An exploration of post-traumatic growth amongst families of women who have experienced postpartum psychosis

WHAT IS KNOWN ON THE SUBJECT?: New parents who have previously experienced psychosis outside and/or following childbirth have an increased likelihood of experiencing an episode during the postpartum period. The decision to try to conceive can be agonising. Receiving care from a specialist perinatal community mental health team can improve outcomes. WHAT DOES THIS PAPER ADD TO EXISTING KNOWLEDGE?: This article offers a first-person insight into the steps the author took to minimise the impact of an episode of postpartum psychosis and/or postnatal depression whilst navigating new motherhood. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: This lived experience narrative aligns with the evidence base that demonstrates specialist perinatal community mental health services improve outcomes. It highlights the importance of maternity care providers asking about mental health history to identify any previous episodes or family history and offering referral to a specialist perinatal mental health service if available. ABSTRACT: Introduction Postpartum psychosis is a life-changing but treatable condition that usually occurs in the first few days to weeks after childbirth affecting 1-2 in 1000 pregnancies. Those who have experienced psychosis before, either as a single episode, related or unrelated to childbirth or as part of a long-term mental health condition have a higher likelihood of experiencing an episode in the postnatal period. Aim In this lived experience narrative the author shares personal experience of planning and navigating pregnancy with a higher likelihood of experiencing postpartum psychosis and postnatal depression around this major life transition due to previous episodes. Methods The author utilises a first-person approach to share and reflect on her lived experience. Findings The author shares her experience of receiving care and some of the steps she took to try to manage the impact of pregnancy and birth on her mental health during this major life transition. She describes how care from a specialist perinatal community mental health team and peer support contributed significantly to her family's well-being. Discussion Specialist perinatal community mental health services can improve outcomes for those with a higher likelihood of experiencing postpartum psychosis and postnatal depression by facilitating planning and mitigating some of the risks that could lead to relapse in the perinatal period.

BackgroundWomen from ethnic minority groups are at greater risk of developing mental health problems. Poor perinatal mental health impacts on maternal morbidity and mortality and can have a devastating impact on child and family wellbeing. It is important to ensure that services are designed to meet the unique needs of women from diverse backgrounds.AimThe aim of the review was to explore ethnic minority women's experiences of perinatal mental ill health, help-seeking and perinatal mental health services in Europe.Data sourcesSearches included CINAHL, Maternity and Infant Care, MEDLINE and PsycINFO with no language or date restrictions. Additional literature was identified by searching reference lists of relevant studies.DesignThis was a mixed method systematic review. Study selection, appraisal and data extraction were conducted by two researchers independently. A convergent approach was adopted for the analysis and the data were synthesised thematically.ResultsThe 15 eligible studies included women from a range of minority ethnic backgrounds and were all undertaken in the United Kingdom (UK). Seven overarching themes were identified; awareness and beliefs about mental health, isolation and seeking support, influence of culture, symptoms and coping strategies, accessing mental health services, experiences of mental health services and what women want.ConclusionLack of awareness about mental ill health, cultural expectations, ongoing stigma, culturally insensitive and fragmented health services and interactions with culturally incompetent and dismissive health providers all impact on ethnic minority women's ability to receive adequate perinatal mental health support in the UK. Future research should focus on in-depth exploration of the experiences of these women across multiple European settings and interventions to reduce health inequalities among vulnerable mothers and families affected by perinatal mental ill health.

