Maternal mental health: Calls for specialist unit in Northern Ireland

BBC News

2 days ago

A new mother who was detained in a psychiatric hospital for five weeks says she "felt like a prisoner" because she was separated from her baby.Shelley Browne, who had postpartum psychosis, was admitted under a mental health order after giving birth three years ago.In Great Britain mothers are cared for in specialist mother and baby units, but women in Northern Ireland are admitted to general psychiatric wards, separated from their babies.The business case for a mother and baby unit is months overdue, but the Department of Health (DoH) said it was well developed.
However, it has also warned any future unit is dependent on funding being identified.Shelley told BBC Spotlight she felt "lonely" and "pathetic" after being dropped off at the door of the Ulster Hospital psychiatric ward without her daughter, but said staff tried their best."I went in voluntarily and it was just the loneliest feeling in the world getting dropped off at a mental health ward with a bag and no baby," the 35-year-old said.Each year, about 100 women in Northern Ireland are admitted to adult psychiatric wards for similar care, without their babies.
What is postpartum psychosis?
A rare but serious mental health illness that can affect any motherSymptoms can include hallucinations, delusions, manic and low moods, loss of inhibitions, restlessness, out-of-character behaviour and confusionIf left untreated the condition can get rapidly worse and lead to mothers harming the baby, themselves or othersThe most severe symptoms usually last between two and 12 weeks but recovery can take several monthsSOURCE: NHS
"I was a mother without her child and I felt like a prisoner," said Shelley."She wasn't with me, and I was in a mental facility. And it just broke me every morning."Seven health ministers have supported the idea of a mother and baby unit in Northern Ireland, but funding has never been found.
Danielle Sands refused hospital treatment to stay with her first son, Joe, in 2022.Instead she relied on specialist community teams."They had made it very clear that when I would go in there, I wouldn't have my Joe with me.""There was voices in my head 24/7, and they were negative," she said."Telling me everything I couldn't do, I wasn't good enough."
Danielle and her partner, Nial, were supported by a community specialist perinatal mental health nurse.The term perinatal covers the period of time from when a woman becomes pregnant, and up to a year after giving birth.
Each of Northern Ireland's five health trusts receive more than 250 referrals for the community services each year, but because of staffing pressures they can only accept about 70 patients at a time.Dr Julie Anderson, chair of the Royal College of Psychiatrists in Northern Ireland, estimates the number of women admitted to hospital could double or triple if a mother and baby unit was established."It's really, really frustrating knowing that there's much better care that our mums should be getting here in Northern Ireland," she said."And frankly, to be honest, somewhat embarrassing that we've been talking about this for almost 20 years and we're still not there yet."
In 2018, Orlaith Quinn died at the Royal Jubilee Maternity Hospital in Belfast.The 33-year-old had given birth to her third child, a daughter, less than 48 hours earlier.Siobhan Graham said her daughter began showing signs of postpartum psychosis shortly after giving birth."To go in and have a baby and come back out in a coffin, and you've three children left without their mother, it's just not a position you think you'll ever find yourself in a million years," she said.Orlaith's body was found in a part of the hospital that is unused at night. She had taken her own life.
A 2022 inquest concluded Orlaith's death had been "foreseeable and preventable" and that there were a number of missed opportunities in her care and treatment.In a statement, the Belfast Health Trust said it would like to extend a sincere and unreserved apology to Orlaith's family.It added its maternity team would like the opportunity to meet Orlaith's family to offer an apology in person.The trust said it was committed to learning from Orlaith's death and had put in place a training programme to help staff recognise the wider spectrum of perinatal mental health disorders, and the risk of maternal suicide.Coroner Maria Dougan tied the death to the absence of a mother and baby unit, finding that one should be established in Northern Ireland.
Consultant perinatal psychiatrist, Dr Jo Black, who is originally from Cookstown, was instrumental in setting up a mother and baby unit in Devon.An eight-bed unit, the layout and decor of Jasmine Lodge means it does not feel clinical.It has areas for families to visit, and a team of specialists.She said it was "extraordinary" there is not a similar unit on the island of Ireland."All of our evidence shows us that maternal suicide remains a major killer in the maternity period," she said."We can't shy away from that, and so these units save lives."
'Poor data collection'
Between 2021 and 2023, 34% of late maternal deaths have been linked to mental health, according to a report by MBRRACE-UK, which includes Northern Ireland. A late maternal death is when a woman died between six weeks and one year after pregnancy.It is currently thought more than 3,500 women develop perinatal mental illness in Northern Ireland each year.However, poor data collection could mean the need for perinatal mental health services is being underestimated, according to Dr Julie Anderson.Spotlight has confirmed the Department of Health has yet to implement a 2017 recommendation from the health regulator to improve data collection.At the time, the Regulation and Quality Improvement Authority (RQIA) said patient coding should be improved.The Department of Health said a review of coding practices for perinatal mental health conditions, and related hospital admissions, was planned.
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