Tag Archives: postpartum psychosis

A day in the life of…a Peer Support Facilitator

Natalie Thompson has worked with APP since 2019 and is based in our Birmingham and Solihull peer support team. Having experienced PP twice herself in 2003 and 2007, and later being diagnosed with bipolar disorder in 2010, Natalie helps support women and families affected by PP (or other illnesses featuring manic or psychotic symptoms). After treatment in an acute psychiatric ward and fantastic care at the Birmingham Mother and Baby Unit (MBU), Natalie knows how challenging it can be to settle back into everyday life.

Here, she shares a typical day in the life of her role with APP.

09:00

I always start the day with a cup of tea (never coffee!) to wake me up. Steaming hot brew at the ready, I’ll open up my laptop, check my emails to see if there’s anything urgent I need to respond to, and then I’ll make a plan for the day. I also have a paper diary to cross reference with to make sure I don’t miss anything – I haven’t quite managed to go entirely paperless yet!

09:30

Armed with another cup of tea, I’ll call the women on my caseload to check in and see how things are. In normal times, this might be a face to face chat but during the pandemic we have tried to stay in touch by phone or zoom meetings. I know from personal experience that chatting to someone who has been through what you have is such a big help and makes you feel less alone in your recovery (which also helps to speed up recovery). From these calls I’ll write up my notes to make sure I am able to reflect on any areas I need to follow up on.

11:00

To end the morning, I might refresh my skills by taking part in training and shared learning. Sometimes this will be provided by the brilliant team at APP, but, as a partner of the local NHS Trust, we are also able to access NHS training and development too. It’s always good to keep learning and hearing best practice and I feel lucky that this is something APP is so supportive of.

12:30

Time for a lunch break. One of the perks of working from home during the pandemic is that my husband always makes our lunch which gives me more time to simply switch off for a break. He usually prepares nice healthy meals – but always tends to over do it with the mayo! (Not that I’m complaining!)

13:30

After lunch, I might attend an MDT meeting (multi disciplinary team meeting – one of the by-products of working in health is the number of acronyms you become accustomed to!). This might be attended by clinicians, nursery nurses etc.... and some of the issues we might address could include women on the high risk pathway and admissions to the MBU. Next up – it’s finally time for my one and only cup of coffee of the day! If I have any more than one I'd be bouncing off the walls!

14:30

Next I’ll make sure I get moving and get some fresh air by doing a socially distanced walk with one of the women on my caseload who is recovering from PP. These ‘walk and talk’ peer support meetings have been great during lockdown – especially for women who feel anxious leaving the house alone and those who don’t have a great social network. Getting out is difficult for new mums as it is, but even more so when you’re recovering from severe mental illness – and we know that exercise and fresh air both contribute to wellness so it’s a win-win.

15:30

Next, I might prepare for the APP café group – a session where several women get together to share their experiences or just to socialise with others who have been through similar experiences. When restrictions allow, these are all done in a physical space, so I’ll check out the venue, make sure they have good facilities and space, etc. Then, I’ll email participants a little reminder or, where outdoor café groups take place, check on the dreaded weather!

16:30

Time to clock off. That’s the great thing about working for a charity that’s committed to mums and babies spending time together – they like to ensure your work doesn’t eat too much into your family time! So even when I work from home I’m pretty strict about clocking off at the end of my shift and joining my family for a relaxing evening.

To find out more about current APP peer support job vacancies, click here.

 

 

 

 

NHS partnership increases peer support across Black Country for mothers experiencing postpartum psychosis

Black Country Healthcare NHS Foundation Trust is partnering with national charity Action on Postpartum Psychosis (APP) to expand specialist peer support services across the region.

Recruitment is currently underway for a dedicated peer support facilitator to work with mothers based in the Black Country who have experienced postpartum psychosis – a severe postnatal mental illness. The service will be managed by APP in conjunction with the Trust, to support women on their road to recovery.

Postpartum psychosis is a debilitating postnatal mental illness that can occur out of the blue. New mums with postpartum psychosis may develop high or low mood, or fluctuate between them, alongside delusions, hallucinations or severe confusion. Many of these mothers have had no previous mental health diagnosis prior to onset – although women with bipolar disorder are at higher risk. It affects around 1400 women and their families every year in the UK and is always a medical emergency. However, it is eminently treatable and most women go on to make a full recovery with the right support.