Ethnic minority women face worse maternity outcomes and increased risk of perinatal mental health issues, yet research on the accessibility and acceptability of perinatal mental health services for these groups is limited. (1) To explore access to and utilisation of mental health services during the perinatal period among ethnic minority women; (2) to explore care pathways to community and inpatient perinatal mental health services; (3) to explore the attitudes, experiences and service improvement suggestions of ethnic minority women with perinatal mental health problems, as well as those of their partners, family members and healthcare professionals and (4) to produce recommendations for improving clinical practice. Mixed-methods study was conducted during 2018-23, encompassing four studies aligned with specific aims: (1) a population-based study of 615,092 women who gave birth in National Health Services hospitals in England, using data from the National Commissioning Data Repository; (2) a retrospective evaluation of patients accessing community perinatal mental health services in Birmingham and London (n = 228) and inpatient services in Birmingham, London and Nottingham (n = 198) using an adapted World Health Organization care pathways questionnaire; (3) a qualitative study with four cohorts across England: service users (n = 37), non-users or those who disengaged (n = 23), partners/family (n = 15) and healthcare professionals (n = 24); (4) findings informed recommendations for practice improvements, coproduced with individuals with lived experience of perinatal mental illness and of being in a minoritised ethnic group. Data were analysed using quantitative and qualitative approaches. Access issues to mental health services were evident for Black African, Asian and White other women compared to White British women. Variability in patient journeys to community perinatal mental health services seem to stem from service-level factors rather than patient needs. Asian patients had more emergency admissions to Mother and Baby Units, while Black patients were less likely to experience multiple services before Mother and Baby Unit admission. Barriers to access included limited service awareness, fear of child removal, stigma, remote clinical appointments and unresponsive services. Despite these challenges, many women found services helpful. Family members noted gaps in family-focused care. Recommendations for improvement include raising awareness, monitoring access for different ethnic groups and addressing concerns about child removal, with a focus on consistent care, family involvement and cultural sensitivity. These findings shed light on health inequalities in perinatal mental health care for ethnic minority women. The results can be utilised to address existing barriers and improve outcomes for mothers, infants and families. Diversity within merged ethnic groups; limited sample of non-English-speaking women; reliance on self-reported measures; use of pre-COVID-19 data; under-representation of Black women who did not engage with services, and over-representation of Black and Asian patients in Birmingham and London samples in the study exploring patient pathways to Mother and Baby Units (compared to maternity population). Implementation of good practices in perinatal mental health care, targeted interventions to address the fear of child removal, innovative strategies to recruit Black and non-English-speaking women and exploring the experiences of 'White other' women. This synopsis presents independent research funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme as award number 17/105/14.

Poor perinatal mental health is a significant public health issue, especially in low- and middle-income countries. In sub-Saharan Africa, perinatal mental health conditions affect more than one in five women. Ethiopia’s mental health strategy mandates the integration of mental health services into primary care. However, screening and treatment for perinatal mental health conditions remain largely limited due to various challenges, including weak integration into maternal and child health services. This study aimed to explore maternal health workers’ knowledge, practices, and perceived factors influencing the screening and management of perinatal mental health conditions in primary healthcare facilities. This qualitative exploratory descriptive study was conducted between August 2023 and March 2024 in ten primary healthcare facilities and the responsible sub-city health department in Addis Ababa. We conducted 25 in-depth interviews with frontline maternal health workers, facility managers, and program coordinators. Interviews were audio-recorded, transcribed verbatim, and translated from Amharic to English. Data were analyzed using Braun and Clarke’s six-phase inductive thematic analysis approach, supported by ATLAS.ti software. Two authors independently coded the data, and themes were developed and refined through team consensus. The Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist was used to guide reporting. We identified four interconnected themes. 1) Foundational knowledge, misconceptions, and attitudes towards perinatal mental health: maternal health workers demonstrated foundational knowledge of perinatal mental health conditions, but this was inconsistent. Notable misconceptions included the conflation of postpartum depression with the ‘baby blues’ and underestimating its local prevalence. Despite these gaps, participants held strongly favorable attitudes towards the integration of perinatal mental health services; 2) Current practices in screening and management of perinatal mental health conditions: practices were informal and reactive, as none of the ten facilities used validated screening tools or followed standardized protocols. Assessment relied on opportunistic observation and patient-reported complaints, while management was limited to basic counseling and unreliable referral pathways; 3) Perceived readiness and capacity gaps: there was a disconnect between managerial confidence and frontline workers’ self-reported unpreparedness. Managers assumed readiness, whereas frontline health workers reported significant capacity gaps in their ability to provide integrated perinatal mental health services; 4) Systemic and socio-cultural barriers to implementation: these included overwhelming workloads, inadequate infrastructure, a shortage of mental health professionals, pervasive stigma, and the spiritual attributions of mental illness, which collectively constrained effective care. This study highlights critical gaps in maternal health workers’ capacity to provide perinatal mental health services, emphasizing the need for targeted training, standardized tools, and systemic support to effectively integrate perinatal mental healthcare into the routine maternal and child health services.

