In the United Kingdom (UK), health visitors (professionals who have at least three years of general nursing education and one year of specialist training) provide home visits to all women after birth as part of universal child health surveillance. These health visitors routinely screen all new mothers for depression and provide home-based treatment to mothers with mild to moderate depression.
Depressed mothers are offered an intervention called a “Listening Visit”, a home-based program consisting of four weekly one-hour sessions which combine active reflective listening and problem solving. It has been observed that these Listening Visits are effective for treating depression. Holden and colleagues observed that 18 of 26 (69%) of depressed mothers in the Listening Visits group recovered from depression compared to 9 of the 24 (38%) women in the control group.
In New York City, a new home-based program, known as ThriveNYC, is being launched in an effort to better address the mental health needs of new mothers. Every first-time parent in New York City will be eligible to receive as many as six home visits from mental health professionals. The plan is to offer at-home screenings for postpartum depression and anxiety and to help connect mothers with appropriate mental health services as needed.
Noting that it may be difficult to engage certain populations, the city will partner with community-based organizations that will send out community health workers, nurses or doulas to meet with first-time parents. The real test, however, will be making sure that this sort of program will be able to ensure that women can connect with appropriate mental health services when needed. It is unclear to me if the home visitors in the ThriveNYC program will be trained to deliver basic postpartum mental health services, but this may be an option if it is difficult to facilitate access to mental health services within a particular community.
This is exciting. In the United States, multiple home visiting programs exist; however, most are not specifically designed to screen for and offer depression treatment to mothers. We are looking forward to hearing more about ThriveNYC.
Ruta Nonacs, MD PhD
Holden JM, Sagovsky R, Cox JL. Counselling in a general practice setting: controlled study of health visitor intervention in treatment of postnatal depression. BMJ. 1989 Jan 28;298(6668):223-6.