Congratulations 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.
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"
We are so grateful to Iain and Sue McKendrick who set up a fundraising page for APP on the occasion of their 50th birthdays. Iain told us,
"We were delighted when we discovered what APP was doing, because 16 years ago, when Sue was ill, there was so little advice and information available. We were incredibly lucky that various friends rallied round to help me, that my mum was able to come and stay for a month or so, and that the local Social Work department was willing to assign some help once Sue was home and I needed to go back to work... but it could all have been so different."
Iain's birthday was in July and Sue's is in December so they threw a big party in between and included the link to the fundraising page on the invitations asking for donations rather than presents. They managed to raise over £700 for APP, so a very big thank you to Sue and Iain!
Sue, as a 50th birthday objective, has collated a collection of her poetry and is having it published. There is a section in the book where she talks about PP, and some of the poems are about that period in our lives, and in reference to her experience, she has called the book 'Method in my Madness'. Read more about Sue's story including some of her powerful poems here.
"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."
Sue experienced PP after the birth of her son Alex in 2000. On the occasion of their 50th birthdays in 2016, Sue and husband Iain asked friends and family to donate to APP, instead of giving them gifts. They raised an incredible sum, over £700! We are so grateful to Sue and Iain and their generous donors. When we got in touch to thank them, Sue sent us a copy of her book, “Method in my Madness” – the title of which came to her during her episode of PP 16 years ago. Here we share three of her wonderful poems.
Sue reflects, “In the year 2000, my world was turned upside-down. I had Postpartum Psychosis, a severe episode of mental illness which begins suddenly in the days following childbirth. During my mania, I was mad about poetry and I promised to write a book called “Method in my Madness”. Clearly, such an idea was ridiculous, because at the time, I could not focus to write a single coherent sentence! It took me about 7 years before I could face writing a poem as it brought back such painful memories.
These poems are a personal reflection on this difficult period in my life. This experience has changed my attitude towards mental illness. As a result, I don’t take my own mental health for granted and try to find time to unwind.”
Out the Sun Roof
Natural birth cancelled and birth plan
abandoned; the baby didn’t come on cue.
Wired up, monitored more than
I wish; should the details be taboo?
Surgeon poised with his knife.
Is this the best day of my life?
They top up the epidural
I can feel poking and prodding.
Midwife and surgeon in conferral;
head stuck, pushing and pulling.
Implements and gowns all sterile.
Iain is watching and holding
my hand; overwhelmed, is it joy?
Huge relief: a baby boy!
One week later, I was in the Royal Edinburgh Hospital. Mental health provisions for mother and baby were inadequate and I was separated from my new baby.
Just a New Mum
Just a new mum: all nervous and tense.
No strength to move about,
cut off from baby, no self–confidence.
Feeling I need to punch out
at doctors who irritate and annoy.
My abilities, I have come to doubt:
one moment sad, one moment happy
and no idea how to change a nappy!
Overwhelmed, I feel overcome.
The ward is abuzz.
Crying because I want my mum;
can’t sleep; my head’s a fuzz;
painkillers make me dazed and numb.
I write lists, joke and sing because
lost my judgement, lost my mind,
memories seem misaligned.
Is this a nervous breakdown?
Pyschosis is diagnosed, agreed;
all day in my dressing gown.
Eyesight distorted, can’t read.
I’m just a new mum – all slowed down.
Expressing milk but can’t feed.
How can I be in such a state,
scared of what will be my fate?
Method in my Madness
With glistening eyes oozing sadness,
he is stressed and tense.
“I think there’s method in my madness!”
He listens and gives me a look,
not wishing to cause offense,
his glistening eyes oozing sadness.
“That’ll be the title of my book.”
It will be full of common sense.
Good title: Method in my Madness!
“Do you like it?” I burble.
He is sitting on the fence,
his glistening eyes oozing sadness.
Baby Alex gurgles.
If only I could write a single sentence.
There must be some method in my madness.
I start to tell a joke about Agnes
and Ayli next door, but lose my focus,
my glistening eyes oozing sadness.
Some day you’ll find method in my madness!
On 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.
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
APP Trustees Dr Ian Jones and Clare Dolman with MMHA's Alain Gregoire and Emily Slater
David is a retired university teacher. David’s mother, Flora, suffered from Postpartum Psychosis in 1933, and died in 1943, before the advent of the NHS, and antipsychotic and mood stabiliser medication in the 1950s.
