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Best Beginnings is the podcast for everyone working in or caring about the early years. Hosted by George Looker, CEO of Babyzone, each episode brings together leading researchers, clinicians, practitioners, policymakers and parents to explore the evidence, ideas and innovations shaping how we support children and families in the UK.
From infant mental health and attachment to workforce challenges and systems change, Best Beginnings goes beyond the headlines to have the conversations that matter most in early childhood.
New episodes drop every Tuesday.
Best Beginnings is brought to you by Babyzone, a national charity operating free, evidence-based family hubs across England for families with children aged 0–5.
00:00:00:04 - 00:00:25:13
Unknown
Often in practice, it's very clear because parents with OCD, there's absolutely no association with harming their infants. They're doing everything they can to move away from those thoughts, to suppress them, to kind of stay safe. And it's very clear on talking to them. They are they're horrified by the fact that the thoughts are in their their mind.
00:00:25:15 - 00:00:39:02
Unknown
Welcome to Best Beginnings, a podcast from Baby Zone charity dedicated to giving every baby the best start in life. I'm George Lucas of Baby Zone, and today I'm joined by Doctor Fiona Collection.
00:00:39:05 - 00:00:56:16
Unknown
most of the last 40 years, whenever we've spoken about new parents and mental health, we've spoken about postnatal depression. Now, new research published by the Annual Review of Clinical Psychology has found something that most people, including most clinicians, don't yet know.
00:00:56:17 - 00:01:28:10
Unknown
The anxiety and related disorders are the most common mental health conditions in the perinatal period. They affect 1 in 5 pregnant and postpartum people, and they are more common than depression. One of the lead voices in that research, and the UK's foremost expert on anxiety and OCD in pregnancy and new parenthood, is my guest today. Fiona is an associate professor of clinical psychology at the University of Oxford, and an honorary consultant at the clinic and clinical psychologist at Oxford Health NHS Foundation Trust.
00:01:28:13 - 00:01:52:14
Unknown
Her research sits at one of the most important and least understood intersections in early childhood, the relationship between a parents mental health and the development of their baby. She spent last two decades building the evidence, and the conditions that she studies are far more common, far more serious, and far more treatable than most people realize, you know. Welcome to Best Beginnings.
00:01:52:14 - 00:01:55:09
Unknown
Thank you so much for spending some time with us this afternoon.
00:01:55:09 - 00:01:57:13
Unknown
Thanks so much for having me. It's surreal delight to be
00:01:57:19 - 00:02:10:18
Unknown
Yeah. And as we mentioned in the introduction, you've obviously dedicated a lot of time and research into this space. What is it about the months around having a baby birth and being a new parent?
00:02:10:19 - 00:02:17:11
Unknown
The year that follows? What is it that's drawn you as a clinical psychologist to this field and kept you there?
00:02:17:16 - 00:02:35:10
Unknown
There's so much going on at this time as any parent will testify. I think just the the amount of change kind of on every level of sort of biological change or social role change is there's so much to kind of contend with.
00:02:35:12 - 00:02:59:19
Unknown
Even if things go as well as they can. Parents really sort of need and deserve support. I don't need to tell you that, but it's a time of increased kind of vulnerability for all the same reasons. I was really lucky to work early in my career on a treatment trial for eating disorders in the perinatal period, which demonstrated some of the things you were talking about there that increased vulnerability.
00:02:59:20 - 00:03:24:07
Unknown
Of course, changes in weight and shape, having to deal with infant feeding. And so if you have vulnerabilities or a preexisting issue, it brings so much to the fore and kind of careful research to really understand the mechanisms can then inform very helpful interventions. So I think having had that exposure as a as a young researcher, it's always stuck with me.
00:03:24:08 - 00:03:43:07
Unknown
The importance of the area, the impact that you can have, not just on one person but on the whole family. And of course, the fantastic collaboration with parents themselves, primarily people with lived experience and of course, colleagues from across the disciplines. Everyone has a role to play in this area.
00:03:43:09 - 00:03:54:02
Unknown
And I guess, you know, this is something that most of us, I think are familiar with perhaps lack a depth of understanding or a sort of formal explanation in terms of what's going on.
00:03:54:03 - 00:04:16:02
Unknown
And again, there's a lot of talk, I guess, around postnatal depression and sort of perinatal mental health, but it's not particularly well understood, perhaps. What what do we mean by these sort of by these big terms that often get bandied around, used in sort of headlines and newspapers for a lot of people. The conversation is just about postnatal depression, but actually, what's the bigger picture look like?
00:04:16:02 - 00:04:22:10
Unknown
What is the the science I guess that's going on during this period? Yeah, I mean,
00:04:22:10 - 00:04:42:15
Unknown
it was like that for a long time, that depression and perhaps psychosis really had a lot of the research attention. And of course they are such important disorders. And it's only really relatively recently that we have had a little bit more evidence that all the other disorders are potentially quite active at this time.
00:04:42:16 - 00:04:48:14
Unknown
And the sort of epidemiological evidence has really only kind of been there for quite a short while.
