Tag Archives: projects

Supporting perinatal mental health: from peer-support to specialist services

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There is a societal expectation that pregnancy and the arrival of a new baby are happy and exciting times.  However, it may come as a surprise to learn that up to 1 in 5 women develop a mental illness during pregnancy or within the first year after having a baby (also known as the ‘perinatal period’).

Up to 1 in 10 women may develop postnatal depression, however, there are actually a number of other mental illnesses that can affect women during pregnancy or following birth.  These include:

  • Antenatal depression
  • Perinatal anxiety
  • Perinatal obsessive compulsive disorder
  • Post-traumatic stress disorder (PTSD)
  • Post-partum psychosis

These illnesses can range from mild to severe.  Left untreated, perinatal mental illnesses can have a devastating effect on mental and physical health.  In fact, suicide is the leading cause of death for mothers during the first year after pregnancy.

The wider impact on children and families

Perinatal mental illnesses can also impact upon children, partners and significant others.  Research shows links to depression in partners, higher rates of divorces, lower levels of emotional and cognitive development and higher levels of behavioural problems and psychological disorders among children.

As well as the high human cost, there are also a number of economic costs associated with failing to address perinatal mental health needs. Research commissioned by the Maternal Mental Health Alliance found that perinatal depression, anxiety and psychosis carry a total long-term cost to society of about £8.1 billion for each one-year cohort of births in the UK.

In comparison, it would cost only an extra £280 million a year to bring the whole pathway of perinatal mental health care up to the level and standards recommended in national guidance.

Access to specialist services is a ‘postcode lottery’

The good news is that most mothers who experience mental ill health can and do make a full recovery.

At present, mild to moderate cases of mental ill health in pregnancy and following birth are treated by the GP through anti-depressants, talking therapies and/or support from a community mental health team.  For more complex or serious illnesses, GPs can make a referral to specialist perinatal mental health services for expert advice and support.  This may involve staying in a specialist psychiatric Mother and Baby Unit (MBU) – where mothers and their baby can be admitted together.

However, despite the high prevalence of, and risks associated with, perinatal mental illness, access to specialist perinatal mental health services across the UK is a postcode lottery.

Maps by the Maternal Mental Health Alliance show that women in around half of the UK have no access to specialist perinatal mental health services.  There are currently no MBUs in Wales or Northern Ireland, meaning mothers with more serious or complex mental illnesses often face either being admitted to a MBU far from home, or being admitted to a general psychiatric ward without their babies, in order to receive treatment.

For those with mild to moderate mental illness, waiting times for NHS talking treatments can be many months.  Lack of awareness means that many cases of mild to moderate mental ill health go undiagnosed and untreated.  There is an urgent need for both greater awareness of mental illness and better access to mental health services across the country.

The role of peer-support

In recognition of and response to the need for better access to mental health support for pregnant and new mothers, a number of local ‘grassroots’ peer-support projects have been established by dedicated volunteers and campaigners.

One such project is Blank Canvas.  Blank Canvas is a creative journaling workshop in Lanarkshire, aimed at women during pregnancy or in the first two years since birth, who are experiencing mental health difficulties.

The project was set up earlier this year by midwife Elaine Connell, together with some of her midwife colleagues, who shared her dedication to improving mental health support for women in the perinatal period.

Elaine was keen to start her own peer support group following her own personal and professional experiences of perinatal mental ill health, and was inspired by the success of other projects focusing on art and creativity, such as Maternal Journal.

As Elaine explains:

“It is free… …to access, and each attendee is given their own art kit to keep. We have a different theme each week and have guest speakers coming to do sessions also. During the group they can explore new art materials and create reflections in their journal, whilst chatting over some tea and cake. Each session they will take home a prompt card which can inspire their journalling during the week until the group meets next.”

Blank Canvas is free to access and works on a self-referral basis, with advertising mainly through Facebook.  A local shop and community space (Swaddle in Hamilton) donated a venue space, and all other costs (including materials) have been raised by volunteers committed to the project, through fundraisers such as coffee mornings and participation in the Kiltwalk.

Elaine has conducted an evaluation of the first 10-week block and feedback from participants has been extremely positive.  Word about the project has spread and the next block of Blank Canvas – which started on the 18th September – is fully subscribed (with a waiting list).  As Elaine notes, this is fantastic for the project, but highlights the high level of demand that exists for mental health support among new mothers.

The long term plan is to run 6-week blocks frequently throughout the year, moving to separate antenatal and postnatal sessions in 2020.  Elaine also hopes to start up a creative journaling group aimed at fathers too – noting that father’s mental health is often overlooked.