Dr Jess Heron, CEO, Action on Postpartum Psychosis, said: “We currently run a number of successful peer support services across the country commissioned by the NHS, including one in partnership with nearby Birmingham and Solihull Mental Health Trust. In combining this type of peer support with the necessary clinical care required we can ensure that women receive a truly holistic, sustained and specialist treatment. It can be daunting leaving hospital after experiencing something as confusing and frightening as postpartum psychosis, so making this additional support available within the community is invaluable for ongoing recovery. Being able to support women and families at this critical stage is key to reducing the trauma, giving hope, and helping women and families feel less alone as they navigate the recovery process.”

Hannah Bissett, National Co-ordinator (NHS Contracts & Regional Projects), Action on Postpartum Psychosis, said: “As a woman who has personally experienced postpartum psychosis I know how isolating and afraid it can make you feel. Peer support is a vital piece of the recovery jigsaw and we now have over 2,800 lived experience users sharing their stories and receiving support from trained volunteers as part of our national peer support forum.

“Having somebody there for you who knows exactly what you’re going through and who can inspire hope will undoubtedly bring a sense of relief and reassurance to women in the region who may find themselves experiencing postpartum psychosis. We’re delighted to be partnering with Black Country Healthcare on this project and I’m looking forward to hearing from applicants with lived experience interested in the peer support role.”

APP already delivers successful and award-winning peer support services working in partnership with NHS Trusts around the UK, as well as managing a thriving online national peer support forum. The charity also provides peer support for partners of women who are experiencing or have experienced postpartum psychosis.

To find out more about the Peer Supporter role, visit www.app-network.org/jobs

 

 

Lobeh’ s story – It wasn’t until I had my fourth child that I experienced postpartum psychosis

 My first experience of psychosis was back in 2009. I was in my last year of university and really struggling with the pressure of studying, my placement and writing up my dissertation. I stopped sleeping for several consecutive days and I just couldn’t shut my brain down.

I was talking really quickly, and became quite aggressive and reactive, shouting in the workplace because I believed people – and even at one stage a cloud – were following me. It wasn’t long before I was sectioned.

It turned out I had experienced a psychotic episode and I was eventually diagnosed with bipolar disorder. I had treatment and psychotherapy and, for many years, I was fit and well.

I met my husband in 2012 after I’d qualified in my profession. Everything was going really well, we married had our first child, then our second, and I was still really well.

When I had my third child there were some indications that my mood was changing and that I was going through some hormone imbalances, but I didn’t experience another psychotic episode until after I had my fourth child in 2018 – nine years after my previous episode of psychosis.

Because of my bipolar disorder, I always knew I was high risk for postpartum psychosis. However, having had three children with no problems, I really wasn’t expecting it to happen. Sadly, though, there were lots of complications and trauma around the birth of my fourth child and I ended up having an elective c-section.

When my baby daughter was born she wasn’t breathing and needed resuscitation which meant that we had no body contact as she was immediately rushed off to intensive care. I was fit and well at the time so was officially discharged but I didn’t want to leave my baby so they allowed me to stay. Within two weeks we were discharged together.

The problems didn’t end there, however, and after a few days at home I experienced fits and, as these were markers for an infection, I was rushed back to hospital where I had to undergo more surgery. They found that some of my placenta had been left inside which had caused the problems.

Once the physical risks had subsided I returned home. This is when the symptoms of postpartum psychosis hit me.

Three days after coming home I started erratically gathering items from the home to sell at a car boot sale – I felt compelled to do it, even though I had just come home with my baby. My attention was so often diverted away from my baby and, as a result, I wasn’t caring for her properly. Sadly, I had lost all sense of reality and I didn’t really understand what was happening or what I was supposed to be doing.

I believed that people were trying to take my baby away, I was driving around disorientated for hours with no idea why and constantly collecting these items to sell. Every day it was as though I woke up on a mission, it was as though something else had control of my mind. I was completely confused, lost all inhibitions, was over thinking and over talking. I would find myself in places or doing things with no idea how I had got there.

My husband tried to support me and he sought medical help and spoke with other members of the family. But the problem was, it’s hard to detect postpartum psychosis because how can you know what is normal behaviour after having a baby? It’s only when it becomes really erratic that it becomes more apparent – and at that stage you always need emergency care.

Eventually, having travelled out of my area and being filed as a missing person I was found in an apartment and sectioned.