00:04:48:18 - 00:05:16:20
Unknown
You know, even being inquiry about anxiety based problems. And I think with more and more research, it's sort of come to the fore that these problems are very common. There's of course, a whole wealth of factors that feed into that, from the situation itself to kind of underlying vulnerabilities, inequalities to the the birth experience, sort of harm from birth trauma, those kind of issues
00:05:16:20 - 00:05:17:24
Unknown
that are really highlighted.
00:05:17:24 - 00:05:27:00
Unknown
The anxiety type of presentations are actually even more prominent. That's now coming through as a regular finding.
00:05:27:00 - 00:05:41:14
Unknown
And why do you think it's taken so long? We sort of spoke about 40 years in the introduction. And why do you think that, given anxiety is more common than depression in this period, and why do you think the public conversation has lagged the reality for such a long time?
00:05:41:14 - 00:06:15:01
Unknown
I think possibly a function of a lack of research, finding into mental health and to perinatal health more generally. The landscape has really changed in 2014, and leading up to that, there was an incredibly influential series of systematic reviews in The Lancet and an economic report, and that was notable in a number of ways. One was it brought together under the Mental Maternal Mental Health Alliance, a 140, I think organizations all run by people with lived experience.
00:06:15:01 - 00:06:43:15
Unknown
So there's always been that within the field. People who've experienced any number of conditions have always wanted to kind of help others in that. So so the Maternal Mental Health Alliance brought them all together. They linked up with a university and they made the economic case for increased investment. So they brought together all the strands of research, and they put a figure of 8.1 billion pounds per year.
00:06:43:15 - 00:07:16:20
Unknown
Was the cost to us as a society of untreated mental maternal mental health issues, most of the costs related to child use of services and so on, but lots for the mother as well. So I think that really changed the conversation. And of course, if you invest early, you can change the trajectory for for families. So it made the government sit up and notice and I think brought things into the conversation as we've been able to communicate with each other more readily through social media and so on.
00:07:16:20 - 00:07:50:13
Unknown
I think all of these things have helped widen the field and bring things into prominence, and that report led to a whole transformation of services. So now there are services to refer to. I think for so long, perinatal mental health, almost skeleton services. The embassy mother baby units were few and far between. You often had to travel for, you know, tens of miles away from family if you were admitted to one community, mental health services were quite sketchy across the board.
00:07:50:13 - 00:08:10:23
Unknown
So again, the Maternal Mental Health Alliance followed up that report with a campaign called Turn the Map Green, which has been incredibly effective and they are wonderful campaigners to this day. So it's a good place to sort of look to for inspiration. And certainly if you are a user of these services,
00:08:11:00 - 00:08:17:12
Unknown
Yeah, it's great, as you say, greater awareness, understanding and conversation around these topics.
00:08:17:14 - 00:08:48:10
Unknown
I guess, you know, we take it back to why it exists or one of the sort of the common reasons, common factors, these vulnerabilities might, might be triggered. We know that having a baby is a stressful life event. And that transition to parent heard, you know, is creating vulnerability for obviously the baby but also a parent. Why? Why does that trigger so many of the mechanisms that you just described?
00:08:48:10 - 00:08:56:06
Unknown
What is it about the science and the evidence that you've seen that things will create all of these different challenges for parents?
00:08:56:08 - 00:09:24:19
Unknown
Yeah, I mean, obviously a number of mechanisms at play. There's biological mechanisms. There are hormonal susceptibilities for some people. There are, of course, a number of psychological mechanisms. The fact that parenthood is underpinned by a sense of responsibility, for example, that's something really relevant to anxiety disorders, to people's sense of threat, to people's sense of kind of understanding threat.
00:09:24:19 - 00:09:32:21
Unknown
So all of the advancement and understanding of these factors has has increased over the last few years.
00:09:32:21 - 00:09:53:03
Unknown
there's been a number of kind of important studies that have really highlighted these mechanisms in operation. It's very hard to isolate kind of specific ones on an individual basis, but really changes over the whole kind of period, I think explain the sense of vulnerability.
00:09:53:03 - 00:09:54:12
Unknown
It's quite dysregulated
00:09:54:17 - 00:10:21:01
Unknown
to go through the perinatal period. There are stresses in terms of social stresses, financial stresses. It's a time of increased risk for domestic violence. So we know that the mechanisms are family wide. It's not just the birthing person, it's the relationship between the two parents. All of these can then multiply the impact on on each other and on the offspring as well.
00:10:21:02 - 00:10:28:05
Unknown
So across the piece, I think increasing kind of research to help really elucidate those mechanisms.
00:10:28:08 - 00:10:57:04
Unknown
And I guess, you know, one of the things that I've been contemplating as I was thinking about today's conversation is how universal this challenge is, but also, obviously, it's massively amplified for certain families, certain parents that are going through very significant struggles and challenges as a result of this. I guess for me, I'm interested in the the kind of the spectrum of different ways that this plays out and sort of the impact that it can have.
00:10:57:05 - 00:11:12:20
Unknown
So do you think this is something that every family goes through, but just as varying levels of severity, or is it kind of very clearly identifiable with kind of very specific kind of elements or impacts that feed into it?
00:11:12:22 - 00:11:41:03
Unknown
I think, you know, everything's on a spectrum, and I think most parents can relate to some of this. But of course, there are increased vulnerabilities in particular groups. You know, even though there's a large proportion of people who do have a clinical issue over the perinatal period, it isn't everyone. I think the latest statistics are 25%. I mean, that's a lot of and that's just focuses on the birthing person.
