APP has contributed to a Government call for evidence to inform the first ever Women’s Health Strategy for England which was published on 20 July 2022. We asked the Government to ensure that the strategy improved the lives of women affected by postpartum psychosis through continued investment in specialist perinatal mental health services, prioritising research into PP and improving support for women with PP during the menopause. We welcome these pledges, however committed funding is needed and we will continue to campaign for the needs of women with PP to be addressed in implementing this strategy.

Perinatal mental health services

“The package includes £100 million for bespoke parent-infant relationship and perinatal mental health support. We are increasing provision of specialist community perinatal mental health services, which provide care and treatment for women with moderate to severe or complex mental health needs, and support the developing relationship between mother and baby. They also offer women with mental health needs advice for planning a pregnancy. The Long Term Plan commits to at least 66,000 women with moderate to severe or complex perinatal mental health needs having access to specialist community care”

Research

A recent study found that although affecting 20% of women, perinatal mental health receives only 4% of all research investment in pregnancy. The Women’s Health Strategy sets a 10-year ambition that “there is more research into women’s health issues – for example, gynaecological conditions, menstrual health, fertility, pregnancy, menopause and post-reproductive health – which leads to a greater understanding of conditions that impact women and how we can meet women’s health needs”.

Menopause

The Government has set a 10-year ambition that “women can access high-quality, personalised menopause care within primary care and, if needed, specialist care in a timely manner, and disparities in access to menopause treatment are reduced” and that “healthcare professionals in primary care are well informed about the menopause, and able to offer women evidence-based advice and treatment options, including HRT and alternatives”

APP welcomes The Women’s Health Strategy for England pledge to invest £100 million in community perinatal mental health services and parent-infant support. We continue to campaign for equal access to MBU beds across the UK.

Changes to the Mental Health Act - what do they mean for women with PP and their families?

APP took part in a Government consultation on changes to the Mental Health Act in January 2021. The Mental Health Act is the legal framework for detaining a person for mental health treatment (being “sectioned”). As PP can escalate quickly and women with PP may lack capacity to make decisions about their own treatment, many women are admitted to hospital under the Mental Health Act.

A draft Bill was published in July 2022 and we are pleased to see the following changes which are especially relevant to families affected by PP

• There is a greater focus on patient choice and autonomy in making decisions about what treatment they would want if they should lose capacity.
• Patients can draw up an ‘advanced decision’ which explains their treatment preferences, and appoints a ‘nominated person’ to advocate for these treatments if they are detained. This can be a partner, family member or friend. The advanced decision is valid if signed by the patient, nominated person and a health professional.
• Any admission to hospital under the Mental Health Act should have a clear therapeutic benefit.
• Patients needing to be detained can no longer be held in a police cell or prison when waiting for assessment.

APP highlighted that we believe a perinatal mental health professional should be consulted in decisions to detain a woman with PP. In our experience, other mental health professionals may not be aware of the level of risk in PP, and the way that symptoms can ‘come and go’ in the early stages of the illness. This means that a woman may be assessed as having capacity or low risk when this can quickly change - causing delays to the urgent admission she needs.

APP also stressed that women with PP should always be admitted to a specialist Mother and Baby Unit as these provide specialist skills and a clear therapeutic benefit for the whole family unit. We believe that the separation of mothers and babies in general psychiatric wards goes against the principles of the new Mental Health Act.

We are very grateful to families with personal experience of bereavement due to PP who courageously shared their experience with us to include in our submission to the Government.

APP welcomes the new draft Mental Health Bill which protects the rights of women with PP who are sectioned to treatment with ‘clear therapeutic benefit’. APP has advised that all admissions under Mental Health Act for women with PP should be to a MBU.

This information has been updated, click here to read our latest information on Postpartum Psychosis and Covid-19

We know that pregnant women and new mothers have many questions about what will happen to their care and how they should access services during coronavirus outbreak. Action on Postpartum Psychosis (APP) is trying to compile up-to-date information for pregnant women at high risk of PP; women and families in crisis or who think they are developing symptoms of psychosis; and for those recovering from PP.

This is a fast-moving situation and health trusts across England, Wales and Scotland are continuing to make changes to their services. APP will update this guide as information becomes available.

Pregnant women

(i.e. those who have had a previous PP or who have a bipolar disorder diagnosis):

You can find APP’s general resources on this topic here & here.

1. What will happen to my antenatal psychiatric appointments or preconception advice appointments?

• In England, Scotland & Wales, there are plans in place for routine home visits and out-patient appointments to continue, but they will be done by telephone or video conferencing. We will add information from Northern Ireland when we have it.
• Perinatal Psychiatrists say that birth planning for women at high risk of PP will in most cases be offered remotely but will still be thorough and comprehensive.

2. How do I get medication during this crisis?

• In England, Scotland and Wales, medication plans for women known to be at high risk can be made with perinatal psychiatrists in advance to ensure there is plenty of time to get prescriptions filled.
• Women who are remaining on Lithium throughout pregnancy will continue to need the same degree of medical vigilance. Antenatal care is still “open for business” and obstetrics/ maternity and perinatal mental health will work collaboratively to ensure the safest possible antenatal care remains uninterrupted.
• In Scotland, medication prescribing remains with GPs on recommendation of mental health services.
• You can phone your GP prescriptions line / psychiatric services and they can send prescriptions directly to your local pharmacy for collection. We will add more information here as we know more.

