Experiences of social work intervention among mothers with perinatal mental health needs

Abstract

Perinatal mental health difficulties are prevalent among women, and the vulnerability of young infants makes this a time when families experiencing multiple adversities may be particularly likely to attract state intervention. However, very little is known about how mothers experience social work intervention during the perinatal period. This study explored experiences of social work intervention among women with perinatal mental health difficulties. Qualitative semi‐structured interviews were carried out with 18 women with 6‐ to 9‐month‐old babies, who had been treated in England for a perinatal mental health difficulty and also had social services intervention. Interviews were analysed using thematic analysis. Findings suggested that mothers had a predominantly negative view of children's social services, especially when social workers had significant child protection concerns. The fear of being judged an unfit mother and having their babies taken away overshadowed their encounters. Mothers felt that social workers would not accept they could be good mothers in spite of their difficulties and set them up to fail. Some felt that social workers focused exclusively on the risks to the baby and did not acknowledge the mother's own needs or understand perinatal mental health. In some cases, social work intervention was described as intensifying pressure on mothers’ mental health, leading to escalating difficulties and increased likelihood of care proceedings. At the same time, our study also included examples of mothers forming positive relationships with social workers, and of ‘turning points’ where initially negative interactions stabilised and child protection concerns lessened. Women's accounts highlighted the importance of feeling ‘known’ by social workers who understood and respected them. The findings also suggested there may be value in improving collaboration between social workers and mental health professionals to create more space for representation of women's needs as well as those of their babies.

Perinatal mental health: a review of progress and challenges

“…Current specialist perinatal mental health service models often exclude certain groups (e.g., women with comorbid substance misuse problems and/or personality disorder or experiences of child removal by social services) 191 . There has been remarkably little research on how services can best help women with complex mental health needs that are likely to impact on the mother and the child.…”

Potentially modifiable risk and protective factors affecting mental and emotional wellness in pregnancy

“…A randomized control trial evaluating repeated nurse home visits demonstrated reduced levels of depression and stress in the intervention group ( Goldfeld et al, 2021 ). A similar study evaluating repeated home visits conducted by a social worker found that the intervention may result in elevated maternal stress levels ( Lever et al, 2019 ). A systematic review examining multi-modal group parenting programs found no significant improvement in maternal stress, anxiety or depression ( Waldrop et al, 2021 ).…”

Integrating Lawyers Into Perinatal Care Teams to Address Unmet, Health-Harming Legal Needs

“…Efforts to mitigate those negative effects include identifying and, when possible, addressing SDOH as part of clinical care, 5 which often means expanding the obstetric care team to include social workers and others. [6][7][8] Focusing on SDOH that raise legal issues, sometimes referred to as, "health-harming legal needs," 9 is a promising approach to expanding the types of SDOH that obstetric teams can help treat. By adding lawyers to the care team, medical-legal partnerships offer a pathway to help patients access direct legal services for specific SDOH.…”

“…Efforts to mitigate those negative effects include identifying and, when possible, addressing SDOH as part of clinical care, 5 which often means expanding the obstetric care team to include social workers and others. 6 – 8 …”