David wrote down his moving story for his children, by way of a historical record, self-explanation, and a caution of the risks of failing to communicate about mental health. He has agreed for us to share it with you.
Stigma, fear, misinformation, lack of awareness regarding PP still exists in many parts of our world - in families, playgrounds, mums and baby groups, our working lives. Thanks to APP’s Big Lottery project, things are changing, and this change is now beginning to take on a pace of its own.
Secrets and Lies tells of the individual pain caused by failure to communicate with loved ones and, in particular, children, about Postpartum Psychosis - and the intergenerational impact of stigma, shame and family secrets.
My mother Flora Agnes Mervin (nee Bell) was born in 1905 and died in 1943. She was, to put it mildly, a tragic figure.
She met my father Henry William Mervin (always known as Harry) at the Civil Service Sports Club at Hilsea in Portsmouth some time during the late 1920s. He was employed by the Post Office which he had joined as a telegraph boy. After service in the army during the First World War he had spent three and a half years in Egypt, working as a wireless operator at the GPO wireless station at Abu Zabal, twenty miles from Cairo. On his return to the UK Harry was posted to the Central Telegraph Office in London where he worked for three years before his marriage to Flora in 1930 at St Marks church in North End, Portsmouth. He was then 31 and she was 26.
On 31st July 1933 I was born in a nursing home in Ealing where the recently married couple had settled. Flora was unable to breast feed me and became, as a consequence, intensely distressed. Harry arrived home one evening to find his wife being looked after by a neighbour who, he said, had found her to be “ in a desperate state of depression.” He then set about removing Flora and her baby back to Portsmouth.
There she was diagnosed as suffering from puerperal insanity, now known as postpartum psychosis; this is a rare condition, occurring in 1-2 of 1000 births, or 0.1%. Flora was admitted to Portsmouth City Mental Hospital, (formerly known as Portsmouth Lunatic Asylum, and later as St. James’ Hospital) on 27th November 1933 with Harry telling the hospital that his wife had been “normal till two months after parturition. She then complained of feeling confused and not able to concentrate on anything. She had difficulty in feeding the baby then she became depressed with suicidal tendencies-remorseful seemed to think she had let her husband down.” Meanwhile her brother, my Uncle, George Balfour Bell, stated “that she had an idea that she had neglected her baby, that the baby was dead, and that she herself should throw herself in the sea.”
The above is heart rending enough, but it is nothing compared to the dreadful, agonising detail of her situation 5 1/2 years later when Dr Thomas Beaton reported that Flora’s “condition on admission was one of acute confusional psychosis. She was grossly confused, restless, hallucinated and needed every nursing care and attention. During the course of her illness the acute excitement and confusion have diminished. She remains now indolent, apathetic and disinterested. She is still vividly hallucinated and continually complains of voices which talk to her from the walls and ceiling. She is still sufficiently intelligent to realise her position, but she is liable, from time to time, to periods of violence, during which she becomes destructive. She is quite incapable of occupying herself, needs considerable attention in regards to her physical habits and cleanliness, and is essentially a patient requiring hospital care and control.”
The same doctor noted further that Flora “has been given intensive treatment, including the modern convulsion therapy, but in spite of this her condition, following the acute confusional state, has shown a progressive deterioration, and she might be described now as suffering from chronic hallucinatory psychosis with a slowly progressing secondary dementia”.
While Flora was going through these ghastly agonies I was a small child totally unaware of my mother’s existence, growing up as an evacuee in Chichester. Seemingly the lady who cared for me there had been instructed by my father to tell me that my mother had died when I was born. It came as a great shock therefore to be informed in 1943 by a fellow evacuee, with the brutal frankness that children are sometimes capable of, “Your mother just died……its in the paper.” I now know that he was referring to the bleak announcement in the Deaths column of the Portsmouth Evening News of 1st October 1943 which read “MERVIN, Flora Agnes (nee Bell) at St James’s Hospital, 27th September. Loving memories Harry, Mother, Balf.”
It is still difficult for me to believe why I did not ask for some sort of explanation for this puzzling new information from the lady looking after me, or from my father on one of his occasional visits. The fact of the matter is I suppose that at the time I was a decidedly timid 10 year old boy and from the beginning I appear to have been drawn into the disgraceful conspiracy of silence surrounding the tragedy of my mother’s life and death.