00:11:41:03 - 00:12:08:04
Unknown
I think, you know, understanding that the sort of normality of it is important, but also it's important for us to identify those who are in need of intervention and help as well. So I think that balance between it does make sense, but that doesn't mean that you should be stuck in these issues, whatever they are. So additional risk factors, you know, of course, the things that I mentioned are some of them there might be biological
00:12:08:04 - 00:12:11:11
Unknown
of abilities, additional kind of social stressors.
00:12:11:11 - 00:12:32:24
Unknown
And these things will often, of course, predate the perinatal period. So having a history of of difficulties, having, you know, other stressors to contend with, structural inequalities, all of these things play play a role in the development of problems and why they might appear at this time with that additional stress.
00:12:33:01 - 00:12:40:13
Unknown
And I wonder, you know, we listeners into this conversation will be practitioners that work in the space.
00:12:40:13 - 00:13:08:05
Unknown
So you know years professionals. What guidance would you say for those people that are working in this field, whether they be in a nursery setting or in one of our hubs where you're seeing lots of mums, lots of parents coming through, how would you sort of change or help want them to think about the approach that they have with those 25%, perhaps, that are having elevated challenges as a result of the different triggers?
00:13:08:06 - 00:13:14:14
Unknown
What what would you say to them as they approach conversations with new parents about their mental health?
00:13:14:16 - 00:13:48:18
Unknown
Yeah, I mean, I think I would want them to know that there they are so valuable. They are probably the most important people in terms of developing relationships and helping people and supporting them in what's going, what they're going through at this time, helping them identify issues and identify help. I think not being afraid to ask, I think if it affects 1 in 4 of us at this time, and it might affect a different one for different points, that it's a conversation.
00:13:48:18 - 00:13:54:18
Unknown
We know from the research that people don't mind being asked about, they appreciate being asked about. So
00:13:54:21 - 00:14:12:07
Unknown
think, yeah, not being not being afraid to ask really at every contact about the parent and their wellbeing. Often people report that there's so much that's of course focused on the pregnancy, the infant, the developing child and and of course, that's right.
00:14:12:07 - 00:14:35:01
Unknown
But being seen as a person in your own right is so helpful. And building those relationships so that people feel able to disclose. And sometimes people are really going through and experiencing the worst things and the worst thoughts and feelings that they've ever had. And you might not know that the first time, second, third or fourth time of meeting them.
00:14:35:01 - 00:14:41:02
Unknown
But I think allowing conversations to to happen, not assuming anything
00:14:41:02 - 00:14:42:21
Unknown
is a good, isn't it?
00:14:42:21 - 00:14:54:02
Unknown
that deeper relationship, building trust with someone so they feel comfortable opening up and and having that conversation a very deep personal conversation. Really interested in a lot of the research that you've done.
00:14:54:03 - 00:15:19:19
Unknown
So we sort of go into a few of the papers, perhaps because I think there's some very interesting kind of illustrations or examples, and picked out one of the ones around perinatal OCD and how mums were being separated from their babies and put through sort of child protection proceedings because clinicians had misread, misconstrued kind of intrusive thoughts as potential danger, I guess.
00:15:19:20 - 00:15:42:04
Unknown
How widespread is that as a scenario still, and kind of how those kind of the association between having those thoughts in actually causing harm or creating harm, how kind of I can imagine that being incredibly distressing for the parent, but also how can we make sure that children are safe, making sure that actually we are protecting those who are very vulnerable?
00:15:42:06 - 00:15:47:11
Unknown
Yeah. How can what can be done there to improve the picture, I guess, or help in that scenario?
00:15:47:16 - 00:16:11:05
Unknown
Yeah, it's such a crucial point. I think we've come a long way in recognizing that perinatal OCD is actually a quite a prominent part of the possible presentations. You know, some of the work that I've been involved with has highlighted, up to 17% of parents might meet criteria at some point in the perinatal period.
00:16:11:05 - 00:16:39:10
Unknown
But if you have thoughts of harming your child, that might. That's obviously the most alarming one for clinicians. It's about how we kind of assess that correctly. Obviously, we want to be making the correct diagnoses, but I think knowing that perinatal ICD is a very likely for the formulation of those, but not assuming that it is, is really is really key and awareness has really increased.
00:16:39:10 - 00:17:06:16
Unknown
But we still do come across cases where it hasn't gone well. There have been a sort of inappropriate social services involvement when some follow up questions might have really helped that person understand and helped the clinician understand that it it really was OCD and it can be quite detrimental, very detrimental if you have OK'd to go into a system where it feels like your worst fears are being kind of reinforced.
00:17:06:16 - 00:17:31:08
Unknown
So whilst it's less common, it's a perpetual conversation. I would say working in this field, we try and help clinicians with kind of tools and, you know, vignettes and kind of ways to explain what is and what would be helpful questions to ask. And if you're not sure, get a second opinion. Really kind of get as much information as you can.
00:17:31:12 - 00:17:54:07
Unknown
Often in practice, it's very clear because parents with OCD, there's absolutely no association with harming their infants. They're doing everything they can to move away from those thoughts, to suppress them, to kind of stay safe. And it's very clear on talking to them. They are they're horrified by the fact that the thoughts are in their their mind.
