Psychiatric Mother-Baby Units

Background

Over the past four years I have undertaken work exploring the practices of Psychiatric Mother-Baby Units. This project, called Examining the design and therapeutic milieu of a purpose built mental health unit, has been undertaken with Kathleen Connellan, Clemence Due, and Clare Bartholomaeus. This project sought to explore the functions of a Psychiatric Mother-Baby Unit, with particular attention to the use of design and space. The project used ethnographic observation and interviews with staff members and architects of the purpose built unit.

A list of my research publications to date can be found further down the page, and are drawn on in the applications of research findings sections below.

Psychiatric mother-baby units (MBUs) are viewed as best practice for improving outcomes for mothers and babies when mothers are experiencing severe forms of mental illness. Generally, MBUs refer to separate wards or buildings dedicated to housing mothers and their babies full time, and are usually staffed by multi-disciplinary teams, including psychiatrists, social workers, and mental health nurses.

Applications of research findings for practitioners

Our research in a psychiatric mother-baby unit focused particularly on people’s interactions with the built environment (a purpose built unit), including in terms of experiences of family within the unit. The ethnographic observations in particular showed that the space both facilitated and limited practices which could be seen as assisting in improving wellbeing for those in the unit. For example, shared living spaces could facilitate communication between mothers staying in the unit, yet a lack of private spaces to talk with family and other visitors meant that mothers were always under possible scrutiny from staff and other people in the unit. The findings suggest that practitioners need to find a balance between regulations which seek to improve the wellbeing of mothers and intervene in any potentially dangerous situations, alongside allowing mothers space with their children and family/other visitors. In other words, the research indicates that a balance needs to be found between creating a sense of home in MBUs, alongside the regulations and scrutiny required of an institutional space.

The research also found that the unit attempted to create feelings of home, such as by having living spaces found in homes (e.g. living rooms, dining rooms, outdoor settings), and that the mothers sometimes appeared to treat the unit as a home, including by wearing their pyjamas in public spaces within the unit. In terms of creating feelings of home, practitioners may pursue options such as private lounges for clients and their visitors and community building events such as barbecues, in order to facilitate wellbeing for clients and their families.

While the findings show that more focus is needed on how interactions between mothers and their families can better be facilitated within units, the findings also show that kinship practices were demonstrated between staff members and mothers. For example, staff and visitors sometimes referred to each other as family or using family terms. However, there is a need to recognise the inherent power imbalances in these relationships. This suggests that it is important for practitioners to remember these power imbalances, and that ultimately their aim is to provide professional services for mothers staying at the unit, although doing this in a welcoming way seemed to benefit the mothers.

An additional finding which had the potential to impact on the therapeutic purpose of the unit was the noise levels. For example, shared nurseries and nurseries next to busy staff spaces meant noise levels could wake babies up. In addition, the sound of crying babies could often be heard through the unit, having potentially disruptive effects on mothers who were often already struggling. These findings indicate that practitioners need to work out the best ways to manage noise levels within the built space they are working in, even if this is not ideal.

Applications of research findings for parents and families

Our observations in the psychiatric mother-baby unit found that it could be both a therapeutic space which assisted mothers in improving their wellbeing and a regulatory space which had numerous rules that needed to be followed. For example, shared living spaces meant mothers staying in the unit could communicate with each other, but there was a lack of private spaces to talk with family and other visitors. These findings highlight that parents staying at MBUs need to be comfortable with the balance between it being a therapeutic space and a medical space in which they will be monitored.

In some ways, the unit attempted to create feelings of home, such as by having living spaces found in homes (e.g. living rooms, dining rooms, outdoor settings), and some mothers also appeared to treat it as a home, such as by wearing their pyjamas in public spaces within the unit. Again, parents should reflect on the balance between the space being somewhat like home but also a medical space.

Finally, the noise levels in the unit ranged from eerily quiet to noisy, including the potential for high noise levels in shared nurseries and the location of nurseries next to busy staff spaces. In addition, the sound of crying babies could often be heard through the unit, having potentially disruptive effects on mothers who were often already struggling. Parents need to be prepared for noise levels that may be disruptive to themselves and their babies.

