Helping new mothers when they are ‘losing their mind’

There is a page on Kathryn Grant’s Bumps and Grind blog that says “New Motherhood Was Not How I Imagined”.

That is an understatement. Because interspersed between wonderful pictures of barbecues, her wedding pictures and her gorgeous son James, Kathryn weaves in the story of her postpartum psychosis. A condition that hit her at the birth of her son and which left her (in her words) “losing my mind”.

We meet in a south London café.  Her son James, now 19 months, plays between the tables, diverted occasionally by a passing lorry, which he excitedly points out to his mother.

Kathryn is a tall, warm, vivacious 33-year-old. Who can ever tell, but to the onlooker she seems a calm and happy mother. Once an economist and management consultant, now – as the blog puts it – a stay-at-home mum.

She is more than that, though.  Because she has “come out”, which seems the only way to describe the psychosis and the impact of this mental illness on her and her family. She is also  a trustee for PANDAS (Pre and Postnatal Depression Advice and Support) and spends time touring the country to raise awareness of the condition.

And she is talking now because Healthwatch England is gathering evidence for its special inquiry into unsafe discharge from NHS hospitals, nursing and care homes, or secure institutions like prisons and mental health units.

They have already looked at what is happening with homeless people (see previous blog) and now it is patients with mental health conditions, including maternal depression and psychosis, and whether or not they are receiving the support they need.

Nobody really knows what causes these conditions, but about 10 to 15 per cent of the maternity population will suffer a significant postnatal depression – that can mean more than 100,000 women in one year – and about one per 500 deliveries result in postnatal psychosis. It can affect any woman, but if left undiagnosed or untreated it can have the most terrible consequences.

Indeed, we have all seen the headlines: “mother kills baby” or kills herself and her children. It does not happen often but when it does it is unbearably heartrending.

This, of course, is not what happened to Kathryn Grant. Yet hanging over any conversation with a mother who has had suffered from this is always that thought of what if? What if it had not been caught in time? What if the treatment hadn’t worked? What if she had not got better?

‘I didn’t know who I was’

Kathryn’s story does follow a similar pattern to other women we have spoken to. A bad labour, ending in an emergency caesarean section, during which she lost a lot of blood. She also developed an infection.

Twenty-four hours after James was born,  her husband was called back to the hospital because she had fallen into a catatonic state.

She recalls thinking she had lost her mind. “I thought my stomach was exploding,” she says.  “I didn’t know who I was or who James was.

“It was very dark, very frightening.” She recalls at one point “seeing” the medical team pulling the curtain around her bed because she had died and they wanted to protect the other patients from the sight.

A perinatal psychiatrist was on duty and he recognised immediately what was happening. For 12 hours she drifted in and out of the psychosis.

But – and this is where the unsafe discharge comes in – once she seemed better and the course of antibiotics had finished, she was sent home. She says now it was not solely the fault of the hospital. She and her family had been keen to go home, too, to begin their new life with their new baby.

“At the time we were putting it down to the traumatic birth and the infection,” she said.

Within 48 hours, though, the psychosis came back and she was taken to A&E. From there she was sent to the South London and Maudsley NHS Foundation Trust mother and baby unit at the Royal Bethlem Hospital.

Preparing to have a baby

Helping the inquiry to gather evidence from mental health patients, is Ann Beales. She has had depression and psychosis, although not caused by childbirth. Indeed, she took the decision not to have a baby because of the medication she was taking.

And she introduced us to Hannah Dunstan. Hannah, whose son Samuel is now four, has bipolar disorder. When she and her husband Tex decided to have a baby, she talked to her mental health team about it, she prepared carefully, and all was fine. At least with her mental health.

But this is a story of a discharge from an NHS hospital going wrong because she was kept in for too long. It took 17 days, and both the Dunstans firmly believe it was because the maternity unit did not quite know what to do with her.

“There was almost a prejudice and assumption that I couldn’t look after Samuel,” Hannah says. “First of all it was my sleeping, then it was my breastfeeding, then it was because my blood pressure went up, which always happens when I am kept inside for too long without fresh air.”

In the end “it fizzled out”, they said, and the family were able to come home. Ann Beales asked if perhaps a simple recommendation to come out of the Healthwatch England inquiry might be ensuring patients know their rights.

Place of safety

But this is not just about poor examples of discharge. Because sometimes it works extremely well.

Like at the Bethlem Hospital in south London. It is a 13-bed mother and baby unit specifically for women with mental health conditions like severe depression or postpartum psychosis.

The average stay here is about three months. It is, said all the women we spoke to, a place of safety. Somewhere where they do not feel frightened and alone, where they can be helped bond with their child and grow back the confidence to be the mother they want to be.

We spoke to Kate Webb, who came back to the unit to talk about her stay. Kate began feeling anxious about three months after the birth of Joseph. By five months it had become signficantly worse and she was given antidepressants.  Eventually, when Joe was eight months old, she was admitted to the unit.

“I was finding it hard to function on a day to day basis,” she told us. “Things that had seemed so easy and normal had become mountains to climb. Keeping enough food in the house, thinking about preparing meals, looking after Joe.

“Everything was just overwhelming and I didn’t feel safe to be on my own. I got to the point where I got so bad that I worried I would harm myself but also that I would harm Joseph which is apparently very common and very scary.”

And Kate also said this, which is crucial to the way these units: “Essentially I needed to be in hospital, and if I was going to be in hospital I needed to be with Joe. Postnatal depression is not just about you. When one has another person to care for, that is when the balance changes.”

Indeed, Rupa Kamat Platjouw, who also spent time here with her baby, Leonardo, said it was for her family and for her babies that she asked to be admitted.  Her depression was so bad she did not ever feel she would get better but she wanted support for her family.

Gradual discharge

This inquiry is, of course, not so much about what the mother and baby unit does, though it is clear they do it well. Both women talked about being given time to do something else like gardening or swimming. This meant time away from obsessing about their abilities as mothers or their fears for themselves, their minds and their babies.

Kate had become desperately concerned that she did not know how to play with Joseph, so the unit was able to video her and play back the footage of her and Joe in which they were bonding wonderfully.

And when it came to discharge, it was how it should be. Gradual and with help both from the unit and in the community. The mothers are sent home for a couple of hours at first, building up to a night and then to a weekend and then… home.

One issue the inquiry will have to consider, though, is that there are not enough of these units. Two have closed in the past year and there are large swathes of the country where there are none at all.

Trudi Seveviratne, a consultant perinatal psychiatrist at the Bethlem unit, said the most recent estimates are that there are 120 too few beds. And because they are a national unit, mothers come to them from as far away as Devon.

“It is not ideal because they want to be near their families and near home,” she said. “And this can mean some women choosing not to do this which means they are relying on support in the community.”

There again, not every area has a perinatal mental health team, and the general mental health teams, Dr Seveviratne says, do not have the expertise that mothers and babies need.

Yet, she adds, not to treat mothers is devastating. “Criminal, I would say. Because at the severe end of the spectrum it may mean a mother killing herself, which is much more common that infanticide, with the mother killing her baby. And at the other end it can mean mothers not getting well for years.”

Useful organisations:
– Pandas
– Action on Postpartum Psycholsis

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