Making a Difference to Local Services

elliehannahsbuCongratulations to APP Peer Support Coordinator, Ellie Ware, who has been appointed to the Executive Group of the Sussex Perinatal Mental Health Clinical Network.

Sussex is one of 20 areas across the country which will benefit from funding to improve care for pregnant women and new mums experiencing, or at risk of experiencing, mental health difficulties.

The Executive Group is intended to be the "driving vehicle for the perinatal mental health programme of work" and oversee delivery of outcomes. In other words, make sure that change happens and services improve. Ellie says:

"It's really exciting and a real privilege to be asked to be part of the Executive Group that will be developing the Sussex perinatal mental health service, which is my local service.
I hope to bring not only my own personal experience of PP -- what was good about my care and what could have been better -- but all the stories and voices of the women and families APP support."  
Sussex Partnership currently offers a Specialist Community Perinatal Service in Brighton & Hove and in East Sussex. The new funding will allow the team to expand and to provide specialist support to women, their families and their babies across the whole county – for the first time in West Sussex – and at East Surrey Hospital. 
Photo shows Peer Support Coordinators Ellie Ware (left) and Hannah Bissett (right) representing APP at London South Bank University Perinatal Mental Health for Healthcare Professionals conference in September 2017. 

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APP at Downing Street Reception for Small Charities

img_4110Fantastic recognition for the good work APP does!

APP Director, Dr Jess Heron, was invited to 10 Downing Street to attend a reception of small charities across the UK that make a big difference to people's lives.

The government recognises that the economic climate is hard for small charities and has pledged to find ways to help small charities doing good work become sustainable.

Dr Heron said "It's fantastic for our work and the amazing dedication of our volunteers to be recognised in this way. We know that we save lives and that we have caused a sea-change in public interest and understanding of PP, but it's great when it's recognised by others"

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Bethlem Royal Hospital Mother and Baby Unit Fundraising For APP

cake sale for Action on Postpartum PsychosisA big thank you to the staff from the Mother and Baby unit at the Bethlem Royal Hospital who are in training for the Hampton Court half marathon in February 2017 and raising money for APP. They say:

"Working on a Mother and Baby unit, we are all very aware of the illness postpartum psychosis, as well as many other illnesses relating to women during pregnancy and after giving birth. We want to raise money for the amazing charity APP and support their work as well as raise awareness around mental health during pregnancy and after having a baby."

They have recently had a very successful cake sale to help towards reaching their fundraising target and have emailed us an update on their endeavours:

"Just wanted to share some photos with you from our cake sale. The fundraising is going well, so far we have raised nearly £500! We are planning to do a raffle for Christmas and of course sharing our JustGiving page for people to sponsor us for the half marathon."

You can support this wonderful team of people at their JustGiving fundraising page here.


cake sale for Action on Postpartum Psychosis
cake sale for Action on Postpartum Psychosis

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Dr Jessica Heron speaks on BBC Radio Wiltshire

Dr Jessica HeronOn 30th Nov Dr Jess Heron, Director of APP was asked to speak on Radio Wiltshire's Breakfast programme. She was asked to respond to the news that Wiltshire mum, Holly York, said that the NHS let her down after she gave birth and was suffering from extreme Postpartum Psychosis.

Jess took the opportunity to explain more about Postpartum Psychosis and to comment on its current status within the field of perinatal mental health. In addition she made an appeal for continued support of APP charity as a consequence upon the ending of major funding by The Big Lottery.

You can listen again here.

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2016 International Marcé Society Conference - Melbourne, Australia

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.

Marce Conference - Action on Postpartum PsychosisOn 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.

Marce conference - Action on Postpartum PsychosisThe 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!

Marce Conference - Action on Postpartum PsychosisIt 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

Marce Conference - Action on Postpartum Psychosis
APP Trustees Dr Ian Jones and Clare Dolman with MMHA's Alain Gregoire and Emily Slater


Marce conference - Action on Postpartum Psychosis
Dr Sue Smith

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New Research Study on Partner Experiences.

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 timeMany felt alone; the shared experience of starting a family with their partner had taken very separate pathsSome 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 unclearMost 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.

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Postpartum Psychosis Stories Nominated for Mind Media Awards


The shortlist for this year's Mind Media Awards features four powerfully told stories of postpartum psychosis. They are: 

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. 

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APP Trustee To Help Shape Ten Year Strategy for Mental Health Research


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!

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Katy's Story Gets APP in the Daily Mail

katytodayCongratulations 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! 

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Perinatal Mental Health Toolkit Launched

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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

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