00:17:54:10 - 00:17:58:00
Unknown
But we must also think about risk to them.
00:17:58:02 - 00:18:16:22
Unknown
Sometimes OCD is sort of construed as a problem of kind of of no risk, but actually it's becoming more and more clear that people can feel so desperate, ashamed of of these thoughts and experiences. It can drive them to, to harm themselves. And we must pay attention to that. Absolutely.
00:18:16:22 - 00:18:22:15
Unknown
Obviously, a very alarming statistics around suicide being a leading cause of maternal death.
00:18:22:15 - 00:18:46:02
Unknown
And, you know, I have to admit, it was I think we sort of saw different care could have changed outcomes for 64% of women that had attempted suicide in the perinatal period. And there's been lots of studies that, again, I think you've coauthored, coauthored around that. In terms of suicide remaining the leading cause of maternal death in the year after birth.
00:18:46:04 - 00:19:14:15
Unknown
I guess what is going back to the earlier question around OCD and struggles that clinicians might have in terms of diagnosis, but also intervention? What does successful intervention like to prevent some of these things around self-harm and ultimately suicide as well? What are you seeing in the field about treatment for some of these conditions that is working and things that we should all be thinking about in terms of early intervention, if any kind of alarms are being raised?
00:19:14:20 - 00:19:27:09
Unknown
Yeah. I mean, we have really good treatments for OCD, though, in the Nice guidelines. They've been around for a long time and we've got some evidence they work really well for perinatal OCD.
00:19:27:11 - 00:19:40:18
Unknown
CBT with exposure and response prevention SSRIs as well from perinatal women want psychological therapy. There's a kind of a strong preference for that.
00:19:40:23 - 00:19:45:16
Unknown
And it really gives them the tools to understand the difficulties.
00:19:45:21 - 00:20:15:10
Unknown
CBT is relatively sort of widely available, but what we're also trying to do is to make sure perinatal tailored CBT is available more easily. And we know from our research it works really well. It helps people understand the thoughts for for what they are not as signals of danger, or that the person is some kind of Munster, which is often what is feared, or that they're somehow going to get it wrong as a
00:20:15:12 - 00:20:20:04
Unknown
but actually a signal that that's that's something that they are worried about.
00:20:20:04 - 00:20:38:06
Unknown
And underlying that, of course, is a very solid foundation of being an excellent parent, really. I can honestly say parents with OCD that I've worked with have a wonderful parents because they are doing so much to care for their children, but swerving that in the wrong way.
00:20:38:08 - 00:20:46:24
Unknown
So effective treatments really do exist. And I think when we are interacting with people, every, every interaction counts.
00:20:46:24 - 00:21:07:11
Unknown
I think thinking back to your question of of practitioners on the ground, normalizing that, giving hope, really kind of for them to know and for them to convey that this is an understandable and treatable problem can make so much difference. And that's really the message we want to continue to kind of convey and propagate.
00:21:07:11 - 00:21:11:00
Unknown
And hopefully we can make that more widespread today.
00:21:11:01 - 00:21:45:17
Unknown
And and I guess, you know, we we work with parents, mothers, fathers, carers with very young children aged 0 to 5. And we see how interactions can change. And we're obviously hoping to see more bonding and, you know, joy, serve and return moments between young children and their families and those that give them care. I guess some of the scenarios that you were just illustrating around OCD in particular, what are you seeing in terms of that mother infant interaction over the period before after?
00:21:45:18 - 00:21:51:23
Unknown
Does that change, as well as the parents kind of mental health and their own kind of external behavior, too?
00:21:52:00 - 00:21:57:21
Unknown
Yeah, there aren't many studies that have really looked at that in detail in the context of OCD.
00:21:58:00 - 00:22:09:16
Unknown
So I think first and foremost, it's important not to make assumptions because we can be so consuming in terms of time and behaviors.
00:22:09:18 - 00:22:36:02
Unknown
It can sometimes go along with an assumption that therefore it is impacting all sorts of things. And I said in my experience, because the underlying bond is there, and that's really kind of reinforced by my research. When we looked at attachment, there really was no difference between parents with ACD and those who didn't. So that affective bond is really there.
00:22:36:04 - 00:22:52:20
Unknown
And that was kind of yeah, independent of diagnosis. What parents report themselves is that when the difficulties are activated, of course it can swerve behavior. It can make people more preoccupied. So we did some observational studies looking at that.
00:22:52:23 - 00:22:58:14
Unknown
there's a category in terms of the observational.
00:22:58:16 - 00:23:20:13
Unknown
Scales of sort of intermittent interference. So that sort of fits with what parents were telling us. But when they were in a space that was kind of safe for them, there was no problem when they were doing things like changing a nappy outside that was much more difficult and sort of impacted interactions. So it was quite a sort of nuanced picture in terms of that.
00:23:20:16 - 00:23:49:10
Unknown
Again, there's a perennial question of whether treatment that's just focused on the parental mental health supports and changes that we didn't find a change in our research that was just focused on parental mental health. So I think that's a fairly consistent finding across disorders that actually support both for the parents own difficulties and how it impacts parenting. And bonding is probably the optimal treatment.
