APP response to the Maternity and Neonatal Investigation report
We welcome the report of the Maternity and Neonatal Investigation (“Amos report”) and thank all our families, staff and volunteers for sharing their stories and for engaging with the inquiry process.
The report recognises the “extent of the under-investment in perinatal mental health services and the impact of this under-investment… with maternal suicide being the leading cause of death for women between six weeks and one year after the end of pregnancy.” It outlines an under-funded, fragmented maternity care system, with inconsistencies in care, services not communicating sufficiently throughout the system, families too often not being listened to, and persistent racial inequalities. These findings reflect the experiences of many women and families affected by postpartum psychosis.
So when a midwife came to visit me at home, I mentioned that I felt like I was hallucinating. I also told her that I hadn’t slept in days and had too much energy. To me she seemed dismissive… nothing much was said about it.
Read Natalie’s full story here.
The report’s call for better coordination between maternity, neonatal, mental health, primary care and community services is particularly important for women experiencing PP. Families often tell us that they encounter multiple services, with no single professional taking responsibility for coordinating care. All professionals should be aware that suspected cases should be assessed within 4 hours and same day admission to a Mother and Baby Unit is best practice. Too often, early warning signs are missed by professionals working in silos or who lack awareness of the need for urgent specialist care.
I think that if there was more awareness of PP amongst the general public and health professionals, I could have been diagnosed earlier, which may have decreased the intensity of the trauma I experienced.
Read Jenny’s full story here.
Despite its many excellent recommendations, we are disappointed that the report does not take the opportunity to centre perinatal mental health within maternity care.
Despite acknowledging the need to address maternal suicide, and the role that mental health plays in all maternity interactions, the report fails to:
• recognise severe mental illness as a critical maternity safety issue
• recognise Mother and Baby Units and perinatal mental health pathways as essential maternity safety infrastructure.
Mental health safety is regarded as largely outside the scope of the report, with a future Taskforce instead promised to consider these issues. If we are to reduce maternal deaths and maternity trauma, perinatal mental health training and safety infrastructure must be embedded within maternity care now.
With timely and appropriate care:
• most women with postpartum psychosis make a full recovery
• trauma and family separation can be avoided
• maternal deaths and infanticide can be prevented.
The report must lead to meaningful change.
1. The Maternity Commissioner and Taskforce must recognise severe postnatal mental illness as a critical maternity safety issue.
2. Plans to protect and strengthen Mother and Baby Units must be included within scope — improving access, evaluating unmet need, and developing legislation that will keep mothers and babies together for care, except when clinically inappropriate.
3. Barriers to equitable care for women from Black and Asian communities must be understood and addressed.
4. Training in postpartum psychosis and perinatal mental illness must be critical to role for mental health and frontline professionals working with perinatal families.
5. Pregnancy-to-postpartum management plans for women at high risk, alongside clear escalation pathways for new episodes, must be in place.
6. Antenatal education for expectant families must cover the symptoms of postpartum psychosis and how to seek help. Fifty per cent of those who become severely unwell with postpartum psychosis have no identifiable risk factors.
7. The critical role that the Third Sector plays in lived experience community building, delivering life-saving peer support, and supporting long term recovery must be understood, valued and embedded in NHS services.
8. National strategic oversight is needed for perinatal mental health as a speciality, to maintain high-quality consistent services, to respond rapidly to changing national circumstances, and support the sharing and scale-up of good practice.
I was brought straight to a hospital, however, there weren’t enough beds in nearby Mother and Baby Units (MBU) so I ended up on a general psychiatric ward and separated from my baby. Unfortunately, when you’re separated from your child this can really trigger more paranoia and make things worse.
Read Lobeh’s full story here.
We will continue to urge policymakers and NHS leaders to ensure that postpartum psychosis is explicitly considered in plans to improve perinatal healthcare. Better awareness, joined-up services and timely specialist treatment save lives.
Rich Baish runs APP’s bereaved families peer support programme:
“My wife took her own life a month after our second child was born in 2022; she’d had no history of mental illness, she was well-supported at home and she was a secondary Maths teacher. Nothing prepared us for what happened, which included a lack of awareness of postpartum psychosis from several healthcare professionals leading up to her death. We spoke to several midwives, each of whom offered differing and contradictory advice to the previous one. Her mental health continued to deteriorate over the next few days. The GP saw her and booked an appointment for a few days time to check in, but she did not make it. It was only after she died that we ascertained that postpartum psychosis is what she was suffering with. It’s vital that every healthcare professional who deals with new mums is aware of PP. Sadly, my family are proof of what can happen if it isn’t taken seriously.”
Dr Sally Wilson leads APP’s health professional training programme:
“My PP began in the postnatal ward. It was very frightening, I truly believed I had killed my baby. Where I lived, there was no MBU and no specialist perinatal mental health service. I was admitted to a general psychiatric ward, but it wasn’t the right place and my husband helped me get out quickly. I was still unwell at 11 months postpartum. I was in the middle of psychosis, deeply depressed and struggling with suicidal thoughts when I first posted on the APP online forum writing the words ‘help, I can’t go on like this’. I had so many replies, was signposted to a psychiatry service for a second opinion on treatment options and was able to access the lifesaving treatment I needed. Through APP, I was given a one-to-one peer supporter, and she was an absolute lifeline for me. She made me feel less alone and gave me hope. I’m not sure that I would be alive today without APP and her peer support. Now, I deliver peer support myself and I also oversee APP’s health professional training programmes. Since it began we have reached more than 30,000 health professionals with lived experience talks and workforce training workshops.”