The Marce Society was founded in 1980 by Professor Ian Brockington (also founder of APP’s research network). The Society promotes research into the mental health of women, their infants, and partners around the time of childbirth, and the Marce Society’s biennial conference plays host to the most cutting edge international research in Perinatal Mental Health. Dr Sue Smith, Consultant Perinatal Psychiatrist, Cardiff, first attended the Conference in 1996. She reports for APP on the differences she has noticed between then and now.
On returning from the Marcé biennial meeting in Melbourne in September I was keen to consolidate the copious notes I had made and summarise what I had learnt. Digging around in my office I found that I had done a similar exercise after attending my first Marcé meeting in London in 1996. I was struck by the similarities between what was presented and discussed then and what was still on the agenda 20 years later.
However what has changed is the number of people who are talking about perinatal mental health, the increased multidisciplinary aspect of the membership of the Marcé, the input from women with lived experience and the ‘women power’ represented by the number of recent female presidents!
It is probably fair to say that in 1996 perinatal mental health services were regarded as something of a luxury. Twenty years on despite still trying to understand the biological underpinnings of peripartum mood disorder (and I left scratching my head after some of these talks!) the absence of a service is now more of a talking point than the presence of one. In the UK the tireless work of the Maternal Mental Health Alliance has highlighted the areas where services are lacking - and the hope is that its launch globally, announced at the conference by Alain Gregoire, will achieve similar things on a worldwide scale.
Accepting that for many countries services are limited and that those attending Marcé are likely to be people from places where services are developing or have developed, it is still impressive that I heard many inspirational talks from various parts of the world including Australia, New Zealand, Canada, USA, Portugal, Scandinavia, France, Malaysia, Bangalore and of course the UK.
A major theme throughout the conference was the importance of pregnancy and within this a particularly fascinating talk was given by Rachel Yehuda from the USA. Her work on holocaust survivors may have demonstrated that psychological difficulties in their offspring could be related to preconception effects of trauma, passed on at conception and further developed during pregnancy.
The concept "It takes a village to raise a child" was a lovely way of introducing a number of talks about how in western societies the role of the family and wider social networks in supporting women in the postnatal period has largely been lost. The challenge is how to replicate this sensitively within the networks of professionals women now encounter in the perinatal period.
There were a number of presentations about fathers and the importance of acknowledging their part in it all. It was interesting to hear about a service where dads were texted daily to ask how they were. It also reminded them to complement their wives/ partners who appreciated this even though they knew they had needed prompting to do it! It was great to see Mark Williams from Wales talk passionately about his experience when his wife suffered severe postnatal depression - though I think his "by 'ere" may have confused some people!
On the theme of decision making about and within pregnancy, it was great to hear Claire Dolman talking about the dilemmas of pregnancy in bipolar disorder and the recent BJPsych open article she did with Ian Jones and Louise Howard.
Simone Vigod from Toronto talked about a decision aid they are developing regards taking antidepressants during pregnancy. Initial results did not demonstrate a great reduction in decisional conflict but with some refinement this could be a very useful tool.
It is very unusual to see a drug company representative at a perinatal meeting but Sage Therapeutics from the USA bucked this trend by presenting their very early but potentially exciting research using allopregnanolone, a metabolite of progesterone, for postnatal depression. It is early days but initial results were promising so watch this space!
It wasn’t all hard work - the Gala Dinner was followed by us being taught how to do Bollywood dancing in advance of the next meeting in Bangalore - some of you may recognise who is getting into the swing of it all!
My take home messages were
- pregnancy is a very important time
- more research is still needed regards the biological underpinnings of peripartum mood disorders as every answer we get provokes another question
- remember the dads
- a lot of people care about this field including those with the power to do something about it i.e those with the purse strings - so we have to keep nagging!
- roll on Bangalore 2018
Read full news item
Men’s experiences of having a partner who requires Mother and Baby Unit admission for first episode postpartum psychosis.