Resources for practitioners

Australian

The Royal Australian & New Zealand College of Psychiatrists. (2015). Position statement 57: Mothers, babies and psychiatric inpatient treatment. RANZCP.

International

National Institute for Health and Care Excellence. (2014). Antenatal and postnatal mental health: Clinical management and service guidance. London: NICE.

Resources for parents and families

Australian
Psychiatric mother-baby units/postpartum mental health – government sources

Government of Western Australia – Healthy WA – Treatment options for parents experiencing emotional problems during pregnancy and after the birth

Health Direct – Postnatal depression

Parentline

Pregnancy, birth & baby – Postpartum psychosis

Victoria State Government – health.vic – Mother and baby mental health services

Psychiatric mother-baby units/postpartum mental health – additional sources

Allatt, C. (2011). Puerperal psychosis: A carer’s survival guide. Woden, ACT.

Beyond Blue – Get immediate support1300 22 4636 (24 hours/7 days a week)

Beyond Blue – Maternal mental health and wellbeing

MumSpace (Support for the emotional health of new mums at every step)

PANDA (Perinatal Anxiety & Depression Australia) – PANDA National Helpline (Mon to Fri, 9am – 7.30pm AEST) 1300 726 306

Raising Children Network – Depression before and after birth

Williams, A. S., & Ellershaw, S. (2014). Puerperal psychosis: Information. Women’s and Children’s Hospital.

Forums

bubhub – Not happy? Emotional health issues

Raising Children Network forum – Parents with depression

International

APNI (Association for Postnatal Illness) (UK)

APP (Action on Postpartum Psychosis) (UK)

PANDAS Foundation (UK)

Royal College of Psychiatrists (UK) – Postnatal depression

Royal College of Psychiatrists (UK) – Postpartum psychosis: Severe mental illness after childbirth

Books/sources with personal stories

BBC One – My baby, psychosis and me

Health Talk Australia – Experiences of hospitalisation for postnatal depression

NHS England – Mother and Baby Unit care – my experience

PANDA – Postnatal psychosis recovery stories

Picture books

Crockett, L. J., & Orazzini, F. (2014). She won’t feel like this forever: A book for children with mothers suffering PTSD. The Australian Birth Trauma and PTSD Treatment Centre.

Faulkner, J. (2013). A monster ate my mum.

Gallagher, H., & McGrath, L. (2016). Happy pants: Why is mummy so sad? Wombat Books.

Lasalandra-Frodella, S., & LaDuca, M. (2011). Mommy, were you happy the day I was born? Quattro M Publishing.

Louis, A., & Siow, J. (1995). Robby Rose and Monkey.

Scott, D. (2001). Making mummy better: A child’s experience of postnatal depression.

Williams, A. S., & Siow, J. (1996). Jake’s dinosaurs.

My research publications

Riggs, D. W., Bartholomaeus, C., Due, C., & Connellan, K. (under review). Engendering a sense of home in an Australian mother-baby psychiatric unit.

Connellan, K., Bartholomaeus, C., Due, C., & Riggs, D. W. (2017). A systematic review of research on psychiatric mother-baby units. Archives of Women’s Mental Health, 20(3), 373-388.

Riggs, D. W., & Peel, E. (2016). Critical kinship studies: An introduction to the field. London: Palgrave Macmillan.

Other research publications (selected)

Australian

Bosanac, P., Buist, A., Milgrom, J., & Burrows, G. (2004). General issues in research in motherhood and schizophrenic illnesses: A pilot study. Stress and Health, 20(1), 43-44.

Buist, A. (1993). A mother and baby unit for psychiatric disorders in an obstetric hospital. Australas Psychiatry, 1(3), 115-116.

Buist, A., Minto, B., Szego, K., Samhuel, M., Shawyer, L., & O’Connor, L. (2004). Mother-baby psychiatric units in Australia – the Victorian experience. Archives of Women’s Mental Health, 7(1), 81-87.

