Action on Postpartum Psychosis (APP) is the national charity for women and families affected by postpartum psychosis.
• APP is a collaboration between women and families with personal experience, world-leading academic researchers and specialist health professionals.
• APP has been a research network since 1996 and a charity since 2011. It is hosted by the University of Birmingham Medical School, NCMH in Cardiff and The Birmingham & Solihull Mental Health Trust.
• Supports women and families - via an award-winning peer support service and comprehensive patient information and resources
• Trains frontline health professionals in the care and management of PP
• Raises awareness of PP and campaigns for improved services
• Facilitates research into all aspects of the illness.
• APP’s peer support forum has over 2,800 lived experience users, sharing experiences and receiving support from trained volunteers. Peer volunteers support around 250 women each year throughout the UK with one to one email and video call support. APP manages seven regional peer support café groups and five NHS partnership projects based in Mother and Baby Units and Perinatal Community Teams.
• APP has almost 100 volunteer regional representatives, who disseminate information to health professionals in their region, support service development, deliver health professional training, or support on a regional project.
• APP has reached almost 10,000 multidisciplinary health professionals through lived experience talks and workforce training.
About Postpartum Psychosis
• Postpartum psychosis episodes follow 1-2 in 1,000 deliveries.
• That’s 1,400 new mums who develop postpartum psychosis each year in the UK and around 140,000 women throughout the world.
• Postpartum psychosis is a frightening and debilitating illness for mothers and families. Symptoms include hallucinations, delusions, mania, and/or severe confusion – but a wide variety of symptoms can occur alongside these core symptoms too. Early signs to look out for include: an unusually elated mood, agitation, irritability, racing thoughts, being unable to or not needing sleep, paranoia or supernatural beliefs.
• Postpartum psychosis is NOT simply a more severe form of postnatal depression. In fact, many mothers with postpartum psychosis do not experience any symptoms of depression at all, rather they experience extreme elation, spirituality, confusion, and quickly lose contact with reality. The majority of women therefore are unable to seek help for themselves and others must obtain help for them. Acute symptoms can be similar to those seen in bipolar disorder.
• It strikes at a time when families are full of expectation. Mothers feel loss, guilt, responsibility for missing out on the early months of motherhood. Fathers become responsible for a newborn or are separated from their families.
• Postpartum psychosis can occur to women from all cultures, social classes, occupations, and educational backgrounds. Often it occurs 'out of the blue' to women without any previous psychiatric history.
• The stakes are high if the illness is not identified sufficiently early, or is poorly managed, both in terms of maternal outcome (including risk of suicide) and child outcome (including rare and tragic cases of infanticide).
• According to The Confidential Enquiries into Maternal and Child Health (MBRRACE-UK) suicide is the leading cause of maternal death in the 12 months after childbirth. Up until the launch of APP, half of these suicides were to women experiencing postpartum psychosis. This proportion is now much reduced, with recurrent major depression accounting for the majority of suicides. Completed suicides are the tip of the iceberg in terms of ‘near miss’ events.
• Postpartum psychosis is eminently treatable, but services must respond quickly and be appropriately set up to manage these psychiatric emergencies. Episodes have a rapid onset, usually within days of delivery and may escalate to full blown psychosis quickly – within hours or days – rather than the weeks or months that is more usual for psychotic episodes that develop outside of the postpartum period.
• Although episodes of postpartum psychosis are among the most severe mental illnesses seen in clinical practice, postpartum psychosis also has one of the best prognoses.
The causes of postpartum psychosis are unknown, but the dramatic hormonal and biological changes that occur at childbirth are thought to be involved. There is evidence of a genetic component to the illness and of a link with bipolar disorder. One in 5 women with a history of bipolar disorder experience postpartum psychosis following childbirth. Sleep disturbance may also be an important trigger. Very few social risk factors have been found.
• The majority of women are substantially recovered within a few months, but full recovery and coming to terms with the illness may take 12 months or longer.
• Recovery is a difficult and lengthy process. Factors that contribute to these difficulties include: lack of information and support – finding about the support available from APP can therefore be lifesaving; lack of access to specialist psychological and practical support to help them as they look after a baby, rebuild relationships, build mothering confidence; managing the isolation caused by lack of visible others who have experienced the illness; the poor awareness in the general public and media; the stigma associated with experiencing mental illness.
• Misguided portrayals in the media can contribute to mothers' feelings of isolation and to difficulties in discussing their experiences with other mothers. Often, when women or their partners search the internet for information about their illness, alarmist stories about mothers harming their babies are the first they encounter. Well researched pieces can signpost to lifesaving support, help families realise there is a community of others out there, and reduce stigma and fear.