A qualitative exploration into health visitors’ experiences of working with infant mental health concerns

This qualitative study explores health visitors’ experiences of working with infant mental health concerns, specifically with children under-five. Increasingly, health visitors have the onerous task to monitor and give advice on the health and development of young children, sometimes in complex family situations. There are several studies regarding the critical importance of the early years, such as, ‘1001 critical days: The importance of the conception to age two period’ (Cross–Party Manifesto, 2013). This research seeks to discover how health visitors think about and act upon infant mental health by asking the question, “What is the lived experience of health visitors working with the mental health of under-fives which is of concern?” Data was gathered from health visitors using the ‘Free Association Narrative Interview’ (Hollway and Jefferson, 2000) this psychoanalytic method supported the analysis of less defended material. Following data collection, thematic analysis was applied to systematically analyse data. Three categories were identified relating to health visitors fluctuating states of mind; ‘anchored,’ linked to feeling secure regarding skills to support families. ‘At the edge,’ describes when health visitors experience unchartered territories and feel less secure regarding skills and capacity. ‘Adrift,’ is a worrying state of mind, closely linked to feelings of isolation and disorientation. Further analysis found categories shared four core elements; sense of agency, linking, capacity and systems structure. These elements provide an internal and external framework needed for health visitor practice. This research found that risk impairs health visitor ability to mentally or practically access these elements. As a child and adolescent psychotherapist, this study is contextualised within the field of psychoanalysis. Psychoanalytic concepts applied to the findings highlight how health visitors’ states of mind fluctuate depending upon their ability to mentalize. Furthermore, if abilities and capacity become impaired health visitors become susceptible to secondary trauma.