Buist, A. E., Dennerstein, L., & Burrows, G. D. (1990). Review of a mother-baby unit in a psychiatric hospital. Australian and New Zealand Journal of Psychiatry, 24(1), 103-108.

Buultjens, M., & Liamputtong, P. (2007). When giving life starts to take the life out of you: Women’s experiences of depression after childbirth. Midwifery, 23(1), 77-91.

Christl, B., Reilly, N., Yin, C., & Austin, M.-P. (2015). Clinical profile and outcomes of women admitted to a psychiatric mother-baby unit. Archives of Women’s Mental Health, 18(6), 805-816.

Connerty, T. J., Roberts, R., & Williams, A. S. (2016). Managing life, motherhood and mental health after discharge from a mother-baby unit: An interpretive phenomenological analysis. Community Mental Health Journal, 52(8), 954-963.

Masciantonio, S. (2015). Mothering & mental illness: An ethnography of attachment in an institutional context. PhD, University of Adelaide, Adelaide.

Milgrom, J., & Beatrice, G. (2003). Coping with the stress of motherhood: Cognitive and defence style of women with postnatal depression. Stress and Health, 19(5), 281-287.

Milgrom, J., Burrows, G. D., Snellen, M., Stamboulakis, W., & Burrows, K. (1998). Psychiatric illness in women: A review of the function of a specialist mother-baby unit. Australian and New Zealand Journal of Psychiatry, 32(5), 680-686.

Nair, R., Bilszta, J., Salam, N., Shafira, N., & Buist, A. (2010). Client evaluation of a specialist inpatient parent-infant psychiatric service. Australasian Psychiatry, 18(6), 573-578.

Nair, R., Bilszta, J., Shafira, N., Salam, N., & Buist, A. (2010). Review of patients admitted to a specialist inpatient parent-infant psychiatric service. Australasian Psychiatry, 18(6), 567-572.

Yelland, C., Girke, T., Tottman, C., & Williams, A. S. (2015). Clinical characteristics and mental health outcomes for women admitted to an Australian mother–baby unit: A focus on borderline personality disorder and emotional dysregulation? Australasian Psychiatry, 23(6), 683-687.

International

Abel, K., Webb, R. T., Salmon, M. P., Wan, M. W., & Appleby, L. (2005). Prevalence and predictors of parenting outcomes in a cohort of mothers with schizophrenia admitted for joint mother and baby psychiatric care in England. The Journal of Clinical Psychiatry, 66(6), 781-789.

Antonysamy, A., Wieck, A., & Wittkowski, A. (2009). Service satisfaction on discharge from a psychiatric mother and baby unit: A representative patient survey. Archives of Women’s Mental Health, 12(5), 359-362.

Bilszta, J. L. C., Buist, A. E., Wang, F., & Zulkefli, N. R. (2012). Use of video feedback intervention in an inpatient perinatal psychiatric setting to improve maternal parenting. Archives of Women’s Mental Health, 15(4), 249-257.

Blundell, J., Wittkowski, A., Wieck, A., & Hare, D. J. (2012). Using the repertory grid technique to examine nursing staff’s construal of mothers with mental health problems. Clinical Psychology & Psychotherapy, 19(3), 260-269.

Boddy, R., Gordon, C., MacCallum, F., & McGuinness, M. (2017). Men’s experiences of having a partner who requires mother and baby unit admission for first episode postpartum psychosis. Journal of Advanced Nursing, 73(2), 399-409.

Butler, H. (2013). Parenting interventions on a mother and baby unit: An investigation. Doctor of Clinical Psychology, The University of Manchester.

Butler, H., Hare, D., Walker, S., Wieck, A., & Wittkowski, A. (2014). The acceptability and feasibility of the Baby Triple P Positive Parenting Programme on a mother and baby unit: Q-methodology with mothers with severe mental illness. Archives of Women’s Mental Health, 17(5), 455-463.

Chandra, P., Desai, G., & Thippeswamy, H. (2013). An inpatient mother baby psychiatric unit in India: A three year experience. Archives of Women’s Mental Health, 16(suppl), s88.

