Charlotte Bevan's death and that of her newborn baby has deeply affected many of us. We feel desperately sad for Charlotte’s partner, family, friends and all those involved in her care. We do not yet know the circumstances of Charlotte’s death and therefore we cannot make assumptions about Charlotte's state of mind, but this is a call to arms.
As trustees of Action on Postpartum Psychosis, we feel we must speak out in general terms about the landscape of care for severe perinatal mental illness. Despite the hard work of this charity and of those allied with us (see Everyone's Business), misinformation, ignorance, and stigma surrounding perinatal mental health abounds.
Postpartum Psychosis is the most common cause of maternal suicide. It must be viewed as a psychiatric emergency. It typically strikes within days of giving birth and escalates in severity, rapidly. It often occurs "out of the blue" to women with no personal or family history of mental illness, but women with previous episodes of mental illness are at greatly increased risk.
We know, via The Confidential Enquiries into Maternal Deaths that suicide is a leading cause of death to new mothers in the UK; we know that Mother & Baby psychiatric units (MBU'S) are highly effective facilities and yet are so scarce as to be a postcode lottery; we see confusion between diagnoses of Postnatal Depression and Postpartum Psychosis - consequently the "highs" and other early symptoms that might herald the rapidly escalating symptoms of psychosis and ensuing loss of touch with reality, can be missed, with tragic consequences.
Those at the front line need to "hear" the stories of those women and families whom we support at APP. They need to know that a psychotic new mother's pathway might be: the appearance of being overly happy, or detached, or anxious or confused – and not at all depressed; of bonding wonderfully with her newborn, but - dangerously - not needing to sleep. Thereafter, matters might quickly degenerate: the mother may well become frightened, perplexed, delusional and suicidal. Even then we cannot assume, a priori, that a mother must be depressed if she takes her own life - in her psychotic state her beliefs are not rational: the vision before her might not be one of impending death.
New mothers, partners, and indeed all front line staff need to know the early signs of Postpartum Psychosis. In women with a history of mental health problems, all staff must know how to talk about mental health symptoms, and how to closely monitor mental wellness, particularly in women at high risk. Clear pathways for quickly managing these postnatal psychiatric emergencies must exist in all regions. Failure to educate all about perinatal mental illness is a form of stigma.
Postpartum Psychosis has good outcomes if identified early. Given prompt treatment, ideally in an MBU, there is real cause for optimism. Many members of this Board are living testament to the wonderful bond of motherhood that can be had after recovery from Postpartum Psychosis. Whatever the conclusion of the eventual report, our sadness is for Charlotte who will not be one of these mothers.
This is the call to arms: to beseech governments to see the benefit, both socially and economically, of urgently addressing perinatal mental illness. Our ask is that all women have access to specialist inpatient and community perinatal mental health services in all areas the country. We ask that front line health professionals have access to the training they need. We at APP know only too well the family tragedies that result from this lack of investment.
Now, more than ever before, we feel there is a growing public and political appetite to address maternal mental health care in the UK. APP and other organisations of the Maternal Mental Health Alliance are working hard to ensure that the voices of women and families are heard.