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Releasing skills in an experienced workforce

It has been a great privilege to deliver a training programme for health visitors to become Perinatal Mental Health Champions in ten venues around England in the past few weeks. The aim is that those trained will pass their training onto their colleagues and become a local resource for the range of issues and professional activities relating to perinatal mental health. Most of those attending are practice teachers and other senior health visitors - in other words those most able to embrace this new role. 

We have been able to offer the trainees an update on the latest research and policy in perinatal mental health and to share with them our vision for a core level of training for all health visitors. They on the other hand have been able to offer us much in return. As we have worked through exercise after exercise I have been thrilled to discover the extent of their collective knowledge. As public health professionals they are very clear about why this work is important and the vast range of potential interventions by health visitors to support depressed mothers. 

For example, they might not be asked every day to consider the negative effects of a mother's depression on her older children, but when asked they soon came up with an impressive lists of unhelpful effects. These included depression in the child or children, being bullied in school, effects on the child's cognitive development (especially in boys) and many more.

What frustrates me is that these very skilled professionals usually keep their knowledge to themselves and don't use it as they could or to look more broadly at health needs other than those of the mother and infant in front of them.

When I joined the health visiting profession things were very different. Health visitors had much more confidence and autonomy as public health professionals. They didn't have the evidence base we have now, but that didn't stop them speaking up and campaigning for things which could be detrimental to the health of clients. Where they lacked services they created them. The problem is that these days their every movement is often so controlled by commissioning targets that they don't have the autonomy or confidence to act on what they know. Other professional groups may be better at articulating dangers for their clients; for example, midwives are frequently in the press concerned at the risk to mothers and babies when their numbers are vulnerable. 

Health visitors need to also speak up too if they have good evidence of the effects of poor services for their clients. In the field of maternal mental health, what has been 'rammed home' for me by our very well informed attendees is the potential scale of this important area for public health improvement. The knock-on effects of chronic or undetected depression in the mother can be immense not only for her, but for her family. Indeed we know that the first year of becoming parents can be a vulnerable one for marriages. 

However there are also the potential effects of perinatal depression for children, with babies suffering if the attachment bond with their caregivers is compromised long-term. Also for older children who equally may not have engaged caregivers recognising their needs and may suffer in silence, becoming depressed or getting into trouble at school or in the community.

While all this information is backed by research, it is also well known to health visitors as a collective. When they pool their knowledge on a piece of flip chart paper the breadth and depth of their vast professional knowledge becomes clear. I would like to call for health visitors (and school nurses) to be put back into the driving seat of their practice - to be given the opportunity to come together and work out what may be the most effective ways of delivering robust and effective health improvement services to their clients within the constrictions of their local resources. My challenge to commissioners and managers is to put these professionals in a room with a piece of flip chart paper and give them the chance to rethink services. I can promise you not only creative cost effective solutions but a workforce inspired and with the professional confidence to deliver them!