Background: There is a high prevalence of depression in the perinatal period and for women who experience maternal loss, which is linked to worse real-world functioning and quality of life. Research evidence indicates that transcranial direct current stimulation (tDCS) can reduce symptoms of depression. Flow FL-100 is a tDCS device self-administered by a patient at home in combination with a software application-delivered wellbeing behaviour therapy training. Training modules include: “Behaviour activation”, “Mindfulness”, “Exercise for your brain”, “An anti-depression diet”, and “Therapeutic sleep”. Purpose/Aim: This study is the first to introduce Flow FL-100 tDCS in combination with a software application-delivered wellbeing behaviour therapy training into a Specialist Perinatal Mental Health Service and Maternal Mental Health Service. In addition to the support and interventions provided by these services, this study investigated the impact on depression, real-world functioning, and health-related quality of life for patients diagnosed with depression. Methods: An open-label patient cohort design with no control group. Baseline and 6-week follow-up assessments were completed using the participant self-report measures: Patient Health Questionnaire (PHQ-9), Work and Social Adjustment Scale (WSAS), and EuroQol five-dimension (EQ-5D-5L). Results: Twenty-five female patients completed six weeks of tDCS treatment. Their average age was 36 years, and their ages ranged from 27 to 42 years. Reliable improvement and remission rates for PHQ-9 were 64% and 52%, respectively. PHQ-9 and WSAS scores significantly improved, with large effect sizes. EQ-5D-5L results showed significant improvements in the EQ health index score and EQ-VAS score, with medium effect sizes. Conclusion: tDCS and online wellbeing behaviour therapy training can be successfully integrated into Perinatal Mental Health Service and Maternal Mental Health Service depression treatment offer. This study’s findings provide evidence that tDCS and online wellbeing behaviour therapy training delivered in conjunction with the interventions provided by Specialist Perinatal Mental Health and Maternal Loss Psychology Services for patients with depression diagnosis can provide improvements in depression symptoms, functioning and quality of life. It is important to be able to offer an evidence-based addition and/or alternative to existing depression treatments (antidepressant medication and psychotherapies).

Perinatal mental health (PMH) services support the mental health needs of women and birthing people in pregnancy and postnatal, alongside the developing relationship between parent and infant. Mental health symptoms in PMH services are routinely screened for, yet there are inconsistencies in whether parent-infant bond is assessed and how. The aim of this study is to assess the predictive validity of screening for parent-infant bonding difficulties (Postpartum Bonding Questionnaire (PBQ)) and psychopathology (CORE-10) to predict patient outcomes at discharge from a PMH service. Secondary analysis of clinical data from a PMH service in Birmingham, United Kingdom, encompassed 948 patient records. A structural equation model was constructed on patient data containing PBQ and CORE-10 scores recorded at initial assessment and discharge from the service. Analysis revealed a significant decrease in bonding difficulties and psychopathology scores from initial assessment to discharge from the service. The predictive model showed CORE-10 scores at discharge were predicted by both initial CORE-10 and PBQ scores, whereas PBQ scores at discharge were predicted solely by initial PBQ scores. Demographic factors including age, parity and ethnicity did not present any direct association with psychopathology or bonding difficulties at either timepoint. This analysis provides evidence of a pathway between early parent-infant bond and later psychopathology symptoms, which exists independently from the pathway between psychopathology symptoms at intake and discharge alone. These findings support embedding self-report assessments of parent-infant bond, in addition to measures of psychopathology, to better predict patient outcomes at discharge from a PMH service.