Why MBUs are so important

I was brought straight to a hospital, however, there weren’t enough beds in nearby Mother and Baby Units (MBU) so I ended up on a general psychiatric ward and separated from my baby. Unfortunately, when you’re separated from your child this can really trigger more paranoia and make things worse.

I was also really scared on the ward which I don’t feel was managed very well and I had a particularly difficult time there. I had just had two major surgeries and some of the women on the ward were incredibly unwell. I got into a disagreement and I remember being kicked and punched. I was found unconscious and sent to A&E.

After I had been on the ward for a month a bed in a Mother and Baby Unit came up, but it was so many miles away from my home and family. MBUs are imperative for the safety and welfare of women who have just had children, and if I had been offered a place closer to home I would have accepted. But as this was so far away I petitioned through a tribunal to instead be discharged.

When you’re separated from your child this can really trigger more paranoia and make things worse

How I found recovery

Every woman has a different experience when it comes to treatment and recovery. In my case, I received antipsychotic medication to alleviate some of the psychosis and then, as I started to come round from the confusion, I started talking therapy to explore how I felt and what had happened. It enabled me to talk about the trauma of the birth which had obviously affected me greatly.

Because I wasn’t with my baby I missed out on some of the bonding time during my recovery so lost my confidence as a mother which was really hard. I also fell into a depression which was really challenging too. Recovery is gradual, and having the therapy and my family and friends around me helped a lot – as did my faith.

I also found lots of help through APP. When I first Googled postpartum psychosis and APP came up in the search, I felt as though I was the only woman in the world going through this. But when I was introduced to the peer support forum I realised that there were many women who had experienced this illness. I joined the monthly meet ups and it was fantastic being able to support and be supported by other women. I am especially pleased that APP is proactively encouraging engagement from BAME communities because mental health is such a taboo subject in some of our communities, so having more knowledge, awareness and engagement is key.

And that’s why I’m sharing my story today. I hope it inspires other women to feel confident in coming forward and asking for help.

BACK TO STORIES

New play shines humorous light into the darkest corners of motherhood

 

after birth, written by Zena Forster and directed by Grace Duggan, is a new comedy deeply rooted in the real life testimonies of women who have experienced postpartum psychosis, including many women within the APP network.

The play is being brought to life by Maiden Moor Productions and will open on Monday 10 June at the North Wall Arts Centre in Oxford. Imaginatively staged, with elements of stand-up and a dynamic original sound score, after birth takes us on a journey of recovery.

The story revolves around holiday camp entertainer Ann, who, alongside the Virgin Mary, has been detained without trial on a medieval plague island in the middle of the Venetian Lagoon.  Buffoonish and malevolent by turns, their doctors are intent on curing them of their heinous crime - Being A Bad Mum.   This is the world of Ann’s mind.  after birth’s protagonist is experiencing postpartum psychosis after the birth of her baby.

The lead character’s experiences might be extreme, but they are recognisable and relatable: what mother hasn’t felt judged, or been demoralised by the myth of the perfect mum?

Playwright Zena Forster said; “Just as the women I interviewed didn’t want to be defined by their illness, after birth isn’t a play about psychosis, it’s a play about a tough, witty woman who happens to have psychosis.  The women I interviewed were amazing – courageous, inspirational and often very funny, it was natural that my protagonist was like that too.”

Grace Duggan, Director said, “Zena has created this incredibly detailed and responsive play about the realities of postpartum psychosis.  after birth doesn’t hold its tongue, it doesn’t shield us from the truth, and it doesn’t stop us from awkwardly laughing with a psychotic mother. We want people to start talking about postpartum psychosis and continue the discussion about the pressure of motherhood. Through our characters and with this story we hope to expose it all and have a laugh along the way.”

after birth grew out of collaboration between Zena Forster and researchers at the National Perinatal Epidemiology Unit (NPEU), Oxford University. For 40 years the NPEU has been the ‘go to’ international centre of research into women’s physical and mental health.  Their annual reports have consistently shown that in the UK suicide stubbornly remains the leading direct cause of maternal death between six weeks and one year after birth, with women from ethnically diverse communities disproportionately affected. The NPEU were keen to find new ways of disseminating their findings with a view to effecting change.

Zena interviewed many women with lived experience of postpartum psychosis, travelling miles around the country to do so. Both Zena and director Grace Duggan dramaturged the piece extensively, developing it significantly for performance in 2021. after birth was awarded the Propeller 2020 opportunity by North Wall, Oxford which includes three performance dates 10, 11, 12 June 2021. A film of the staged performance is also being made and the NPEU are undertaking further research of how this filmed performance could be used in both therapeutic settings and in health professional education.