00:23:49:12 - 00:24:14:22
Unknown
And I was reading around some of the research that you've been doing recently around what happens to women when they're admitted to mother and baby units, and the sort of the experience from the inside that they're going through, and the sort of research in terms of some women that are with OCD that are admitted to MBAs, feel like they're being treated in a way that they're worried that their thoughts mean they're dangerous, I guess.
00:24:14:22 - 00:24:38:06
Unknown
How have you seen clinical practice evolve in those spaces, based on some of the intervention and the research that you've done, but also, what would you expect now from a woman that's been admitted to hospital to sort of expect, I guess, as a sort of from the staff that are caring for the family, caring for her. What do you think clinical practice best practice should look like?
00:24:38:08 - 00:24:55:13
Unknown
Yeah. I mean, I think one of the findings from that study is that I think all of the participants pretty much said ending up in the MBA was a result of really not having had enough community treatment, and that really would have been the optimal for for them.
00:24:55:13 - 00:25:00:09
Unknown
And of course, that speaks to resources and all sorts of other, other issues.
00:25:00:09 - 00:25:21:13
Unknown
People end up in MBAs because there is a lot of concern about them and risks of harm to self and to their kind of relationship as well. So quite often at that point, it's a really tricky point to be having therapy because people are often, you know, very severe and in a, in a crisis at that point.
00:25:21:13 - 00:25:21:23
Unknown
So
00:25:21:23 - 00:25:51:20
Unknown
I guess ideally we would not have women with OCD so often in Mbu situations. And they're they're wonderful units. There's a very much a mixture of diagnoses. So it can be a really tricky place to be if you have OCD on those kind of units, if you have sort of extreme worries about contamination, you're immediately an environment where there's it's out of your control and it has to be that way.
00:25:51:20 - 00:25:52:04
Unknown
So
00:25:52:06 - 00:26:04:07
Unknown
what that study kind of spoke to you is having a sort of consistent team understanding of the person, and that being sort of shared across the team is absolutely best practice. And that's what we would hope for
00:26:04:07 - 00:26:14:20
Unknown
passing that on through the shifts and really helping the person to kind of understand their problem, act against their problem and transition out of that.
00:26:14:20 - 00:26:34:02
Unknown
Because for some women that we spoke to, actually being in the unit gave them, it was a kind of like a big safety behavior, and it was really leaving the unit that then, of course, was very difficult when they didn't have that sense of kind of, you know, being watched in the unit and the safety that that entailed.
00:26:34:02 - 00:26:44:13
Unknown
So I think we always need to think about the kind of getting people through, interacting with the outside world in the supportive way as possible, from the kind of earliest steps.
00:26:44:13 - 00:27:24:23
Unknown
But as you were saying, those community resources, the community that perhaps can make early intervention or early diagnoses and support oftentimes is lacking the resource to be able to cope with the volume of mums that might be presenting. With these challenges and questions, what would you be saying if the Chancellor was listening, or the Health Secretary was listening to say, look, we need financially in terms of support, but also from a policy and structural standpoint as well, to ensure that for the families that need this help, it's there, readily accessible and available and easy to navigate.
00:27:25:02 - 00:27:25:24
Unknown
00:27:26:01 - 00:27:52:24
Unknown
Yes, that last point is absolutely crucial, I think, because so many people, if there's just a structural barrier to accessing things, you know, you're so busy and occupied with the business of looking after babies or attending appointments that it's very difficult to go, I won't, you know, I've got to fill in another form to do that. So I think really thinking holistically right from the beginning of pregnancy would be the ideal.
00:27:53:02 - 00:28:19:00
Unknown
There's a lot of kind of interest at the moment of sort of trying to integrate maternity and mental health services in a meaningful way, and that makes sense. It's it's nonstick kind of contact with services. It makes sense that everybody should be screened regularly through that, that process. It's a time where people are in contact with services that the services are kind of there.
00:28:19:00 - 00:28:38:23
Unknown
So I think focusing it to early intervention within that system would be something I would massively encourage. I mean, all parents I think deserve that sense that they are being held and looked after should, should, should they need it. But of course, we know that for that 25% they will need
00:28:39:02 - 00:28:52:04
Unknown
So if we can kind of smooth out some of those barriers, if we can have that resource that's easily accessible through the kind of maternity and early postnatal systems, that was what I would kind of urge.
00:28:52:04 - 00:28:52:12
Unknown
Really.
00:28:52:17 - 00:29:05:22
Unknown
Yeah. And I don't know if you share the same sentiment, but it does seem to be somewhat encouraging. There is more, as you say, dialog discourse about mental health through the perinatal period. And so the government
00:29:06:01 - 00:29:22:01
Unknown
appointed a new sort of role as the, you know, the government's first maternity adviser, for example, and documented campaigns from people like Louise Thompson that have been quite sort of widespread in the media as well.
00:29:22:01 - 00:29:47:15
Unknown
And there's obviously been quite a few investigations. Baroness Amos investigation into maternity and neonatal care as well. I mean, do you think that the time is right for some of these conversations to be right at the highest level of government, or is there still a lot to be kind of considered and a lot that's missing, I guess, from the national conversation that's taking place.