Perinatal mental health (PMH) difficulties are prevalent and often accompanied by parent-infant relationship difficulties. National Health Service community PMH services (PMHS) support birthing parents (typically mothers) experiencing moderate-to-severe and complex mental health difficulties. While PMHS primarily address maternal mental health, treatment can include interventions targeting parent-infant relationships. The Circle of Security-Parenting (COS-P) programme is widely used within PMHS in England and offers a potential solution to the evidence gaps for interventions that: i) target both parental mental health and parent-infant relationship quality; (ii) are transdiagnostic; and iii) delivered in groups. This study evaluates the acceptability of COS-P, an attachment-informed, group intervention delivered in PMHS in ten 90-min sessions, predominantly online. This qualitative study analysed the perspectives of parents (COS-P recipients) and practitioners (COS-P providers) in the intervention arm of a wider randomised controlled trial. Data collection involved interviews (58 parents, 7 practitioners) and focus groups (6 practitioners). Reflexive thematic analysis was conducted by a team including co-researchers with lived experience and interdisciplinary academics and practitioners. Four themes were constructed: (1) ‘Flamingos’, capturing the power of the group in normalising and validating demands relating to motherhood and PMH; (2) ‘Practise Babies’, highlighting the universal necessity and benefit of practising relationship skills, without expectations of perfection and with opportunities for repair; (3) ‘the Dark Things’, describing the emotional intensity for parents and practitioners arising from current and past relationships, occasionally necessitating extra support; and (4) ‘the Ripples’, illustrating shifts in understanding and compassion that may extend beyond the parent-infant relationship and interact with other interventions. These themes encompass both positive and negative experiences for parents and practitioners, as well as practical considerations for implementing COS-P within PMHS. Although COS-P is positively regarded by many parents and practitioners in PMHS, attention to individual and service-specific factors remains crucial. Findings underscore the importance of trauma-informed approaches, particularly regarding intervention timing, sequencing, and ensuring personal agency in treatment decisions. Moreover, the effective facilitation of parent-infant psychological group interventions demands significant skill and resource allocation before, during, and outside sessions, impacting workforce planning, practitioner training, and supervision. ISRCTN18308962. Registered 18/02/2022.

Aims The case for perinatal psychiatry as a subspecialty is strong. In the context of perinatal mental illness consideration has to be given to; differences in presentation, the need to account for mother and baby and the risks associated with inadequate treatment. Specialist services improve outcomes, reduce risks and save money. Despite the government's agenda of preventative healthcare, service provision has been inequitable across the UK. Here we detail the journey towards the development of new Community Perinatal Mental Health Services in Northern Ireland (NI). Methods In NI the first embers of a perinatal service were ignited by Dr Janine Lynch approximately 15 years ago when she established a small community perinatal team in Belfast Health and Social Care Trust (BHSCT). Her commitment and foresight regarding training inspired others, resulting in high levels of interest among trainees. From this grew a dedicated group of consultants committed to supporting service development across NI. A multidisciplinary regional perinatal mental health forum was formed leading the development of a Northern Ireland Care Pathway in 2012. In partnership with women with lived experience, this forum led the bid for perinatal service development across the province. Results Following years of campaigning the need for services was recognised in both the Bamford Review (2012) and RQIA Perinatal Review (2017). A commitment for funding for specialist teams, across all five health and social care trusts, was outlined in the Mental Health Action Plan in May 2020. Funding was finally approved in January 2021. Significant work has gone into training to ensure there is a workforce ready to deliver services with focus on upskilling all professionals who deliver care to mums during the perinatal period. A competency framework has been developed to compliment this. It is important to recognise the support and commitment of many members of the college Perinatal Faculty throughout this journey. Conclusion Community perinatal mental health services are at an exciting juncture in NI. Each of the trusts have made a commitment to the development of services under the co-ordination of the Public Health Agency. Several have progressed to recruitment of key staff with the aspiration for services to go live before the end of the year. There will be an overarching, integrated approach, co-ordinated by the new Regional Perinatal Network. As newly recruited consultants we look forward to working in partnership to address this long-standing health inequality and improve the outcome for women and their babies in NI.