Elkin, A., Gilburt, H., Slade, M., Lloyd-Evans, B., Gregoire, A., Johnson, S., & Howard, L. M. (2009). A national survey of psychiatric mother and baby units in England. Psychiatric Services, 60(5), 629-633.

Gillham, R., & Wittkowski, A. (2015). Outcomes for women admitted to a mother and baby unit: A systematic review. International Journal of Women’s Health, 7, 459-476.

Glangeaud-Freudenthal, N. M. C., & Barnett, B. E. W. (2004). Mother-baby inpatient psychiatric care in different countries: Data collection and issues – introduction. Archives of Women’s Mental Health, 7(1), 49-51.

Glangeaud-Freudenthal, N. M. C., Howard, L. M., & Sutter-Dallay, A. L. (2014). Treatment – mother-infant inpatient units. Best Practice & Research Clinical Obstetrics and Gynaecology, 28(1), 147-157.

Glangeaud-Freudenthal, N. M. C., Sutter, A.-L., Thieulin, A.-C., Dagens-Lafont, V., Zimmermann, M.-A., Debourg, A., . . . Khoshnood, B. (2011). Inpatient mother-and-child postpartum psychiatric care: Factors associated with improvement in maternal mental health. European Psychiatry, 26(4), 215-223.

Glangeaud-Freudenthal, N. M.-C., Sutter-Dallay, A.-L., Thieulin, A.-C., Dagens, V. r., Zimmermann, M.-A., Debourg, A., . . . Poinso, F. (2013). Predictors of infant foster care in cases of maternal psychiatric disorders. Social Psychiatry and Psychiatric Epidemiology, 48(4), 553-561.

Glangeaud-Freudenthal, N. M.-C., & The MBU-SMF Working Group. (2004). Mother-baby psychiatric units (MBUs): National data collection in France and in Belgium (1999–2000). Archives of Women’s Mental Health, 7(1), 59-64.

Green, D. J., Hofberg, K., Carr, C., Fanneran, T., & Sumathipala, A. (2016). A 10-year history of perinatal care at the Brockington Mother and Baby Unit Stafford. Archives of Women’s Mental Health, 19(3), 507-513.

Grube, M. (2005). Inpatient treatment of women with postpartum psychiatric disorders – the role of the male partners. Archives of Women’s Mental Health, 8(3), 163-170.

Hipwell, A. E., Goossens, F. A., Melhuish, E. C., & Kumar, R. (2000). Severe maternal psychopathology and infant-mother attachment. Development and Psychopathology, 12(2), 157-175.

Howard, L., Shah, N., Salmon, M., & Appleby, L. (2003). Predictors of social services supervision of babies of mothers with mental illness after admission to a psychiatric mother and baby unit. Social Psychiatry and Psychiatric Epidemiology, 38(8), 450-455.

Howard, L. M., Thornicroft, G., Salmon, M., & Appleby, L. (2004). Predictors of parenting outcome in women with psychotic disorders discharged from mother and baby units. Acta Psychiatrica Scandinavica, 110(5), 347-355.

Irving, C. B., & Saylan, M. (2007). Mother and baby units for schizophrenia. Cochrane Database of Systematic Reviews (Issue 1. Art. No. CD006333).

Kemp, N. (2011). Fathers’ experiences of a mother and baby unit: A qualitative study. Doctor of Clinical Psychology, Canterbury Christ Church University.

Kenny, M., Conroy, S., Pariante, C. M., Seneviratne, G., & Pawlby, S. (2013). Mother-infant interaction in mother and baby unit patients: Before and after treatment. Journal of Psychiatric Research, 47(9), 1192-1198.

Maizel, S., Katzenelson, S. K., & Fainstein, V. (2005). The Jerusalem psychiatric mother-baby unit. Archives of Women’s Mental Health, 8(3), 200-202.

Meltzer-Brody, S., Brandon, A. R., Pearson, B., Burns, L., Raines, C., Bullard, E., & Rubinow, D. (2014). Evaluating the clinical effectiveness of a specialized perinatal psychiatry inpatient unit. Archives of Women’s Mental Health, 17(2), 107-113.

