'Somebody to Lean On' first appeared in Mental Health Today, February 2011. To subscribe to the magazine click here.
Mainstream perinatal mental health services in Hackney are being bolstered by an innovative project that uses volunteers to reach out to ethnic minority groups, reports Ian A McMillan
Saddaf Aslam took up the newly-created post of perinatal support co-ordinator with the charity Family Action last August. Based in the east London borough of Hackney, Aslam is aiming to recruit and train eight volunteers who will support local women with mental health problems who are in the later stages of pregnancy, or who have a child aged under one.
Given the array of minority ethnic groups that have settled in the area, Aslam could never hope to have every group represented. But with a large Turkish and Kurdish population locally, she is pleased to have a Turkish-speaking volunteer already on her books. An Urdu/Punjabi speaker herself, Aslam also wants to make links with members of the Orthodox Jewish community. "My volunteers can act as interpreters with the perinatal mental health team, for example, but have a one-to-one relationship with the families as well."
The first tranche of volunteers includes professionals, such as trainee counsellors and educational psychologists, who, Aslam explains, "would like to give something back" or are seeking practical experience as part of their career development.
Others include mothers with two or three older children who know first-hand what problems new mums face. So far, all the volunteers are women but Aslam is optimistic that a man who has shown interest will sign up soon. "A child does need a positive role model. A good attachment to a male figure - be they a next-door neighbour, a granddad, a brother, an uncle or a dad - is so important."
Volunteers come forward after spotting Aslam's advertisements on the internet, or in local newspapers, libraries and children's centres. The recruitment process is backed by Family Action's human resources department, which can advise on potentially tricky areas such as Criminal Records Bureau reports. "Family Action has a very good track record of supporting our volunteers to take up paid positions - one of our counsellors began as a volunteer, for example."
Aslam's tailor-made training programme started in early December, running one-day-a-week over two months. Topics included postnatal depression, attachment issues, budget management, record-keeping, confidentiality, the roles and responsibilities of a volunteer, and safeguarding.
Becoming familiar with the borough's children's centres is crucial as many families will go on to receive long-term support from them once the volunteer's involvement ends.
While Family Action runs similar family-based projects in Swaffham, Norfolk; West Mansfield, Nottinghamshire; Oxford and the south London boroughs of Southwark and Lewisham, what marks Aslam's project out is its focus on mental health issues and use of volunteers. All the projects use the same attachment model, which is based on the NEWPIN approach.
With roots running back to the early 1980s, the NEWPIN approach is based on the idea that boosting children's and parents' emotional wellbeing helps to reduce the likelihood of any episodes of emotional, physical or sexual abuse in the future.
One of Aslam's first tasks was to forge links with relevant services in the statutory and voluntary sectors. "These include domestic violence teams, for example. It's really crucial that we tap into children's centre services and that we also liaise with the local safeguarding board, because we are supporting vulnerable children and families. We also link with the perinatal mental health team, which is based in Homerton Hospital."
One of the boons of working for Family Action is that it has a well-established reputation in Hackney, says Aslam. "The services know what we are doing and vice versa. I have to ensure that my work does not overlap with others. I am currently making the service known to the local modern matrons and they can then filter information down to ground-level staff, like midwives and health visitors. At the end of the day, the children's needs are paramount."
Aslam's previous experience in supporting vulnerable families means that potentially baffling acronyms such as CAF (common assessment framework) and MAT (multi-agency team) roll off her tongue easily. "Families are referred to the MAT by the children's centres and are then placed on a CAF and then the referrals come to me," she explains. "CAFs came about as a result of the inquiry into the death of Victoria Climbié. These mean that all the organisations involved with a family know what each other is doing, and can decide on a course of action together."
Three months into her post, Aslam already carries her own caseload of three families. In one, the mother has a history of mild postnatal depression. Isolated in her flat with two children aged under three for most of the week - her partner is only able to visit on Saturdays - the mother was virtually housebound. In part she was daunted by the practical difficulties of getting two children and a double buggy safely down 50-odd steps to the main door. "When I visit, she's ready to go out, she's absolutely ecstatic and she's playing with the children. I see her growing while we are together," says Aslam.
The woman's goal is to be rehoused in more suitable accommodation, Aslam explains. "She says she doesn't mind if it's on the 20th floor of a tower block, as long as it has a lift."
In a second case, Aslam supports a mother who has had depression. Her twins were born prematurely and one is showing developmental delays, triggering guilt feelings in the mother. In addition, the professional qualifications she gained in her home country are not recognised in the UK, and her work prospects are diminished as a result. "Neither she nor her husband has any family here and she is struggling to understand how this society works."
As well as offering emotional befriending, Aslam has also helped the mother to engage with services in a practical way, for example, by looking after one twin while the other attends physiotherapy sessions with her mother.
"I encourage her to see her children as two different people with different personalities."
Family Action volunteers receive travel expenses, and are encouraged to walk or use public transport on visits. "We don't want families to become reliant on being given lifts, plus I don't have the resources to pay if their car is clamped!"
Each volunteer is asked to devote up to three hours to each weekly visit, including travelling time. At first, they will be allocated one family each, though Aslam doesn't rule out giving volunteers more cases if they are capable and willing.
Volunteers receive monthly supervision sessions, giving them a chance to discuss families' progress and any emerging problems. Aslam can refer them on for counselling sessions with Family Action staff if they are troubled by what they have witnessed, and help is at hand from the charity's therapeutic family support workers should a safeguarding issue arise.
Aslam's post runs for three years, with funding coming from Family Action and the Big Lottery Fund. Despite the recession, she is adamant that cutting services for families with young children where one or both parents have, or have had mental health difficulties would be counter-productive. "I would say to the government: 'If you cut funding from these services, what will happen to these families?' Down the road, we will see more suicides and more child protection problems."
Despite having a "fantastic husband and family support network" and a sound knowledge base, Aslam experienced a bout of postnatal depression six months after her daughter was born two years ago. "Some people are not so lucky," she notes. "Now when I see mothers with postnatal illness who say "you don't know what we're going through", I say: 'I do. But it takes time and you have to persevere'."
154,000 children in England live with a parent who has a severe and enduring mental health problem
140,000 families (2%) across Britain have children in them who experience multiple disadvantages
Children whose mothers have depression and schizophrenia can experience developmental delays in language, motor skills and concentration
Family Action helps more than 45,000 vulnerable families and children every year, and runs more than 100 services in England
Source: Family Action and Home-Based Family Support: Addressing the needs of the most vulnerable children and families (2010) Published by Family Action, London. (click here to read)