Perinatal mental health services and organisations such as APP are becoming increasingly aware of the need to support and involve partners of women who have experienced postpartum psychosis (PP). However, there has previously been little academic research into the needs of partners during this time. A recent study has focused on the experiences of seven men whilst their partner and baby were admitted to a Mother and Baby Unit (MBU) for treatment of PP. The author of the paper has written a piece for APP to tell us more about the findings of the study and how this could affect how services work with partners in future.
Research has told us that PP can have a life changing impact on women’s experiences of motherhood, relationships and sense of self. Their partners also often need to adjust to understanding the condition and support recovery. Perhaps understandably, the vast majority of perinatal health research and clinical practice has previously been focussed on the wellbeing of the mother and baby. Whilst dads are being increasingly recognised it is often in their capacity as a partner who is supporting the mother, rather than as a person in their own right. In the research, it remains unclear how dads are affected by the severe and sudden nature of PP and by the separation from their partner and baby during their admission to an MBU. This study aimed to explore dads’ experiences of early fatherhood and relationships during their partner’s admission for their first episode of PP, to help improve our understanding of their needs and how services can work with families during this difficult time.
How was the study conducted?
Seven fathers were recruited from two UK MBUs. For all participants, this was their first child with their partner. All of the men’s partners were inpatients on an MBU at the time of being recruited but were nearing discharge after having some periods of home leave. The men took part in interviews, which were analysed using an approach which focuses on making sense of how people understand their individual experiences.
What were the main findings?
The participants’ stories reflected the natural uncertainty surrounding the birth of a child, which was amplified by the unexpected onset of a severe mental health problem. There were two main themes within these fathers’ stories which are detailed below and illustrated with quotes from the interviews. All names used are pseudonyms to protect the participants’ anonymity.
Main theme 1: What the f**k is going on?
This theme reflects the lack of understanding surrounding PP and its treatment. Frustration and anger were common, perhaps due to feeling helpless, loss of control and fearful. Most men found it difficult to recognise the early stages of PP, as they were not sure what is normal for a new mother. For most, this was their first child and their first direct experience of a mental health difficulty.
I… didn’t really see the… signs because A. I’m not experienced in them and B. I knew there was something up but I put it down to her being absolutely over exhausted. (James)
As symptoms progressed to the more acute stages, men expressed a range of emotions such as shock, confusion and embarrassment. Experiences of seeking professional help were varied. Health professionals (e.g. GP’s or A&E staff) didn’t always know about PP which sometimes led to a delay in treatment and frustration for partners. Most of the participants didn’t know what PP was when the diagnosis was first given, although having a name for their partner’s difficulties often seemed to give some sense of understanding and hope. Some found the internet useful for finding more information, including personal stories from other families on the APP website.
At the time, if I remember rightly, I didn’t even hear the postpartum… it was just psychosis… So I didn’t even relate it to any giving birth…. It was just, my wife’s gone psychotic. (Neil)
Following diagnosis, all participants wanted to be involved in their partner’s care; however not feeling heard or valued by professionals was common. Many felt their concerns were dismissed and not taken seriously. There was lots of frustration with confidentiality procedures and the priority seemed to be on mother and baby, not dads. Some were comfortable in challenging this and asking for information, others were less so. When done well, information sharing and involvement helped dads’ understanding of what was happening for their partner.
For the first five days, all I got was, ‘you’re not married, your son’s not registered, you’ve got no right to know where they are or what’s going on’. And that’s all I got, from everybody. So all I knew was, my son had disappeared, my girlfriend had disappeared. (Tim)
I think I might have got on the doctor’s nerves a little bit. Because [the doctor] was…
like, ‘well, this is about me and your partner’, but obviously [my partner]… might not
even think of the questions that I think of. (Neil)
Main theme 2: Time to figure out how your family works
This theme captures the impact of PP on the roles, relationships and identity within the family.
