What is PP

Many people have never heard of postpartum psychosis (PP) until they, or a loved one, are affected by it. It’s the most severe form of postnatal mental illness that occurs after having a baby. It can happen out of the blue to women with no previous mental illness or can be a recurrence of an existing illness like bipolar disorder. It affects 1 to 2 in every 1,000 births – around 600-1,200 new mothers in the UK every year.

Symptoms

Symptoms can come on very rapidly in the days after birth or escalate more gradually. It can make people think unusual thoughts and behave in a way that is completely out of character for them. PP is different to postnatal depression. Women may experience hallucinations, delusions, mania, or confusion. Some women will also experience anxiety and depression alongside other symptoms, but not always. It can present in a range of different ways. You can read more about symptoms of postpartum psychosis here.

If you would find it helpful to talk to someone about what PP is and how it can make you behave, APP staff are always willing to help answer your questions. Send an email to: app@app-network.org and we can arrange a time to talk.

Causes

We still have much to learn about the causes of PP. What is known is that:
It’s not yours or your partner’s fault. It wasn’t caused by anything you or your partner thought or did. Relationship problems, family income, stresses, the baby being wanted or not do not cause PP.

PP seems to be triggered by the dramatic changes in hormone levels that happen at birth. Studies have not yet identified how these factors act to trigger the onset of severe mental illness. Women are more likely to have PP if a close family relative has had it - so genetic factors are thought to play a role. Sleep changes, thyroid problems and pre-eclampsia might also have a role, as might the shock or trauma from a difficult birth but more research is desperately needed. You can read more about what’s known about PP causes here.

If you would find it helpful to talk to someone about what’s known about the causes of PP, APP staff are always willing to help answer your questions. Send an email to: app@app-network.org and we can find a time to talk that suits you.

Postpartum psychosis isn’t a term commonly found in the first-time dad handbook – I’d never heard of it, anyway… and I had no idea that it was what [my wife] was going through until she was acutely unwell and suicidal.

Risks of PP

Most women with PP recover, although it can take a long time. Tragic outcomes are rare in the UK, but PP can be life-threatening.

Psychiatric illness is a leading cause of new mothers dying in the 12 months following childbirth in the UK. PP accounts for a significant proportion of these deaths, albeit a smaller proportion than they used to before APP was set up.

Women with acute psychosis and those recovering from psychosis are at risk of accidents and suicidal behaviours. Because women are responsible for a vulnerable newborn at a time they are so severely unwell and out of touch with reality, harm to the infant is also a possibility.

About maternal deaths caused by PP

Deaths resulting from PP are rare but when they do happen it can be for a number of reasons:

  • Acute mania or psychosis: Psychosis can result in women acting on bizarre, confused or delusional beliefs. Beliefs might include things like: the world is going to end; there is something desperately wrong with the baby; they are the cause of all the evil in the world, and a whole host of other beliefs. Suicidal behaviour or fatal accidents can also result from women acting out of character or taking risks whilst feeling elated or ‘high’. Beliefs might include: I am invincible so nothing can harm me; I can save the world if I die; I can hear God asking me to do this. Women who are in a manic or elated state might drive too fast, act without normal inhibitions, and take part in risky activities.
  • Treatment or care-related deaths: Very occasionally, women have died as a result of a reaction to, or side effect of medication or treatment.
  • Subsequent depression, relapse, difficult recovery journey: Many women who experience PP experience a lengthy period of postnatal depression and anxiety after they have recovered from the acute psychosis. Recovery can be a difficult journey and it continues long after discharge from NHS care. Women often struggle with isolation, anxiety, depression, mania/psychosis relapse, and face stigma and self-stigma whilst learning to be a mother. Feelings of despair, loss of hope for recovery, a belief that a woman’s baby and other family members would be better off without them can result in suicidal thoughts and behaviours. Some women experience what seems to be deeply set in, recurrent or treatment resistant suicidality during the recovery phase. Although rare, this can be very difficult for health professionals and families to manage. After 12-24 months, care will usually be transferred away from the Perinatal Mental Health Team to a General Adult Psychiatric team, and this can be a hard transition for families.

Whatever the ultimate cause of the PP-related death, the loss of a new mother at such a critical time in family life will deeply impact families, children, wider communities and health professionals.

There are likely to be inquests and investigations to help health professionals learn from the tragedy. You can find more information about what you can expect from these, as well as making complaints to the NHS, campaigning to change care practices, and gaining legal support here.

What is APP working to change?

For far too long, PP was a silent mental illness. Women faced stigma and so the illness was hidden. Families were unable to speak out to address the poor public awareness of the illness, lack of health professional knowledge, lack of research, and services that were not designed for managing severe mental illness in new mothers.

APP’s vision is for all women and families affected by PP to benefit from best practice care through to full recovery. We work to raise awareness of postpartum psychosis, train health professionals and all those who might come into contact with women at risk, or recovering, from it; we are reducing isolation and stigma with peer support services in MBUs, communities and online. We work to raise awareness to funders and facilitate research into the illness. We’re working with families with experience of PP, specialist clinicians and world leading academics to reduce maternal deaths caused by PP and increase support for women and their families. APP is the only charity in the world highlighting postpartum psychosis, and we work to influence care and understanding of PP globally.

Between when APP was formed in 2011 and today (Jan 2025):

  • We’ve trained 520 health professionals in best practice care for postpartum psychosis.
  • 14,243 health professionals have heard an APP lived experience speaker.
  • Our Storytelling volunteers have shared their experiences with hundreds of media pieces each year in regional, national and international media, to get consistent and myth busting messages to the public, activating interest in APP’s work, support services, and ensuring the voices of women and families with PP are heard.
  • We’ve supported thousands of women and their family members through our peer support forum, one-to-one and group meetings, reducing isolation and increasing hope. Almost fifty per cent say they might not be alive without APP peer support.
  • We’ve developed information guides about PP, co-written by women and families with experience, academics and clinical experts.
  • Our toolkit for antenatal educators helps professionals talk to expectant parents about the signs and risks of PP.
  • Our Mother and Baby Unit (MBU) campaign has led to five new MBUs opening since 2018, a Chester unit on track to open in autumn 2025 and the announcement of plans for Northern Ireland’s first MBU. Services have developed new postpartum psychosis care pathways that explicitly consider the needs of new mums who develop rapid and severe illness.
  • Our campaigning work has led to PP’s inclusion in professional competency guidelines and new resources being developed for midwives, health visitors, and psychiatrists. Our training partnership with the Institute of Health Visiting means all Health Visitor Perinatal Champions hear an APP Lived Experience speaker.
  • Funding for PP research has increased and there are many more researchers working on studies to enhance our understanding of PP and its causes. APP is currently supporting work in: molecular genetic and clinical studies; enhancing psychological recovery after PP; and experiences and barriers to care for those from diverse communities.

We know there is still a long way to go, and we won’t stop until women stop dying from this treatable illness, women are no longer traumatised by their treatment for PP, and tragic outcomes cease to occur.