Much later, when I was nearly 40, I became aware of the circumstances surrounding my mother’s death and my father’s marriage to my stepmother. In a letter written in 1972, he reported that after Flora’s incarceration in November 1933, when he was still working in London “I came down to Portsmouth nearly every week end to visit your mother and you. For the first few weeks it seemed as though your mother might recover, but as the months went by, and she eventually failed even to recognise me, any hopes I had began to fade.” Shortly after Dad returned to Portsmouth and continued for three years to visit Flora with her condition showing no sign of improvement and it becoming increasingly evident that she would never recover.
This was surely an incredibly stressful period in my father’s life. His financial situation was desperate, there was no NHS to provide for Flora’s care and the 25 shillings per week this cost took a large chunk of his meagre salary of £5 per week. His plight was such that whilst in London he was dependent for survival on a weekly whip round by his Post Office colleagues. His finances eased when he was back in Portsmouth living with his mother, although understandably, he suffered from bouts of depression and came to dread having to visit a wife who no longer recognised him. He appears to have given up on the visits in 1936 and it was then that his relationship with Norah began and his life took a turn for the better.
The 12 page letter Dad sent me nearly four decades after these events, arose from a conversation I had with a half sister when she came with her husband to visit us in Knightcote in 1971. On that occasion, probably after a few drinks, I spoke to my her of my frustration at knowing nothing of my mother, of having no idea about what sort of person she was and my unhappiness at my father’s unwillingness to talk to me about these matters.
In that letter he begins by saying “I have always been conscious of my failure to enlighten you on the tragic events following your birth, and I have appreciated your feelings on the subject. You did on one occasion ask me one or two questions about your mother’s illness, which I answered, but nothing followed that, and I have always found it difficult to open the subject verbally - hence this letter.” I remember the occasion he refers to well, indeed my memory of that event is rather better than his. I was home for the weekend, some time in my twenties, and we went for a drink at the nearby pub. In the relaxed atmosphere of that place, I finally plucked up the courage to ask, “My mother, was she anything like me?” This was answered with a resounding “No” with Dad making it clear that no further discussion would be welcome. This bleak, fleeting exchange was the one and only occasion, throughout my life, when my father spoke to me about my mother.
Partly, of course, the fault is mine. I should have had more guts; I was just not brave enough to insist on him giving me some answers to the questions that had troubled me for so long and which trouble me even yet. What sort of woman had that beautiful young girl in her confirmation dress grown up to be? What attracted him to her? What were her interests? What were her strengths and her talents? What made her laugh and what made her cry?
It is difficult not to conclude that my mother was badly let down by her closest relations. Not only by her husband but also by her brother and her mother. Each of the latter two went to their grave without so much as speaking her name to her only child. What they effectively did was to reduce her to the status of a non person, to deny her very existence. Why did they not realise that this was a unforgivable thing to do? In that notice in the paper on her death it said “Loving memories Harry, Mother, Balf” What an awful, bitter irony given the complete failure to honour her memory by speaking about her in any way to her son. All human beings, rather pathetically, are anxious to be remembered. “We will remember them” is the refrain at remembrance ceremonies. In fact few of us will be remembered for very long, and yet for immediate family members to act as if a deceased person has not even existed, to blot out all memory of them, is to do them a terrible disservice.
In trying to understand why my father was unable to look me in the eye and to ever talk to me about my mother, I assume that it was partly due to an understandable wish to shut out of his mind dreadfully painful memories. It may also be the case that it was because he felt guilty. Not about remarrying, given the circumstances he was surely entitled to do that, but because of the unfortunate sequence of events that took place in 1943.
Five years previously the law had been changed to provide grounds for divorce other than adultery. Wilful desertion for three years or more; cruelty; and incurable insanity were now added and Dad and Norah decided to take advantage of this change. They wished to get married and now he could divorce Flora to make that possible. There duly appeared in the Portsmouth Evening News of 9th July 1943 under the headline INSANITY GROUNDS FOR DIVORCE, “A decree nisi was also granted to Henry William Mervin of St. George’s Road, Southsea against Mrs Flora Agnes Mervin on the ground of her incurable insanity. They were married at St Mark’s Church, Portsmouth in 1930 and there is one child. Since 1933 Mrs Mervin has been a patient at the City Mental Hospital.” A little less than three months after the divorce the desperately ill Flora died and a month after that the marriage took place. As my father said in his letter “it was a tragic coincidence that your Mother died during the same year”
The fact that Flora died so soon after the divorce may have instilled in my father some pangs of guilt and possibly, in retrospect, he may have also felt badly about his decision to not have me present at his wedding-an event of which I was totally unaware at the time. I have often wondered why I was excluded from that occasion. It is not as if I was a baby. I was 10 years old and my indignation at being left out increased considerably when I discovered many years later, that a cousin of almost the same age did attend. Presumably, the concern was that if I had been there it might have led to me asking some difficult questions. To put it another way, my exclusion was a major contribution to the conspiracy of silence regarding my mother amongst her relations.