One of the key things Elaine has learned from the creation of Blank Canvas is that there is a lack of support available for people who want to establish their own peer-support groups:

“What has been clear when forming the group, is that there is very little support to establish peer support. There are lots of people who want to help others but who won’t because they don’t know where to begin, or how to access funding, or lack of training opportunities.”

Grassroots peer-support groups are an important source of support for mothers in the perinatal period, particularly in cases of mild to moderate mental ill health, where NHS capacity is strained.

Attending peer-support groups such as Blank Canvas may also have a preventative effect for mums who attend during pregnancy. Statistically, women who experience antenatal anxiety are more likely to develop postnatal depression, and so early intervention could help to reduce that risk.

Urgent need for better access to specialist services

While these projects have been successful, they are aimed predominantly at women experiencing mild to moderate mental ill health.

For those experiencing more complex or serious mental ill health, there remains an urgent need for better access to specialist treatment and support.  The Maternal Mental Health Alliance ‘Everyone’s Business’ campaign calls for all women throughout the UK who experience perinatal mental ill health to receive the care that they and their families need.  Specifically, it demands that:

  • perinatal mental health care should be clearly set at a national level and complied with
  • specialist perinatal mental health teams meeting national quality standards should be available for women in every area of the UK
  • training in perinatal mental health care should be delivered to all professionals involved in the care of women during pregnancy and the first year after birth

Promising signs of progress

There have been some promising signs of progress.  NHS England recently announced their plans to rollout specialist perinatal community services across the whole of England, including the opening of four new Mother and Baby Units.

And in Scotland, the Scottish Government recently announced the rollout of an initial £1 million for perinatal mental health services, as part of a wider £50 million investment in mental health services.  This initial investment will support a range of areas, including supporting the third sector to provide counselling, befriending and peer support for women and their families.  It will also help provide more consistent access to psychological assessment and treatment, by increasing staffing levels and training at Mother and Baby Units, for women with the most serious illnesses.

The Scottish Government also established a Perinatal and Infant Mental Health Programme Board earlier this year.  The PIMH Programme Board aims to help implement the commitments to improving perinatal and infant mental health set out in the 2018/19 Programme for Government and Better Mental Health in Scotland.

Clare Thomson, Everyone’s Business Co-ordinator for Scotland, says “It’s fantastic to see the evidence-based approach to developing community perinatal mental health services and look forward to hearing about the first steps – particularly in the North of Scotland“.

Perinatal mental health is Everyone’s Business

However, there is still much to do, including ensuring that this funding translates into services on the ground.  Wales and Northern Ireland are still without MBUs and there is a pressing need to raise awareness of and address mental illness among fathers.

The cost to the public sector of perinatal mental health problems is 5 times the cost of improving services.  It clearly makes sense to invest in improving this care – not only from an economic perspective, but to help improve the lives of women, their children and families across the country. And while more funding is essential to achieve this, raising awareness of the importance of perinatal mental health really is ‘everyone’s business’.

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Gardens of the dead: cemeteries as spaces for nature

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“The cemetery is an open space among the ruins, covered in winter with violets and daisies.” Percy Bysshe Shelley, Preface to Adonais (1891)

Percy Shelley’s description of the Protestant Cemetery in Rome perfectly illustrates how the cemetery, often negatively associated with death and decay, can in fact be a place where nature flourishes.

In this blog post, we highlight some of the great work being done to promote and conserve biodiversity in cemeteries, and the wider benefits of this.

Cemeteries as ‘green oases’

The importance of cemeteries as urban green spaces is often overlooked.  Relatively untouched by surrounding urban development, cemeteries often act as green oases, providing a range of important natural habitats for many different – and often rare – plant life and animals.

Indeed, as the 2000-01 Select Committee Report on Cemeteries observes:

“Cemeteries support a wide range of habitats, including relict grasslands, heath, ancient and secondary woodland, scrub, hedges, ponds and flushes, as well as more artificial features such as high maintenance lawns, stands of trees, ornamental flower beds, and shrubberies. In addition, buildings, monuments, tombs and headstones, made from a variety of rocks, can provide support for lichens, mosses and ferns, as well as providing geological interest. A large number of rare species of trees, plants, fungi, invertebrates, reptiles, birds and mammals are found in cemeteries. Cemeteries are often designated as local Wildlife Sites, and sometimes as Nature Reserves.”

Green space such as that provided by cemeteries, churchyards and other burial sites is important for a number of reasons.