The time has never been riper for a recovery story. after birth is an opposite celebration of resilience in the face of inequality and adversity. There is a growing need and appetite for work that explores the disadvantages that women face in our unequal, patriarchal society.  Between eight and nine out of ten women in the UK will become mothers. The pandemic has exposed and heightened the inequalities they face.  More and more evidence is emerging that maternal mental health has suffered over the last year, with black and brown mums disproportionately affected. after birth creates a timely space for us to talk about these pressing issues.

As an international centre for research into women’s health and as a vibrant creative hub, Oxford was the perfect place for this play to be developed. Oxford’s North Wall has long been committed to nurturing creative talent – Alice Vilanculo (actor), Will Alder (sound design), Grace Duggan (director) all received early career support through the theatre’s various development programmes and are delighted to be back in Oxford as established artists.  Likewise, Oxfordshire Theatre Makers (OTM) and Arts at the Old Fire Station provided backing and opportunities to develop and promote the play.  Oxford’s supportive city council provided important early seed funding.  Oxford colleges have helped with funding too. after birth’s playwright Zena Forster is based in Oxford, as is Bafta award winning film maker Jo Eliot who will be filming the performance.

Commenting on  after birth, Professor  Rachel Rowe, Senior Health Services Researcher, National Perinatal Epidemiology Unit said “through after birth we hope to engage audiences with research evidence about maternal mental health, to raise awareness, reduce stigma, encourage discussion and ultimately improve care and outcomes for women affected by postnatal mental illness. The play promotes some key public health messages about postnatal mental health, but importantly it’s also funny and full of hope – it should be a really good night out.”

To book tickets, click here

Only Mother and Baby Unit of its kind in Wales to open in Swansea Bay

A new unit has been set up to help women in Wales who experience serious mental health problems during pregnancy and following the birth of their child.

Uned Gobaith (‘Unit of Hope’) will be the only inpatient unit of its kind in Wales to offer multidisciplinary mental health care to women from 32 weeks of pregnancy until their baby is one year old.

Until now, mothers who needed serious mental health care have either been supported in the community, admitted to acute mental health wards without their babies, or have had to travel to one of the specialist mother and baby units in England.

At present, the closest unit for women living in the Swansea Bay UHB area is in Bristol.

Based at Tonna Hospital, near Neath, the new unit is designed to be a home away from home where mums will have access to specialist care for themselves and their babies.

It has six individual bedrooms for women and their little ones. Mums who are admitted will also have access to a shared living room and kitchen areas along with a playroom, quiet room and sensory room.

In addition, accommodation will be available for family members travelling from further away to visit their loved ones.

Supporting the mothers and their babies on site will be a multidisciplinary team that includes psychologists, mental health nurses and psychiatrists, as well as social workers, health visitors and midwives.

Nursery nurses will be on hand around the clock too, to look after babies while mothers rest or receive treatment.

Uned Gobaith was commissioned by the Welsh Health Specialised Services Committee, and made possible thanks to Welsh Government funding and support from mental health specialists in community and inpatient care.

A patient and service user group also gave crucial feedback during the development process, and chose the unit’s name.

Dr Jess Heron, CEO, Action on Postpartum Psychosis (APP), added “APP’s staff and lived experience volunteers in Wales have been campaigning for this unit for several years, and we have worked closely with the MBU development group to ensure that the voices of women with Lived Experience have shaped all aspects of the design of the new unit. Today’s news is testament to the power of positive collaboration, shared experiences and person-centred approaches to care.”

Toni Evans, 34, from Port Talbot, experienced serious mental health problems during and after her second pregnancy. Now a member of the patient group, she believes a local unit like Uned Gobaith would have made a huge difference to her treatment and recovery.

“It just got worse and worse as the pregnancy went on,” Toni said.

“The depression just got unbearable. I remember ringing my husband on the way to work one day saying that I was going to drive into a wall because I just needed help. Obviously I didn’t, but I just wanted to get out of it.

“Once the baby was born, I started medication straight away, but within two weeks my mental health deteriorated even further.”

Toni was seen by a mental health crisis team and, with the support of her “amazing” midwife, she was admitted to an acute mental health ward.

This type of ward has no facilities for babies or small children so Toni spent three days away from Sarah while she was assessed.