Apart from any guilt no doubt the other factor that prevented my father and others from talking about Flora and her illness with me was the shame and the stigma attached in that era to having insanity in the family. To use an even uglier word she was consigned to a hospital that had just a few years previously been known as the Portsmouth Lunatic Asylum. The fact that this poor woman was insane, or was in the terminology of the time a lunatic, was apparently thought to be sufficient reason for her name to be kept out of family conversations, for her relations to blot out all memory of her and to conduct themselves as if she had never lived.
What has writing this very sad story accomplished? In a small way it has allowed me to give vent to my long felt unhappiness at the treatment of my mother. It has had, for me, a helpful cathartic effect, allowing me to come to terms with an issue which has troubled me for many years It has also brought home to me the merits of speaking frankly, of facing unpalatable truths, of getting things out in the open. Obviously there are limits to speaking frankly. Civilised behaviour requires that we do not give voice to every thought that passes through our heads irrespective of the hurt, or the offence it may cause others, but that doesn’t justify what happened in this case where secrets and lies had tragic consequences.
There is also an element of weakness in writing letters about important matters, rather than speaking about them face to face. And now here am I doing the same, putting my innermost thoughts down on paper, having failed to give voice to them when it could have counted. To add to that, I am ashamed to say, that when I had that conversation with my half sister that led to Dad’s letter I cravenly asked her not to tell him what I had said, for fear of upsetting him- an injunction she evidently ignored. Similarly, on an earlier occasion, I said much the same to an aunt in talking about these matters, in the wake of a drink or two, at a wedding. She subsequently sent me a short letter with a few words that I have treasured ever since “Your Mother was pretty, gay and very intelligent.” At last some one had told me just a little of the woman who brought me into the world and whose awful, indescribably unbearable illness had come about as the result of my birth.
My father was a decent, kindly man who had a hard life, and he endured horrors and privations of a sort that have never befallen me. He did however find it difficult to face up to his responsibility to the poor damaged Flora. He is not alone in that of course, both her mother and her brother should have done more to honour and preserve her memory. And then there is my own culpability. On more than a few occasions, I shrank from confronting my father: I lacked the guts in other words, to demand the answers that I so sorely needed. Finally, this unhappy story does nothing to restore in me any sort of religious belief. Why would a supposedly merciful God allow an innocent young woman to suffer ten long years of torment followed by the obliteration of all memory of her having lived?
David and his son John, Flora's grandsonJohn's children Lizzie and Charlotte, Flora's great granddaughters
David's daughter Alice and her children Rachel and Jack, Flora's great grandchildren
Holly Hawood is running the Thames Meander Marathon on Saturday 5th November.
Her sister, Beth, experienced PP after the birth of her son, Leo and this is just the first in a series of 12 marathons she intends to run over the next year to raise money for APP.
You can read more about her story and donate to encourage this incredible effort over at her JustGiving page. In the meantime, Holly emailed us with a pre-race update:
"I have attached a photo of my first training run with my fabulous running partner Alaska. She is my cheerleader on my long distance training runs, and even at crawling pace when I'm on mile 17 of 18 she will give me that little helpful pull up the final hill!
Alaska is 3 and I've been running with her since she was a year old. She's helped me train for 10K and half marathon races in the past, and knowing that she needs to stretch her legs encourages me to put my kit on and go!
On Saturday I embark on Marathon 1 of 12. 5th of November, a poignant date for me as it is my nephew Leo's 3rd birthday. My sister has now fully recovered from her PPP after Leo's birth and they are celebrating his birthday in Disneyland Paris.
I will be thinking of her every step of my marathon journey and be thankful that she had the amazing support she did. Without that support I know things would have been different."
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.
Congratulations to APP Peer Support Coordinator, Ellie Ware, who has been appointed to the Executive Group of the Sussex Perinatal Mental Health Clinical Network.
Fantastic recognition for the good work APP does!
A big thank you to the staff from the 
