Mother and baby units in perinatal mental healthcare
In February, NHS England announced a £23 million additional investment in perinatal mental health services. It is hoped this development will overturn concerns about the use of effective interventions for women at risk of developing mental illness during or after pregnancy.
In February, NHS England announced a £23 million additional investment in perinatal mental health services. It is hoped this development will overturn concerning statistics around the use of effective intervention for women at risk of developing mental illness during or after pregnancy.
Having a baby is often described as a time of joy and hope and, fortunately for many families, it is just that. But for women who develop a perinatal mental illness, the experience can be very different.
Between 10% and 20% of women develop a mental illness during pregnancy or in the first year after having a baby, according to research from Public Health England (2017) . Without prompt and effective intervention problems such as antenatal and postnatal depression, perinatal anxiety and postpartum psychosis can have a long-lasting impact on the woman, her baby and the whole family unit.
Perinatal mental health services, including community-based care and inpatient care in mother and baby units (MBUs), provide vital support to women with these problems and their babies.
There are currently just 17 MBUs in the UK: Wales and Northern Ireland have none, and large areas of England and Scotland have no easily accessible units.
10% to 20%
of women develop a mental illness during pregnancy or in the first year after having a baby
(Source: Public Health England)
In early February 2018, NHS England announced an additional investment of £23 million in perinatal mental health services, as part of a phased £365 million programme to give at least 30,000 women each year access to specialist treatment by 2020/2021.
Under this programme, an additional four eight-bed MBUs will open in Kent, Devon, Lancashire and Norfolk this year. Bed numbers in existing units are also set to increase by 49% during 2018/2019.
Ed Freshwater is a community mental health nurse with the Mother and Baby Service in Birmingham. He says the lack of MBUs nationally is a big concern.
‘I’ve seen families struggle as mum is admitted with the baby, while her partner and other children can be hundreds of miles away.’
He describes the new units as ‘a welcome first step’, a view shared with Deborah Griffin, clinical service lead at the London Channi Kumar MBU at Bethlem Royal Hospital. She says the new units are ‘brilliant, and much needed, however we still need more beds.’
Ms Griffin has been a mental health nurse for more than 30 years and has worked in perinatal care for approximately 14 years.
She believes MBUs are absolutely vital as they 'provide a way to keep mums and babies together, when they would otherwise be separated in order for the mum to access treatment.’
Day-to-day care in mother and baby units
Staff working in an mother and baby units (MBU) have a common goal: to enable a mother to recover from perinatal mental illness without being separated from her baby, and to support her to return home and look after the baby safely. With this goal in mind, the daily routine of patients is a careful balance of free time and organised activities.
Deborah Griffin explains: ‘The routine has to work for the mums or they may not want to stay. There is a balance to be achieved, which includes assessment, care, treatment and support, occupational therapy as part of recovery, and facilitating periods of leave and time with friends and family.’
Building a rapport can be essential
Devina Vencatasawmy, a mental health nurse and Service Manager at Coombe Wood Perinatal Services in London, says nurses need a set of personal attributes to work in MBUs.
‘It’s emotionally challenging to see mothers who are so unwell and unable to look after their babies, so resilience is important. And it’s a nurturing field of work, so you must have compassion and warmth.’
Mother and baby units in Wales and Northern Ireland
Ms Griffin agrees that developing a rapport with patients is essential. She emphasises the importance of picking up on non-verbal cues that may indicate a worsening of a woman’s condition – for example, if the mother or baby appears distressed and agitated.
She says that robust documentation skills are also important. ‘Nurses are often required to communicate complex and highly sensitive information about the women and their babies in our care to external agencies.’
What can staff do to help?
Ms Griffin says that for some staff, working in the MBU can ‘trigger thoughts regarding their own experiences of being parented, or of themselves as parents if they have children.’ She explains that there is a comprehensive programme of supervision, reflective practice and training to help staff cope with the demands of the job.
Women admitted to MBUs can unwittingly be a danger to their babies, so risk management is an important issue, Ms Vencatasawmy says.
‘We always want the mums and babies to be together, but you have to be constantly aware of the risk to the baby when a mum is unwell.’
The number of units due to open in England during 2018
Despite these difficulties, Ms Vencatasawmy says most perinatal mental health nurses are proud to work in a specialist role that is highly valued: ‘We are not just caretakers – we provide assessment and treatment and care to patients, just like any other professionals in the unit.’
As with most nursing work, the most rewarding aspect of the job is seeing the patient getting their lives back to normal, but in MBUs the reward is doubled.
As Ms Griffin says: ‘Working in the MBU calls on all of the core nursing skills. We provide holistic care, where physical, mental health and social needs are all assessed and addressed. The most rewarding thing is seeing women recover and develop their confidence in being a mother to their baby.’
Case study – former service user Eve Canavan
Eve Canavan gave birth to her son in 2010. She had been well during pregnancy, but soon after giving birth she began to feel strange and confused.
Things grew steadily worse once she returned home: she describes experiencing hallucinations and feeling ‘terrified’ of her son.
Initially she and her partner found it difficult to access the right help, and various professionals dismissed her symptoms as signs of sleep deprivation.
She was finally admitted to a mother and baby unit (MBU) during a visit to see family members in Nottingham, where, for the first time, a junior psychiatrist suggested that she could be experiencing postpartum psychosis.
‘Warm and secure’
Ms Canavan’s first impression of the MBU was that it felt ‘warm and secure’.
She was prescribed antidepressants and antipsychotics, and given a bedroom with a cot for her son.
The unit had a kitchen and bathroom, and a homely feel. ‘You could even have a bath,’ she remembers. Her partner was able to stay each night until 9pm.
Ms Canavan spent two weeks in the unit full time. She gradually built up to spending time on her own with her son, and then going home for short periods.
Reflecting on her experience, Ms Canavan is clear about the importance of the MBU in her recovery: ‘I would be dead if I hadn’t gone into the unit.’
Joanna Bacon is a freelance journalist