While she was in hospital, a member of the Perinatal Response and Management Service (PRAMS) team (which works with women at risk of developing mental health problems during pregnancy and after birth) told Toni a space was available at a specialist mother and baby mental health unit in Derby.

“At this point I couldn’t really think, I couldn’t answer questions so my husband had to say yes for me,” Toni said.

Toni and Sarah made the daunting 180-mile journey with two chaperones and a driver she had not met before. Arriving at 8pm, she struggled to get her bearings properly in a completely unfamiliar place.

“When we finally got to the unit, I didn’t want the chaperones to leave – they were part of home, they were Welsh, they were from where I’m from,” Toni said.

“I was being left in England, in a different country to where my family was.”

While Toni did make good progress in the seven weeks she was at the unit, the distance between her and Sarah in Derby, and her husband and son at home in South Wales was very hard for them all.

“My husband would come and visit but it had to be every other weekend because he had to take time off work and take my son out of school,” Toni said.

“And it cost a lot of money, driving up there and staying in a hotel.”

If there had been a unit closer to home, Toni believes it would have made a real difference to her family, her recovery and her transition back to home life.

“The people that I was in the unit with were local so they would have visitors a few times a week. I really was on my own up there,” she added.

The distance also meant that Toni went through a different going home process. While other patients would get to go back to their families for a few hours at a time before building up to overnight stays or weekends, Toni travelled to Port Talbot for week-long stays.

She had the support of local mental health specialists but it was hard for her to drop back into home life again.

“That was a difficult transition to go from being in the unit where you are so incubated and then back into the big wide world for a week with the baby and your family and everyday life,” Toni said.

“Some mums would go home for a little bit and it would be too much but they could go back to the unit.

“I didn’t have that choice. I had to travel four hours home and then if I didn’t like it, I’d have to go four hours back.

“It was just more pressure. I didn’t want to make my husband do that trip unnecessarily when he was doing it on weekends. It felt like I should suck it up and get on with it at home.

“It made a big difference to my recovery.”

After seven weeks of support and mental health treatment at the unit in Derby, Toni and Sarah made the journey home for a final time.

That was not the end of Toni’s mental health journey, however. When Sarah was six months old, Toni had a manic episode and went back into hospital for four weeks.

But this time there were no beds available in any mother and baby unit, so Toni was taken to a mixed acute mental health ward - without Sarah.

Toni has since been diagnosed as bipolar and is taking positive steps forward in her mental health journey.

But she feels that if she had been able to go to a unit closer to home, her experience of inpatient treatment would have been “completely different” – and is vital for other mothers’ recovery.

“I think it would have been a lot smoother and I wouldn’t have felt so isolated there. I was missing my son – at the time he was four years old – and my husband.

“I felt like I had taken the baby away from them because they weren’t able to visit,” Toni said.

“A unit here is just going to make an unbelievable difference for mothers in Wales. It definitely would have made a difference to me.”

Uned Gobaith is due to open in mid-April and will be accepting mothers and babies for treatment immediately.

Janet Williams, Associate Service Director of Mental Health and Learning Disabilities at Swansea Bay University Health Board, has been part of the team leading the unit’s development.

Janet said, “When Uned Gobaith opens, we will be able to help women like Toni who are experiencing serious mental health problems, and their babies, in a safe environment much closer to home.

“This important service will significantly enhance perinatal care services across Wales and we are very proud to be hosting it in Swansea Bay University Health Board.

“It will be the only mother and baby unit of its kind in Wales, and its development has only been possible with support from a wide range of experts, teams and patients across the country.”

Minister for Mental Health and Wellbeing, Eluned Morgan, said: “It is fantastic news that we have our own perinatal mother and baby unit in Wales to support those struggling with their mental health.

“This will make a significant difference to the experience of new mothers as they will be able to get the specialist support that they and their babies need closer to home.

“We all know that the pandemic restrictions have added to the challenges during this last year and so I welcome the addition of this facility which will complement our strengthened perinatal community offer.”

Sharon Fernandez, National Clinical Lead for Perinatal Mental Health, said: “The opening of Uned Gobaith is a huge step forward for the treatment of pregnant women and new mothers experiencing severe mental distress.

“Providing this kind of specialised mental and emotional support for women at one of the most vulnerable times in their life is essential, and the family-friendly environment Uned Gobaith offers means that partners and older children can be involved and get the support they need too.

“As a network, we were very pleased to play a role in the development of Uned Gobaith.