00:29:47:17 - 00:30:20:09
Unknown
I mean, I think, I think both of those things are true. Yeah, absolutely. It's brilliant that there is a maternity adviser to sort of coordinate this, this kind of it's the whole sort of constellation of factors that come together for people at this point. And we know that these inquiries have come from hugely difficult situations that sort of fan out to kind of stressed systems and underfunded systems, but the sort of complexity of, of the users through this system means we need this coordinated approach.
00:30:20:09 - 00:30:42:19
Unknown
So absolutely is fantastic that it's being recognized and taken seriously at the very top level. There is still so much to be done, but there's there's things coming through from all sectors, I think, that are sort of highlighting the importance and urgency of focusing on maternity as a as a focal point, as part of this journey
00:30:42:21 - 00:30:53:09
Unknown
of addressing an immediate risk, but also an opportunity to really, you know, enhance the health of the next generation.
00:30:53:11 - 00:31:23:17
Unknown
And we have a lot of fathers that listen to podcasts and that we engage with as well every week in our hubs, I guess. Advice for fathers in this scenario how to support the family, how to support mums that may be experiencing heightened stress, anxiety, OCD. What would you recommend in those scenarios? And then also, selfishly, I was very interested in the research in terms of the narrative and paternal stress and how that has a big impact as well.
00:31:23:19 - 00:31:29:17
Unknown
What advice and guidance would you have for dads and other members of the family? Perhaps they're listening.
00:31:29:19 - 00:31:53:13
Unknown
Yeah. That they are absolutely active and important. You members of this whole picture have a really active role to play. There is a gradual change of kind of culture, I suppose within services there's there's moves and calls to actually screen dads for their own mental
00:31:53:15 - 00:31:54:17
Unknown
to normalize that.
00:31:54:17 - 00:32:11:00
Unknown
It's very stressful for the whole family potentially at these times, especially if one or other of you is experiencing difficulties. We know that's very common. And all these problems are also quite common in in dads as well, and do manifest in very similar ways.
00:32:11:00 - 00:32:39:14
Unknown
So I think kind of working as a team and for us as healthcare professionals, to think of the family as a team is is kind of part of the picture, certainly kind of speaking with dads and speaking with with families as a whole kind of, you know, accessing information about the difficulties, accessing your own help if you need it for us to kind of normalize that.
00:32:39:14 - 00:32:45:19
Unknown
And it's okay to feel stressed and it's okay to kind of find ways to to help manage that
00:32:45:19 - 00:33:10:21
Unknown
and that, you know, managing your own stress, managing, you know, helping your partner will have down the line impacts as well. So I think keeping that overall kind of messaging there. But yes, I think recognizing the non birthing parent dads, fathers partners as so important in their own right and as part of this system.
00:33:10:24 - 00:33:25:01
Unknown
and I think it's, as you say, very important that the partner birth partners kind of are looking to make sure they can really help the family, but also help themselves if they are in a struggling themselves.
00:33:25:01 - 00:33:53:00
Unknown
And yeah, making sure that everyone is included in the conversation. I was also drawn to one of the trials that came out around the intergenerational cycle and transmission of anxiety, perhaps from anxious parents through to 1 to 3 year olds, and sort of the study that I think you've been running to look at, interrupting, perhaps the generational transmission of anxiety, I guess.
00:33:53:00 - 00:33:59:03
Unknown
What what did you learn from that? What happened and what still needs to be proven, I guess, in that space?
00:33:59:03 - 00:34:22:08
Unknown
Well, I know from working clinically with anxious parents, one of the things that draws them to treatment is wanting to prevent the impact on kids. And in other trials that I've worked on, apart from that one, people would say, well, that's the reason I'm here, not for your lovely treatment, because but I think this is a vehicle for me to to be a better parent.
00:34:22:10 - 00:34:51:07
Unknown
That's such a great starting point. And we had this intervention that was very kind of light touch, I suppose, just to kind of group to consecutive groups for a parents with anxiety. And it's the only project or research project that I've done that we were oversubscribed. And what parents said that they really liked about this was that it gave them practical skills to address some of the things that they were worried about.
00:34:51:07 - 00:35:11:22
Unknown
So we adapted it from an intervention that already existed, and we adapted it for the for the early years, we had 100% kind of completion of all our measures. So all of the things which might find tedious that enable us to kind of try and evaluate our groups, people really didn't mind doing that, and we had very good feedback.
00:35:11:22 - 00:35:34:12
Unknown
And one of the things I think they liked to say gave practical skills. And it wasn't about their own mental health, it was about how to apply things as a parent. But actually it did have quite a significant impact on their own mental health. So for that study, it was a small scale study. We're only able to follow up over a kind of six week period.
00:35:34:14 - 00:36:05:08
Unknown
We would love to do that on a on a bigger scale because actually interventions for parental mental health as, as said, they can be very involved. They can be kind of quite sort of time consuming. And perhaps it isn't what parents would prioritize. So I think there are lots of questions to that come from that actually, maybe this kind of smaller scale, more practical intervention where people address what's in front of them.
00:36:05:08 - 00:36:15:01
Unknown
It gave them a boost. It helped with their own sense of confidence and self-efficacy, and they could see the impact on their children. They were doing more with their children. So I'd love to follow that
00:36:15:01 - 00:36:27:06
Unknown
And any kind of practical guidance for parents that might be listening and sort of thinking about the behaviors that your intervention was trying to shift or change or ways of doing things differently.