From an environmental perspective, green space can help to address the negative effects of climate change, including the catastrophic decline in the number of insects. And from a human perspective, research has consistently shown the health and wellbeing benefits of access to green space.

Thus, cemeteries have an important role to play in both supporting the environment and promoting the health and wellbeing of local people.

Case study: Glasgow Necropolis

The Glasgow Necropolis is an impressive example of a Victorian garden cemetery, designed to be both inspiring and aesthetically pleasing.

Today, it is the second largest greenspace in the centre of Glasgow and provides a diverse range of habitats for wildlife, including sandy slopes, ivy-covered rock, wooded areas and unmown areas of grass and wildflowers.

The Friends of Glasgow Necropolis is a charity staffed entirely by volunteers dedicated to the conservation of the cemetery.

As well important monument conservation and restoration projects, and hosting walking tours to engage and educate the public, they also work to support the cemetery’s role as a space for nature.  One key aspect of this is recording and monitoring the flora and fauna within the cemetery.

Recent surveys have found that the Necropolis supports over 400 species of animals – including a variety of species of birds, bees, butterflies, insects and spiders, as well as deer, foxes, squirrels and rabbits, and a variety of other small mammals. Some of these species are particularly rare, including the aptly-named hoverfly, Eumerus funeralis.

There is also a wide diversity of plant life.  In total, 180 species of flowering plants and trees have been recorded in the Necropolis, and there are also at least 15 species of lichens – including one rare species (Lecania cyrtella).

Other key projects have sought to actively enhance the biodiversity of the cemetery – such as the creation of a wildflower meadow, planted with the help of local school children, and the creation of the ‘Green Man’ – a 3D grass head sculpture, in collaboration with the Glasgow School of Art, Glasgow City Council, Dennistoun Community Council, Dennistoun Conservation Society and Foundation Scotland.

There are also plans underway to create a ‘tree map’ for the Necropolis – a visual representation of the different tree species that exist within the cemetery grounds.

Engaging local communities

Across the UK there are a number of examples of other grassroots projects working to promote, conserve and engage local communities in cemeteries’ rich natural heritage.

Some notable examples include:

There have also larger-scale projects and campaigns to promote the role of cemeteries as havens for wildlife.

Caring for God’s Acre is a charity working to “support groups and individuals to investigate, care for, and enjoy burial grounds”.

For a week in June each year, they run a national ‘Love your Burial Ground’ campaign, which encourages people to connect with and celebrate their local churchyards, cemeteries and burial grounds through a variety of local events.

They are also responsible for running the ‘Beautiful Burial Grounds Project’ – a £600,000 Heritage Lottery Fund project that aims to “inspire, engage and support interest groups, communities and individuals to learn about, research and survey the natural, built and social heritage of their local burial grounds”.

The project includes collecting, collating and disseminating data on the importance of burial grounds for biodiversity, providing training events on recording biodiversity and disseminating a variety of resources such as short films, toolkits and pop ups to encourage communities to value their burial grounds as refuges for wildlife.

The Green Flag Award scheme has also been involved in the promotion of cemeteries as spaces for nature.  The scheme “recognises and rewards well managed parks and green spaces” and at present, over 80 cemeteries have received this award, including Tipton Cemetery in Sandwell, and the new Dumbarton Cemetery – the first cemetery in Scotland to be awarded a Green Flag.

Challenges to address

There are of course a number of challenges to be addressed if the full potential of cemeteries as green spaces are to be realised.

Firstly, there is a lack of data on the plant and animal species that exist within cemeteries.  This lack of ecological awareness can mean that sometimes burial ground management and maintenance can be well-intentioned, but inappropriate or damaging.  Thus, projects to record species – such as those conducted by the Friends of Glasgow Necropolis and other cemeteries’ friends groups – are incredibly important.

There is also a need to find an appropriate balance between allowing nature to flourish and ensuring that the cemetery remains accessible.  For example, there have been complaints that long grass around headstones can make it difficult for some people to visit family graves.  The Select Committee Report on Cemeteries notes that: “conservation must not be confused with neglect. A neglected cemetery does not become a haven for flora and fauna.”

Health and safety is another key consideration.  Unstable memorials can cause serious – and sometimes fatal – injuries.  Any project operating within cemeteries needs to be aware of this risk, particularly if it involves children or young people.  The Scottish Government recently published guidance for local authorities on inspecting and making safe memorials and headstones.

