Using co-production and co-design in FNP to make maternal mental health a priority

Emma Cook is a clinical quality lead for the Family Nurse Partnership National Unit.

FNP has sites in over half the local authorities across the country; the nature of working at this scale means a great deal of diversity in local needs and priorities. As part of the Accelerated Design And Programme Testing (ADAPT) project, the FNP National Unit have been working alongside local FNP teams in a co-production capacity to assess, change and develop aspects of the programme that allow nurses to flex certain aspects to better meet individual client needs.

In Nottingham, improving maternal mental health services is a local priority, so, as part of ADAPT, the FNP site team have been working to tackle and reduce the increasing level of need in this area.  FNP teams already work with clients on complex issues around mental health, anxiety and work to create positive change. The team in Nottingham wanted to further strengthen and revise their universal offer and also to add a targeted offer to be used with clients with an identified mental health need.  A ‘toolkit’ of materials was developed to complement the FNP interventions already delivered by family nurses that would help clients to:

• Understand and learn more about their emotional/mental health
• Identify appropriate self-help and coping strategies
• Improve how they interact with their child.

The team in Nottingham engaged with clients across all stages of their work, ensuring their adaptation was informed by their views, experience and feedback. During these sessions, the clients were incredibly open in discussing how they felt about their mental health experiences - almost all wanted to understand more about mental health generally, and were reassured by how common mental health issues can be during pregnancy and within the first year of having a child.

Nurses also found that there was a consensus around the fear which many clients felt in admitting to someone that they were struggling with their mental health; worrying that people would judge them and question their ability to parent, which they worried might, in turn, increase the risk of their child being removed by children’s services. All of the clients reported they felt comfortable sharing their concerns with their family nurse due to the trusting therapeutic relationship the programme endeavours to support.

The targeted toolkit that has been developed enables the family nurse to flex the FNP programme, to ensure clients receive the appropriate level of support with their mental health. It provides family nurses with a variety of resources to enable them to facilitate interventions with clients that are experiencing mild to moderate levels of anxiety and depression, whilst also helping to provide additional support for clients awaiting further support from specialist services following referral.

We hope that the delivery of the adaptation will, over time, support the refinement of effective tools to address maternal mental health issues promptly, offering the earliest possible interventions and preventing escalation to specialist services.