00:36:27:11 - 00:36:37:01
Unknown
I realized sort of a short period of time here, but anything in particular that stood out as a really effective mechanism that perhaps some parents can take home with them after listening to
00:36:37:07 - 00:36:47:15
Unknown
I think one of the messages to to say to anxious parents, because with this worry is that we know that the impact on isn't about how anxious you feel, it's about what you're showing.
00:36:47:15 - 00:37:10:20
Unknown
So that's a really handy thing to know. It's, you know, your children can't see into your mind. If you're playing the role of a more confident parent, then that's what will make the difference in terms of the feedback. The parents really like the sort of child centered play aspects, so kind of really kind of getting outside their, their own worries, really sort of focusing outwards.
00:37:10:20 - 00:37:14:19
Unknown
So I think that was more fun as well.
00:37:14:21 - 00:37:38:23
Unknown
You know, help with sort of limit setting as well, sort of thinking about what you would want your child to start to sort of imbibe what, what kind of what would help them feel more confident. What what do you want them to be thinking and feeling at a slightly later stage and starting now to kind of play the role of reinforcing all of those, those kind of thoughts and ideas.
00:37:39:00 - 00:37:59:08
Unknown
And you also coauthored a book, Break Free from Maternal Anxiety. And, you know, parents that might be listening, that are frightened, they don't know what what to think and don't really know how to access support. And that's one of the things that we see time and time again, is our parents with low confidence. They don't even know where to seek help.
00:37:59:08 - 00:38:18:15
Unknown
From what you know, the book, the books, the papers that you've written, what would be the thing that you would want to convey to that parent? Listening at two in the morning and is concerned before they close your book or stop listening to the podcast, you know, what are the situations that you think you can really help them with?
00:38:18:17 - 00:38:39:09
Unknown
I guess I would also want to sound a note that if it's two in the morning, you might feel better if you are able to get a little bit more sleep. And I think sleep is really under researched, even though every parent will tell you it's decimated and the perinatal period. But that's probably also having quite an important role in how you're feeling.
00:38:39:09 - 00:38:53:17
Unknown
And that bit does get better. But in terms of these other issues that say we have got years of research that has helped kind of refine these treatments and they can work really well.
00:38:53:17 - 00:39:02:07
Unknown
There's a whole sort of community has said under the Maternal Mental Health Alliance, for almost every kind of aspect of perinatal mental health that you can think of.
00:39:02:08 - 00:39:32:10
Unknown
And I think going to those organizations where it times with you to get peer support, to get people who've already navigated the system, there will be someone there who has some relatable experience. They won't have walked exactly in your shoes, but they will have a good idea of what you might be going through. So I think in lieu of kind of a sometimes a very straightforward referral pathway, those organizations can really help you navigate.
00:39:32:11 - 00:39:58:04
Unknown
But we do have great perinatal therapists within talking therapies. You can self refer to those. We obviously have our specialist services as well. And they are very good at triaging and helping people signpost people in different directions. It's not perfect, but I think there I say there's a real community within perinatal mental health that I would really encourage people to, to access.
00:39:58:08 - 00:40:40:06
Unknown
Yeah. It's such a key message that there are people out there. And even while you said, you know, 1 in 5 mums and people are struggling and have common mental health problems, but perhaps don't meet the threshold for specialist services. And I know that a lot of work that that Anna Freud's report that kind of calls this out to, I guess, what would you look for in terms of those that are missing out the structurally that aren't being served by statutory services groups that don't necessarily meet the threshold for perinatal perinatal mental health support, Who is currently kind of commonly falling through those cracks.
00:40:40:06 - 00:40:44:17
Unknown
What can we do to help those that are most vulnerable and most underserved?
00:40:44:19 - 00:41:21:03
Unknown
Yeah, it's not one and the same, I think. Is it? So not meeting the threshold and then falling through the cracks can be separate issues. And some of the sort of reports into maternal death, for example, really to sort of highlight the complexity, that sort of co-occurrence of physical health problems as well as mental health problems, dealing with other sort of structural issues, housing younger parents we know are mentally higher risk have, you know, much more exposure to sort of trauma and other, other sort of complications.
00:41:21:03 - 00:41:52:03
Unknown
So I think focusing resources, thinking sort of structurally, those, those sorts of groups, we know, of course, like disparities according to living in more deprived areas, according to race as well. So kind of making sure that the services and we keep sort of checking in with who was who was actually using the services, doing a better job with making the services appeal and fit the people in most in need of the services.
00:41:52:03 - 00:41:55:14
Unknown
This is an ongoing endeavor,
00:41:55:16 - 00:42:23:21
Unknown
loneliness and isolation are just independent risk factors. And it feels like that's something that we really can do something about. And again, it's something that would apply to everybody but would have the most impact. If you are a single, single parent dealing with all the other sort of structural stuff, I think, you know, where I was working in Slam, it was really noticeable that there was this sort of whole access of of issues that people had to deal with.