Most participants felt more responsibility to care for both their partner and baby as PP symptoms progressed. Many dads felt pushed to their coping limits and appreciated help from family and friends. Some women were first admitted to general inpatient units which were not felt to be very helpful or appropriate. MBU admission was usually a relief and gave permission for dads to look after themselves. Many trusted the MBU staffs’ expertise and saw it as an opportunity for learning and growth. However, handing over caring responsibility was difficult for some.
We were doing the right thing… It was a relief that somebody else was going to look after her and the medication.... I could come in, give her… all my attention for… a few hours in the morning, a few in the afternoon, a few in the night… And I knew the baby was being taken care of. But then I’d go back and have time to… recharge my batteries. (Michael)
Most dads felt a huge loss for their relationship and partner during this time. Many felt alone; the shared experience of starting a family with their partner had taken very separate paths. Some went through a grieving process as their partner’s identity seemed to have been changed by PP. For others PP was seen as something external ‘taking over’ their partner.
She was here but I thought her personality was dead, so my relationship with her personality is dead … My personality clicks with her personality, yeah and if she’s not there… our relationship isn’t there… it felt like she was dead. So when I was at home I felt like I was single. I felt like I’d lost everything. (Ashley)
Men tended to feel less loss around the separation from their child; this relationship was often seen as more stable and positive. Many had started to reconnect with their partner as they started to recover, but the long-term impact was unclear. Most did not want more children because of future risk of PP.
It’s just not worth… the risk… to my partner. And obviously the baby would be there as well. That’s… one of my concerns… she might never have a brother or sister… I’ve got a brother and he’s my best mate... My child won’t have that and I feel guilty about that, for her. But… I just don’t think, well, at this point in time anyway, that it would be an option. (Michael)
PP delayed adjustment to being a family, which was often made worse by large distances between home and the MBU. There were lost opportunities to do ‘normal’ activities with the baby and some expectations of parenthood were not met.
You feel, a bit deflated…. Because you’ve got two weeks off from work, you have all these plans to do these great things and bed down and suddenly that two weeks is gone. Because you’re in hospital. And then you… need to go back to work but we haven’t had time to bond at home. (Neil)
For some it was hard to parent the way they wanted to on the MBU but others had more positive experiences. Some were worried about how family life would be when returning home, whilst others saw their family as ‘back to normal’ already.
I don’t want to say it’s made us grow up… but I suppose it has... It’s made us… become my parents… It’s a different life to the one we’d sort of planned, even while she was pregnant. (Matthew)
Recommendations from the research
Whilst only a small number of experiences were reported in this study, some recommendations can be made to try to improve future practice and research in this increasingly important area:
- Improved awareness of PP is needed, for both health professionals and the public, to allow faster diagnosis, access to the right treatment and less stigma around the condition.
- Improved access to MBUs is needed. In this study, general mental health services were not viewed as appropriate by dads (previous research has found women feel the same). Many men had to travel large distances to visit their family due to the lack of availability of local units, which created increased stress, separation and financial pressures.
- Health services need to improve how they work together with fathers. Many felt excluded from their partner and baby’s care, causing more frustration and confusion.
- The timing and type of support services offer to fathers should be considered; even if men say ‘no’ once they might need help in future. Many of the participants reported not feeling ready to talk about what was happening until the time was right for them.
- Sometimes services do get it right! Most men had positive experiences of MBUs and saw them as a valuable resource which helped their partner’s recovery and their own ability to support their family.
- The sample of participants was limited; more research is needed with partners with different backgrounds and family structures (e.g. different cultures, families with multiple children).
The researchers would like to thank all of the men who took part in the study and their partners for consenting to this at a challenging and emotional time for their families. Thanks also go to the staff teams at the MBUs who helped in recruiting for the study.Read full news item
The shortlist for this year's Mind Media Awards features four powerfully told stories of postpartum psychosis. They are:
- BBC One documentary, My Baby, Psychosis and Me, which aired in February this year.
- BBC Radio 4's The Listening Project on Postpartum Psychosis.
