the place of perinatal and infant mental health services in ‘the’ service system is, we argue, secondary to the conceptualisation of perinatal and infant mental health as whole of family approach over this life stage supported by connected responsive services.
Dispersed and disconnected services and systems with a focus on ‘episodes of care’ and poor connection between public and private providers and the universal systems, such as maternal and child health, are not able to provide the continuity or consistency of care required. The growth in the workforce required to meet the implementation of the Royal Commission into Victoria’s Mental Health System (2021 a, b) recommendations, provides an opportunity to build new knowledge, skills, and approaches to perinatal and infant mental health.
“Vulnerable parents across the life span accessing a range of adult focussed services present us with an opportunity to intervene and indeed to prevent the onset of inter-generational challenges” (Cuff, 2017, p. 123). Providing appropriate services for families living with parental mental illness is complex. The evidence base for family inclusive practice is strong and supports both mental health recovery and infant and child wellbeing.
This brief review of current Victorian policy and reform repeatedly identifies themes of complex demand and disconnected service systems. Family-focused child and infant services would consider parents and parenting, mental health, and wellbeing. Family-focused adult services would consider their parenting roles, mental health and wellbeing, family relationships, and the needs of children and infants.
Proactive support of the parenting role and/or transition to parenthood alongside the parent’s mental health management provides a meaningful purpose and direction for service delivery and collaboration between services. The FaPMI Practice Standards (Goodyear et al., 2015) provide clear expectations that support the early identification of parents and their dependent children. They support family-focused engagement and interventions in adult mental health services. Challenges to implementing Practice Standards may be addressed by authorising environments which mandate policy and procedures to ensure these are embedded.
The Australian Clinical Practice Guidelines for mental health care in the perinatal period (Austin et al., 2017) provide a launching point to extend guidance to family-focused work with parents with a pre-existing mental illness. The development of resources that support family-focused practice in a range of settings is more likely to engage the wider audience it seeks to reach. The COPE website provides good material as a resource to develop this work.
The Perinatal Inquiry (Family Community Development Committee, 2018), and the Mental Health Royal Commission (Royal Commission into Victoria’s Mental Health System, 2021 a, b) produced significant recommendations that contribute to workforce development, funding, and resourcing and focus on creating collaborative and coordinated models of care. Understanding how existing services may need to reshape and find ways to connect with other elements of service provision for families throughout the perinatal period will be a grand undertaking best done with families themselves in codesigned frameworks. The lived experiences of families alongside professional stakeholders representing the layers of services involved in the perinatal period can inform the development of models of care that support early intervention and ensure a collaborative focus on the infant, parents, and the whole family.
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Authors
Clark, Carol,
Families where a Parent has a Mental Illness (FaPMI) Coordinator,
Northern Area Mental Health Service, Australia
Jewell, Hanna,
Family Practice Consultant, Coordinator of The Victorian FaPMI Program,
The Bouverie Centre, La Trobe University, Australia
Cosgriff, Cheree,
FaPMI Co-ordinator,
Grampians Area Mental Health, Ballarat Health Services, Australia
Hegarty, Michelle,
FaPMI Coordinator,
Eastern Health Adult Mental Health Program, Australia