Other potential barriers to the use of cemeteries as green spaces include the lack of onsite facilities, such as toilets and bins, physical constraints, such as steep stairs, lack of vehicle access/wheelchair access, and concerns about visitor safety and anti-social behaviour.  These issues, however, are not insurmountable – for example, the Friends of Glasgow Necropolis have recognised these accessibility concerns and raised funds from grant applications to resurface many of the paths on the lower levels of the cemetery to make it easier for people with mobility problems to get around.

‘Living places’ that inspire

“It is worth remembering too that cemeteries were set up not just to bury the dead but to stir the Muses among the living.” Fiona Green, a landscape historian, quotes John Strang‘s Necropolis Glasguensis (1831)

Cemeteries are not just for the dead.  They are in many ways ‘living places’ – havens for a range of plant and animal species in the midst of urban housing and development.  They also have an important role to play in the wider community, providing opportunities for local people to connect with and be inspired by nature.

And hopefully, after reading about the many ways in which people across the country are getting involved with nature at their own local burial grounds, you may be similarly inspired.

If you’ve enjoyed this blog, take a look at some more posts on the subject of biodiversity:

Why the future of public transport has to be green

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Image by flickr user Justin Pickard via Creative Commons

Image by flickr user Justin Pickard via Creative Commons

By Morwen Johnson

Ending our use of oil, coal and natural gas by the end of the century? It seems an impossible task, but this week’s G7 Summit closed with the announcement that the leaders of 7 leading industrial nations had agreed to phase out the use of fossil fuels. As one of the G7, the UK is part of this long-term commitment to reduce greenhouse gas emissions. It is also legally-bound, via The Climate Change Act (2008), to cut carbon emissions by 80% by 2050.

These national and international targets will only be met however if we all make practical changes to our patterns of energy consumption. Organisations like the Energy Saving Trust Foundation and NESTA have pointed out that providing new technologies is not enough to increase public engagement with alternative energy. Success is dependent on getting real people to use these technologies in everyday situations.

Use of renewable energy in public transport

Earlier this week I attended an event on the use of renewable energy in public transport. Not being a transport specialist, but interested from the point of view of community development and social exclusion, it was a useful introduction to some of the innovative work that is underway in Europe.

Organised to present the results of the REPUTE (Renewable Energy in Public Transport Enterprise) project, the event explored the challenges of ensuring accessible public transport in rural areas. People in rural areas typically travel 50% further than people living in urban areas. Travel which is essential to daily life such as going to school or work, going shopping or getting to doctors and hospitals all requires longer journeys, mostly by car or bus. A lack of integration between different modes of transport also makes travel by car more convenient in rural areas.

Pilot projects showcased at the event included personal travel planning in Fort William; solar-powered real-time bus information signs in the Highlands and Islands region; and electric vehicle rental in rural towns in Portugal.

A new guide written by Oxford Brookes University was also launched at the event and includes lots of examples of community-based transport and energy schemes.

Signs of progress

I picked up on a few heartening signs of a shift in attitudes. Many local authorities are publicly supporting alternative energy use in their fleets and providing charging points. A recent survey showed that Scottish councils in particular are leading the way in the UK in the adoption of electric vehicles, with Dundee placed in the number 1 spot and South Lanarkshire, Glasgow and Fife also in the top 5.

  • Aberdeen now has the largest fleet of hydrogen fuel buses of any authority in Europe.
  • 2 of Edinburgh’s bus routes have switched completely to low carbon hybrid vehicles.
  • There are more electric vehicles in Scottish car clubs than the total in car clubs in the rest of the UK.
  • Elsewhere in Europe, Oslo’s initiative to open up bus lanes to electric vehicles has become a victim of its own success with the announcement in May that the law is being changed. A fifth of new cars bought in Norway in the last 3 years have been electric.

A key aspect of pilot schemes is to introduce the public to new energy solutions in a way that is engaging. For example, visitors to the Brecon Beacons National Park can hire electric cars to travel around the area, turning eco travel into a fun activity in itself. A new ‘poo bus’ which runs in Bristol and is fuelled by bio-waste, is a witty way to spark debate about alternative fuel sources. And in Oxford, the city is transforming into a Living Lab for integrated transport experimentation.

Public transport as eco-transport

The need for a transport system which is cleaner and less-energy dependent is clear – the transport sector is the fastest growing source of greenhouse gas emissions.

However investing in innovative renewable energy technologies at a time of budget constraints, requires government and local authorities to show leadership and vision. More importantly, there won’t be a step change in behaviour and attitudes without imaginative approaches to community engagement. Locally-led projects such as those highlighted by REPUTE’s guide are a great way to do this.

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