- BBC One Eastenders, Stacey Branning postpartum psychosis storyline that APP collaborated on with Mind and Bipolar UK.
- The Sun Fabulous Magazine article, "Having a baby made me psychotic" featuring APP media volunteer, Kathryn.
Mind's CEO, Paul Farmer said, "The media we consume, whether through TV documentaries, print news, digital blogs, radio or film, has a huge impact on people’s attitudes towards mental health problems."
We believe that all four of these sensitively told PP stories go some way to raise awareness of the symptoms, help reduce the stigma surrounding this mental illness and help those who develop Postpartum Psychosis get diagnosed and treated more quickly.
The winners will be announced on 14th November.Read full news item
Congratulations to APP trustee Clare Dolman who has been invited to take part in the development of a national ten-year strategy for mental health research.
The recently published Five Year Forward View for Mental Health recommended that the Department of Health, working with others, should set out a ten-year strategy for mental health research. The work has been divided into different areas to cover Basic Research, Translational Research, Population and Health Services Research and Children and Young People.
Clare, who lectures at the Institute of Psychiatry, Psychology and Neuroscience, King’s College London on service user research, often referring to examples from her own experience of bipolar disorder and postpartum psychosis, has been asked to be Deputy Chair of the Population and Health Service working group. Clare said,
“I’m very pleased to have been asked to take part in this important exercise, especially as it enables me to represent people using mental health services, particularly perinatal services”.
Overseen by Professor Chris Whitty, the government’s Chief Scientific Adviser, these groups will meet over the next few months with a view to publishing recommendations next year.
This week also saw the launch of a paper written by Clare on on decision making in pregnancy for women with bipolar (see photo) which you can find here. Double congratulations!Read full news item
Congratulations to APP Media Volunteer, Katy Chachou, who pulled out all the stops to get her story told in a sensitive, informative and positive way by the Daily Mail.
APP was contacted by freelance journalist Jane Feinmann following the paper's recent report on the tragic case of Alice Gibson-Watt.
Katy and her husband George were interviewed for the piece and a photographer sent to get pictures of mother and daughter today. Katy even agreed to be contacted while on holiday abroad to make the article happen.
Also included are some great quotes from APP Chair, Giles Berrisford, alongside informed comments from perinatal mental health experts Dr Judy Shakespeare and Dr Carrie Ladd from the Royal College of General Practitioners.
It's a great piece combining a traumatic personal experience with expert opinion. It demonstrates that PP can happen to any new mother but that full recovery is possible. We hope it will help raise awareness of PP among a large and new audience. Happily, the online article also carries a link to APP's website at the foot and embeds our stigma-busting video.
Huge thanks to Katy and Giles for their excellent work!Read full news item
The Royal College of General Practitioners has launched a new Perinatal Mental Health Toolkit designed to support GPs and other healthcare professionals as a go-to collation of resources that could support them to deliver the care their patients with perinatal mental health conditions need.
But the Toolkit isn't just for GPs. It contains plenty of patient and even partner resources including APP's Insider Guides and Peer Support Service.
Dr Carrie Ladd, RCGP Clinical Fellow for Perinatal Mental Health, and lead on the PMH toolkit, said it "has been developed in consultation with women who have had perinatal mental health problems, and we hope it will give them the confidence to approach health professionals, and be better informed about their choices and what they should expect."
APP Chair, Dr Giles Berrisford gave a keynote presentation at the launch talking about NHS England's strategy for transforming perinatal mental health. Following the hashtag #PMHtoolkit on Twitter showed how positively the Toolkit is being received and a sense of optimism about the future of perinatal mental health services.
Find out more, take a look at the Perinatal Mental Health Toolkit on the RCGP website.
We are pleased to announce that APP will continue to host the successful Everyone’s Business Campaign on behalf of the Maternal Mental Health Alliance (MMHA), following the award by Comic Relief of a grant of £750,000 for the next phase of the campaign.