During pregnancy and the postpartum period, women's mental health can deteriorate quickly. Timely and easy access to services is critically important; however, little is known about the pathways women take to access services. Previous research has shown that women from ethnic minority groups in the United Kingdom experience more access issues compared to the White British women. To describe pathways taken to specialist community perinatal mental health services and explore how they vary across services and ethnic groups. This is a two-site, longitudinal retrospective service evaluation conducted in Birmingham and London during 6 months (1 July-31 December 2019). Electronic records of 228 women were accessed and data were extracted on help-seeking behaviour, referral process and the type of pathway (i.e. simple or complex). Data were collected using the adapted World Health Organization encounter form and analysed using uni- and multivariable analyses. The median time from the start of perinatal mental illness to contact with perinatal mental health services was 20 weeks. The majority of patients accessed perinatal mental health services through primary care (69%) and their pathway was simple, that is they saw one service before perinatal mental health services (63%). The simple pathway was used as a proxy for accessible services. In Birmingham, compared to London, more referrals came from secondary care, more women were experiencing current deterioration in mental health, and more women followed a complex pathway. Despite differences between ethnic groups regarding type of pathway and duration of patient journey, there was no evidence of difference when models controlled for confounders such as clinical presentation, general characteristics and location. The service's location was the strongest predictor of the type of pathway and duration of patient journey. The heterogeneity among categorised ethnic groups; data extracted from available electronic records and not validated with patient's own accounts of their pathways to care; unanalysed declined referrals; the study was conducted before the COVID-19 pandemic and pathways may be different in the post-COVID-19 period. The study provides important insights into how patients find their way to community perinatal mental health services. It shows that there is a great degree of variability in the time taken to get into these services, and the pathway taken. This variation does not come from different needs of patients or different clinical presentations but rather from service-level factors. The studied community perinatal mental health services in the United Kingdom operate with a significant degree of variability in the types and characteristics of patient pathways. Future research should explore these issues on the national and international levels. Additionally, future research should explore the reasons for the different pathways taken and the outcomes and risks associated with them. This article presents independent research funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme as award number 17/105/14.

IntroductionIn most low-income countries, including Ethiopia, mental healthcare has not been fully integrated into perinatal services. As a prerequisite for the integration, this project aimed to understand the facilitators and barriers to integrating mental health services into perinatal care.MethodsThis exploratory qualitative research used in-depth interviews with 25 purposely selected participants representing diverse stakeholders (perinatal women, health service coordinators and providers, and community health workers and community volunteers). The transcribed interviews were coded and analyzed using Atlas ti Software.ResultsThe study found the following major impediments to providing and receiving perinatal mental health services: a) the lack of sense of ownership and accountability, b) constraints related to institutional resources and infrastructure; c) inequitable access to healthcare; d) the absence of supportive policy framework with focus on perinatal mental health; e) cultural beliefs and community perceptions; f) limited support from stakeholders; g) limited practice of compassionate and respectful care; and h) poor service planning and coordination. The opportunities for the integration of mental healthcare into perinatal services are a) the presence of maternal and child health (MCH) and mental health professionals, b) a conducive structure linking hospitals to the community and c) a convenient institutional infrastructure, d) higher level government support. Strategies suggested for the integration are awareness creation, capacity building, development of guidelines and checklists, and stakeholder engagement.ConclusionThe current Ethiopian primary healthcare system offers a conductive structure for the integration of mental healthcare into perinatal services. The existing bottlenecks against the service integration can be tackled by training health professionals, community sensitization, and advocacy and generating evidence that leads to the development of evidence-based implementation tools and health service delivery models tailored to local needs. The strategies outlined in this study may be used to design perinatal mental health services at multiple levels.