3. What impact does Covid-19 have on pregnancy, foetal development or risk of postnatal illness?

• Our best knowledge to date is that Covid-19 doesn’t seem to cause problems with pregnancy or transmit to the foetus, so it is believed that having CV-19 is unlikely to impact on your baby’s development. Most pregnant women who develop the illness will experience mild or moderate cold or flu-like symptoms. Pregnant women with other health conditions should be extra cautious as they may be more unwell than other women. Pregnant women have been placed in the ‘vulnerable group’ as a precautionary measure as not enough is yet known about the virus. The Royal College of Midwives and The Royal College of Obstetricians and Gynaecologists have produced some excellent guidance for health professionals and women, which is being regularly updated here and here.
• We do not yet know whether anxiety or stress due to the crisis will impact on rates of maternal mental illness. We know that managing stress in pregnancy and the postnatal period is important. You can find excellent advice from Mind about managing anxiety and isolation here and from the Mental Health Foundation here.
• APP are here for you. If you are a pregnant women with previous experience of PP, you can talk to an APP peer supporter by visiting our forum or registering for email or video support here. We are looking at other services we can provide for women and families with our network of peer supporters and clinical experts during this anxious time.

Women and families in crisis or developing symptoms

You can find APP’s general resources about symptoms of postpartum psychosis here and getting help here. You can find more information on common early symptoms here. You can find APP information guides about PP for women and partners here.

1. If I develop symptoms of PP, how will assessment happen?

• If you believe you are developing symptoms of postpartum psychosis (or your partner, family members is) you need to act urgently via the normal routes: telephone your GP, maternity services, or 111. If you believe you or someone in your household is in imminent danger, call 999. In most areas, urgent home visits are still being completed, but initial contact may be via video call (particularly if the person also has a cough or high temperature).
• In Scotland, A&E mental health presentations are being diverted directly to mental health sites. Crisis/Out of Hours staff will work in assessment centres with extra resources, seeing people from A&E and other urgent referrals. Glasgow is currently looking to complete urgent referrals, where the specific team has capacity, at the assessment centres which are more likely to be set up for assessment of patients who may already be infected. Other areas of Scotland are likely to be making similar arrangements.

2. Are Mother & Baby Units staying open?

• In England and Scotland MBUs will remain open and are doing an enormous amount of work to minimise any risk of infection on inpatient units (There are no units in Wales; Welsh admissions are normally transferred to MBUs in England.)

3. How are MBU’s managing coronavirus?

• MBUs are following general NHS inpatient guidance on barrier nursing and staff will be using personal protection equipment (PPE) for patients with coronavirus symptoms. MBUs have set up isolation areas to care for women separately.
• As we write, MBU visiting is still in place. Traditional visiting hours are not being restricted in order to avoid peak numbers. However, visitor numbers are being limited for any individual, restricting visitors to close family and no children. Units will have different advice for this – some units will restrict visits to one named family member per patient. We believe this advice may change today, and visiting in-person may be restricted.
• Patients will be supported to use facetime and telephone video calling more. Peer Support, including that delivered by APP, will be available via video call.
• NHS guidance on visiting during the coronavirus crisis can be found here.

During recovery

You can find APP’s general resources on recovery here.

1. How will I get medication? How will I be monitored and supported during recovery?

Urgent home visits will continue. Most route appointments will happen via video call. There is a possibility that other professionals will reduce their routine home visits but this is not entirely clear at the moment and this is an evolving situation.

2. How can I manage my anxiety, depression, isolation during recovery if home visits do not happen, and we are meant to be socially distancing?

UK wide, online resources and peer support will be incredibly important for recovering women. There is already a wide range of online resources and more are being produced each day. The links below contains further resources, recommended reading and support and will be added to.

3. Social distancing and isolation mean my usual family support, and especially grandparents, are not available. Where can we find help?

APP will continue our national peer support services throughout the outbreak. Our Forum is available for you to talk to other women and partners: www.app-network.org/peer-support/

We also offer one to one peer support for anyone in the UK, where you are paired with an APP coordinator with lived experience, or a volunteer peer supporter. We can give this one to one peer support via private messaging on the forum, or via video call. If you would like to access this support, email app@app-network.org.

Action on Postpartum Psychosis

Connect with APP via Facebook, Twitter, Instagram and follow the news on our website to find out more about what APP can offer.

Links and more information/support:

For a list of England’s community teams go to: https://nhswebbeds.co.uk/community-team/list
For a list of Mother & Baby Units go to: https://nhswebbeds.co.uk

APP offer support for those affected by postpartum psychosis or at risk of PP, due to bipolar disorder. For telephone, email or Facebook support for postnatal depression and anxiety, see: https://www.pandasfoundation.org.uk/

For general advice about managing mental health, isolation and anxiety:

• Government Advice: Looking after mental health: https://www.gov.uk/government/publications/covid-19-guidance-for-the-public-on-mental-health-and-wellbeing/guidance-for-the-public-on-the-mental-health-and-wellbeing-aspects-of-coronavirus-covid-19
• NHS: Dealing with a mental health crisis: https://www.nhs.uk/using-the-nhs/nhs-services/mental-health-services/dealing-with-a-mental-health-crisis-or-emergency/
• Recovery College Online: https://www.recoverycollegeonline.co.uk/your-mental-health/coronavirus/
• MIND: www.mind.org.uk/information-support/coronavirus-and-your-wellbeing/
• The Mental Health Foundation: www.mentalhealth.org.uk/publications/looking-after-your-mental-health-during-coronavirus-outbreak

For advice specific to perinatal mental health during Coronavirus:

• RCPsych: Covid-10: Mental health before, during and after pregnancy: https://www.rcpsych.ac.uk/mental-health/treatments-and-wellbeing/perinatal-care-and-covid-19

For more advice about Coronovirus:

• Coronavirus (COVID-19): latest information and advice on GOV.uk
• Information about the virus and how to protect yourself on NHS.uk
• Royal College of Psychiatrists advice for Perinatal Services
• Maternal Mental Health Alliance update
• Bipolar UK coronavirus update for pregnant women with bipolar disorder