Noorlander, Y., Bergink, V., & van den Berg, M. P. (2008). Perceived and observed mother-child interaction at time of hospitalization and release in postpartum depression and psychosis. Archives of Women’s Mental Health, 11(1), 49-56.

Pawlby, S., Fernyhough, C., Meins, E., Pariante, C. M., Seneviratne, G., & Bentall, R. P. (2010). Mind-mindedness and maternal responsiveness in infant-mother interactions in mothers with severe mental illness. Psychological Medicine, 40(11), 1861-1869.

Poinso, F., Gay, M. P., Glangeaud-Freudenthal, N. M. C., & Rufo, M. (2002). Care in a mother-baby psychiatric unit: Analysis of separation at discharge. Archives of Women’s Mental Health, 5(2), 49-58.

Reid, H., Wieck, A., Matrunola, A., & Wittkowski, A. (2016). The experiences of fathers when their partners are admitted with their infants to a psychiatric mother and baby unit. Clinical Psychology & Psychotherapy, 24(4), 919-931.

Salmon, M., Abel, K., Cordingley, L., Friedman, T., & Appleby, L. (2003). Clinical and parenting skills outcomes following joint mother-baby psychiatric admission. Australian and New Zealand Journal of Psychiatry, 37(5), 556-562.

Salmon, M. P., Abel, K., Webb, R., Warburton, A. L., & Appleby, L. (2004). A national audit of joint mother and baby admissions to UK psychiatric hospitals: An overview of findings. Archives of Women’s Mental Health, 7(1), 65-70.

Seneviratne, G., Conroy, S., & Marks, M. (2003). Parenting assessment in a psychiatric mother and baby unit. The British Journal of Social Work, 33(4), 535-555.

Sutter-Dallay, A. L., Bales, M., Pambrun, E., Glangeaud-Freudenthal, N. M. C., Wisner, K. L., & Verdoux, H. (2015). Impact of prenatal exposure to psychotropic drugs on neonatal outcome in infants of mothers with serious psychiatric illnesses. The Journal of Clinical Psychiatry, 76(7), 967-973.

Van Puyvelde, M., Rodrigues, H., Loots, G., De Coster, L., Du Ville, K., Matthijs, L., . . . Pattyn, N. (2014). Shall we dance? Music as a port of entrance to maternal-infant intersubjectivity in a context of postnatal depression. Infant Mental Health Journal, 35(3), 220-232.

Vliegen, N., Casalin, S., Luyten, P., Docx, R., Lenaerts, M., Tang, E., & Kempke, S. (2013). Hospitalization-based treatment for postpartum depressed mothers and their babies: Rationale, principles, and preliminary follow-up data. Psychiatry, 76(2), 150-168.

Vliegen, N., Luyten, P., Besser, A., Casalin, S., Kempke, S., & Tang, E. (2010). Stability and change in levels of depression and personality a follow-up study of postpartum depressed mothers that were hospitalized in a mother-infant unit. The Journal of Nervous and Mental Disease, 198(1), 45-51.

Wan, M. W., Salmon, M. P., Riordan, D. M., Appleby, L., Webb, R., & Abel, K. M. (2007). What predicts poor mother-infant interaction in schizophrenia? Psychological Medicine, 37(4), 537-546.

Wan, M. W., Warburton, A. L., Appleby, L., & Abel, K. M. (2007). Mother and baby unit admissions: Feasibility study examining child outcomes 4-6 years on. Australian and New Zealand Journal of Psychiatry, 41(2), 150-156.

Wan, M. W., Warren, K., Salmon, M. P., & Abel, K. M. (2008). Patterns of maternal responding in postpartum mothers with schizophrenia. Infant Behavior & Development, 31(3), 532-538.

Whitmore, J., Heron, J., & Wainscott, G. (2011). Predictors of parenting concern in a mother and baby unit over a 10-year period. International Journal of Social Psychiatry, 57(5), 455-461.