The Everyone’s Business campaign calls for all women throughout the UK who experience perinatal mental health problems to receive the care they and their families need. The grant will enable the MMHA, supported by APP, to sustain and build on the momentum of the first phase of the campaign. A recent independent evaluation shows that over the past three years the Everyone’s Business Campaign has made a significant impact in six key areas, including enabling perinatal mental health to become a political priority and strengthening the case for improved perinatal health services.
Dr Jess Heron, Director of APP says, ‘Action on Postpartum Psychosis is delighted to have been asked to continue hosting the Everyone’s Business Campaign. We have been pleased to play our part in the campaign’s success so far and very much look forward to working with MMHA to help deliver the next phase. The campaign is absolutely vital and has already had a real impact to women and families. Crucially, for families affected by Postpartum Psychosis, it is changing national consciousness of the importance of access to good maternal mental health care. There is still much more to do over the coming years and this would not be possible without Comic Relief’s support.’Read full news item
Leicestershire Partnership NHS Trust today released a great video to highlight the expansion of specialist psychiatric support for mothers who experience mental illness.
Two families share stories of recovery in the film, including a mum who experienced Postpartum Psychosis after the birth of her first child. She and her husband are now expecting again, having taken advice from the perinatal mental health team and put a care plan in place. Their story begins about 6 minutes in.Read full news item
The character of Sarah Platt in Coronation Street is currently under psychiatric care in a Mother and Baby Unit having experienced psychotic episodes. On Monday 4th July she was diagnosed on screen with Postpartum Psychosis (PP).
It is good to see that Postpartum Psychosis is being tackled by the major soaps, and that the term is receiving wider use. For years, PP has been a silent mental illness. Many women and families affected by PP have not previously heard of it. They do not know: the signs and symptoms to watch out for; where to get help; or that they will recover. Many struggle to discuss their experiences with friends or other new mums, for fear of stigma, and because most of their friends have also not heard of it.
Unfortunately APP was not approached or consulted about this storyline. APP have requested that the programme list us on ITV’s Advice webpage, but the programme have stated that they cannot. MIND have told us that they will direct any enquires they receive to APP – to our website, email and peer support forum.
There is a concern being expressed by many of our members that the experience and symptoms the character Sarah Platt is portraying in the soap opera are not typical of PP, and not in line with their own experience of the illness.
Although PP can manifest in a wide variety of ways and it is hard to describe a ‘typical case’, it would be more usual for PP to begin in the first few days following childbirth, with women developing hallucinations, delusions, mania, depression, odd and erratic behaviour. It can get worse very quickly and should always be treated as a medical emergency. Most women need to be admitted to a Mother & Baby unit for treatment. To date, there has been little evidence that social or psychological factors play a major role in causing PP, for most women. Research suggests that a person’s genes may play a role, as well as sleep disruption, and the major hormonal and biological changes that occur around the time of birth.
PP affects people of all social classes, education levels, family backgrounds and cultures. PP can happen ‘out of the blue’ to women without previous experience of mental illness. There are some groups of women, women with a history of bipolar disorder for example, who are at much higher risk.
APP offers support to all women suffering from psychosis in the postpartum year. Whether an episode is triggered by childbirth or later in the postpartum year, many of the issues women need support with when ill and managing a baby will be the same.
• Insider Guides - developed with the help of women who have experienced PP and their partners www.app-network.org/what-is-pp/app-guides
• Peer Support – an online forum where you can talk to other women and partners that have ‘been there’ www.app-network.org/peer-support
• 1:1 email support – we can connect you with a trained peer supporter – all of whom have recovered from PP www.app-network.org/peer-supportRead full news item
Yesterday, Monday 6 June 2016, the charity Parent Infant Partnership (PIP) UK launched the UK’s first Infant Mental Health Awareness week, and a new campaign ‘Building Babies Minds’ which seeks to highlight the importance of laying the foundation of the mind for good mental health in infancy. At APP, we understand the importance of mothers and babies getting a good start in life and we welcome this campaign to raise awareness.Read full news item