00:42:23:22 - 00:42:48:01
Unknown
And so I couldn't do our sort of fancy interventions, but actually just being there, trying to rhyme, going to write a letter to housing all of the other stuff. You think amazing that they're just showing up and talking to me about whatever and doing their best. I think, yeah, there's this having services that at least show that that is, you know, recognized that they're dealing with so many other issues
00:42:48:01 - 00:42:52:12
Unknown
that mental health problems are not the sort of isolated issues.
00:42:52:14 - 00:42:53:21
Unknown
So it makes it
00:42:53:23 - 00:42:58:11
Unknown
temporary accommodation, if you're living, you know, you've got no network around you.
00:42:58:12 - 00:43:31:03
Unknown
You don't speak the language. All of these things. And we work a lot in the northwest and in our hubs in Blackburn and Wigan and Warrington in particular, some of the communities where, you know, culturally mum doesn't have as much independence. And so therefore, you know, becomes again isolated and they become separate from society. When we know that you need to have a village of people, a community of people that you can call on, share your concerns, share your challenges with, and how we navigate that, I think is really important.
00:43:31:04 - 00:43:46:10
Unknown
Creating inclusive spaces, open spaces that don't have stigma associated with them so that people can attend a talk on mental health and it not be something that they felt like they've been assigned to.
00:43:46:15 - 00:44:06:14
Unknown
I think that is so important. I always feel like nobody wants to come and see me, to be frank. It's like, who does you want something that's integrated and non stigmatizing? And we've been there before in terms of kind of, you know, shore start and all the different sort of iterations like that's clearly is the best model because it's a one stop shop.
00:44:06:18 - 00:44:14:23
Unknown
Everything is there. And mental health is just part of the conversation rather than, oh, you have to go over there because there's something wrong with you.
00:44:15:01 - 00:44:21:10
Unknown
it's that integration of everything under one roof, as you say, that can be so powerful for a family.
00:44:21:10 - 00:44:39:00
Unknown
And I think that's why we see early intervention. We're able to help with diagnoses, help with identifying what support is around a family so that they can have these conversations in a safe way. Yeah, hopefully that's where we can make the biggest impact.
00:44:39:02 - 00:44:55:02
Unknown
and health visiting. Actually, that's something I should have said with the policy side. I mean, they've been absolutely sort of decimated in terms of numbers. And it's so valuable because it's a universal service that is skilled to sort of pick up and help with the practical aspects of being a parent.
00:44:55:02 - 00:44:56:02
Unknown
So
00:44:56:04 - 00:45:19:18
Unknown
I'd like to close out on a more positive note, I guess, given we've spoken about the complexity and the challenges, but you've been in this field for a long time and have seen a lot of change. What gives you hope? What gives you a sense that we're moving in the right direction, and that there is a path to greater support for families, for mums in particular, that are experiencing challenges that we've discussed
00:45:19:20 - 00:45:20:24
Unknown
today.
00:45:21:01 - 00:45:53:24
Unknown
I mean, speaking to people with lived experience, sometimes they've had the most awful experiences of services and so on. But the fact that they might be coming back to make things better. It's a constant refrain, and that has made a difference. I mean, as I've mentioned several times already, that the sort of coalition of people who really wanted to make a difference has just transformed the offer and continues to do so.
00:45:53:24 - 00:46:17:23
Unknown
There's no more nothing more inspiring, really, than than seeing that, seeing that we can all actually contribute to this picture and that that working so well within the individual space as well. Seeing, seeing with my own eyes and walking alongside people as they put these treatments into, into effect and make the changes that they need to is a constant inspiration.
00:46:17:23 - 00:46:33:22
Unknown
So always learning from the people that I work with, there's always room for improvement. But I think there's that that real collaboration and willingness across the board. There's a common purpose, really, of really trying to make things better and seeing that it
00:46:34:03 - 00:46:41:21
Unknown
has great. Thank you so much. Brilliant. Thank you so much for joining this afternoon. And thank you to everyone who's listening.
00:46:41:23 - 00:46:43:19
Unknown
Pleasure. Thanks so much.
00:46:43:21 - 00:47:09:04
Unknown
Fiona. Thank you so much. What I got from this conversation is there's so much going on and helping a mum with OCD or other challenges can not just have an implication for mental health perspective, but has a much wider impact on that child's development through the early years. And supporting a parent is one of the most powerful things we can do for a child and the rest of the family.
00:47:09:04 - 00:47:32:13
Unknown
And it means that every week a patient waits for treatment is a week that matters for both of them. Perinatal mental health is not a separate conversation from early child development. It's the same conversation. What happens to a parent's mind in those first months shapes what happens in the relationship between that parent and their baby, and that relationship is where the development begins.
00:47:32:15 - 00:48:00:19
Unknown
Fiona's books, Break Free from maternal anxiety and Break Free from OCD are available. And if there's anything else in this episode that's been close to home, support and resources are linked in the show notes, including maternal OCD. The charity that Fiona is a patron of, and the Pandas Foundation and Baby Zones own Baby Body app. The Samaritans, are also available on 116123 around the clock.
00:48:00:21 - 00:48:15:10
Unknown
Thank you for listening to Best Beginnings, a podcast from Baby Zone for more evidence and form support on babies in the early years, subscribe to this channel. If you found this conversation helpful, please do share it with someone who might need it. We'll see you next time. Thank
00:48:15:12 - 00:48:15:19
Unknown
We.