You can’t have one without the other: The case for integrated perinatal and infant mental health services

Abstract

Perinatal and infant psychiatry has been described as ‘a specialty in search of a home’ (Newman, 2020), referring to its awkward placement between adult and child mental health services. Inherent tension comes from bringing together two distinct clinical traditions – infant mental health, with its focus on parent–child relationships and infant development, and perinatal psychiatry, with its focus on maternal mental illness in pregnancy and the postpartum. The practical challenge lies in holding the interests of parents and infants in mind as one works with a parent–child dyad. At a systems level, this can produce structurally separate services for parents and infants, resulting in the fragmentation of care for families in need. A fundamental challenge for perinatal and infant psychiatry is integration. Psychiatrists working in this field must attend to the mental health of new and expectant parents, the socialemotional well-being and development of young children, the quality of parent–child and co-parenting relationships, and the cohesion of the family-as-a-whole. Such a holistic and complex view of the life of families with young children demands interdisciplinary collaboration, as the different perspectives brought to bear by clinicians from various professional backgrounds help shed light on the distinct but interconnected facets of this crucial developmental transition. At the heart of integrated care is a commitment to prioritising the needs and perspectives of families who use these services, a recognition that the whole is greater than the sum of the parts, and an understanding of the primacy of relationships – within the family, between the family and the service system, and between various parts of the system that support families. We present the case for an integrated approach to perinatal and infant mental health (PIMH) services, to help guide review and reform.