“Its opening is a tribute to the hard work and commitment of everyone involved, especially the many women who shared their own personal experiences of perinatal mental health difficulties in order to improve services for others.”

 

Q and A with Hollyoaks’ Jessamy Stoddart

We chatted to Jessamy Stoddart who plays Liberty in Hollyoaks to reflect on what she’s learnt about postpartum psychosis (PP), and how APP helped Jessamy create an authentic and powerful performance of a woman experiencing PP.

First of all, for any readers who haven’t seen Hollyoaks, can you tell us a bit about Liberty’s storyline?

So... Liberty was carrying a baby for her sister. The birth was sudden and traumatic, and she lost a lot of blood. After this, during her physical recovery she started hallucinating and confiding in a nurse that wasn’t actually there. From this point on, it was clear she was suffering from postpartum psychosis, however it went unnoticed for quite some time. She has now received help and is very much on the mend.

When the Hollyoaks team first discussed PP with you, what, if anything, did you know about the illness and how did you feel about the storyline?

Being completely truthful, I had never come across postpartum psychosis before. Like many, I knew of people who had experienced postnatal depression, but psychosis was completely new to me. When researching I was shocked at the effects PP had on the mothers and those around them. I was honoured to tackle such an important storyline.

You took part in a Zoom session with staff and women with experience of PP. How did this support you in developing your portrayal?

This Zoom call was invaluable to my process. Hearing stories first hand, as well as talking to partners and health care professionals gave me such great insight. It also gave me a comfort blanket, knowing if I had any questions I could always speak to someone from the charity.

 

 

 

 


Did you learn anything new from speaking directly with women who have experienced PP? How did it add to the research that you did for the role?

Absolutely. It was so great to speak to incredible women who have come out the other side, who could really give me insight into what was going through their mind at the time. I had watched many documentaries but this really added to the research from a recovery perspective. It was amazing to speak to healthcare professionals too, to see what they would consider were the physical attributes of those who are suffering - I put a lot of this physicality into my character. I also found speaking to the partners of those going through PP so very interesting. They are smack bang in the middle of the symptoms often before it’s been diagnosed. So it’s a very traumatic experience for them – something that I’d never really considered.

Why do you think it’s important for soaps to tackle storylines like this?

Knowledge is power. If tackling this storyline helps even one person to recognise the symptoms early on, then we’ve done our job!

Finally, what’s next for Liberty?

Recovery and getting her ‘sparkle’ back! I’d also love to finish by saying a huge thank you to everyone at APP. The work you do is truly incredible!

Anybody who would like to become part of the APP network can sign up here.

You can also keep up to date with what we’re doing on Twitter, Facebook and Instagram.

Postpartum Psychosis & Menopause on BBC Radio 4 Woman's Hour

p0440gttProfessor Ian Jones and Val from APP discuss PP and menopausal relapse with Jenni Murray on today's Woman's Hour on BBC Radio 4. Listen again here on iPlayer.

The long-term outlook after an episode of PP tends to be very good and women recover fully. However, some women who have had PP will have further episodes of illness unrelated to childbirth.

Just over half of women with Postpartum Psychosis will experience an episode of depression, bipolar disorder or related illness at some point in their lifetime. (This estimate includes women with and without experience of mental illness before their PP episode, and so the risk may be lower for women whose PP episode was ‘out of the blue’.) For more information see our research on recurrence rates or view to our survey of recovery in APP members.

It has been suggested that some women who experience PP may be vulnerable to relapse at times of major hormonal fluctuation, such as during the perimenopause (the time from the onset of menopausal symptoms, such as hot flushes and irregular periods, until the menopause itself).  

A case series review of post-menopausal women with a history of PP, found that 30% reported an episode of illness (including depression or mania/psychosis) during the perimenopause. Strikingly, most women who relapsed during the perimenopause had been well during the years in between childbirth and the menopause. Further studies are needed to explore this potential risk period more fully and identify which women might be at risk of perimenopausal relapse. Women, their partners and families should be vigilant for signs of relapse during the perimenopause and seek help from their GP or mental health team should symptoms develop. For more information about relapse planning, see page 14 of our Insider Guide on Recovery after PP

APP is here to support women and families who suffer illness episodes following their PP, no matter how many years have elapsed since the PP episode. If you would like to talk to others with similar experiences and concerns, please visit our peer support forum or request email support. We are campaigning and conducting research to improve understanding of this illness. If you would like to help us, or to find out more about current studies, please get in touch.