IntroductionToday the maternal death of black women is four times than the maternal death of white women. A lot has been written about the physical health of black women during pregnancy and childbirth however the perinatal mental health of this group of women is less well researched. I wanted to investigate if black and ethnic minority women in the UK had the same access to perinatal mental health services.ObjectivesTo explore how the access to perinatal mental health services vary between white British and non-white British women.MethodsA literature review was conducted. Papers were selected based on their focus on perinatal mental health service access and differences in access based on ethnicities. Most research focused on the perinatal mental health service access of white British and non-white British groups of women.ResultsThe literature review revealed that black African, Asian and minority white women had significantly lower access to community perinatal mental health services when compared to white British women. It was also found that that black African, Asian and minority White women had a higher percentage of involuntary admissions to psychiatric hospitals when compared to white British women.ConclusionsThe literature would suggest that there is less access to perinatal mental health for non-white British women. This suggested that the disparities that exist within perinatal physical health extend into perinatal maternal health.DisclosureNo significant relationships.

Postpartum psychosis (PPP) is a rare but severe psychiatric condition that emerges within weeks after childbirth, often requiring urgent intervention. Recovery-oriented practice (ROP) in mental health emphasizes hope, empowerment, and person-centered care, yet its application in PPP remains complex due to risks to both mother and infant. This systematic review synthesizes multidisciplinary clinicians’ perspectives on ROP in PPP, drawing from psychiatry, nursing, psychology, and social work. A comprehensive search of PubMed, PsycINFO, CINAHL, and Scopus (2000–2025) identified studies reporting clinicians’ views on recovery principles in PPP care. Findings reveal that clinicians conceptualize recovery as more than symptom remission, encompassing maternal role restoration, identity reconstruction, and family reintegration. Psychiatrists prioritize stabilization and risk management, while nurses emphasize compassionate, holistic care. Psychologists highlight traumainformed approaches, and social workers stress family support and stigma reduction. Barriers to ROP include limited specialized training, fragmented service pathways, and institutional focus on acute stabilization. Facilitators include integrated multidisciplinary models, peer support, family-inclusive interventions, and policy frameworks prioritizing maternal mental health. Clinicians consistently value recovery-oriented principles but struggle with systemic constraints. This review underscores the need for integrated care pathways, enhanced training, and collaborative approaches that balance safety with empowerment. Embedding recovery principles into perinatal mental health services can improve outcomes for mothers, infants, and families, while advancing equity and accessibility in psychiatric care.

Perinatal mental health service use in a representative sample of US women

IntroductionCommunity Perinatal Mental Health Services (CPMHS) have been established in the UK, however, there is limited research around their real-world effectiveness. Post-Partum Psychosis (PPP), a severe episode of affective psychosis usually occurring soon after birth, has known risk factors. CPMHS offer assessment and interventions for women with risk factors for PPP, with a view to reducing the risk of its occurrence, as well as, where necessary, to proactively manage the illness to minimise the impact on the mother-infant dyad, as well as associated risks to self and/or others.ObjectivesTo review the rate of PPP in women with established risk factors, who were referred and managed by our CPMHS between September 2019-September 2021. This rate will be compared with the known rates of PPP reported in the literature. Rates of non-psychotic relapse, acute hospitalisation, children social care supervision and mother-infant separation as a result of postnatal relapse will be (amongst others) secondary outcomes. Perinatal interventions offered to reduce the risk of PPP and contingency planning will also be reviewed.MethodsThis will be a retrospective case review study involving women referred and cared for by our CPMHS from October 2019 to October 2021, with known risk factors for PPP. Women identified as high risk for PPP receive consultant led-care in our service, therefore cases will be identified via the individual caseloads. Subsequently, electronic case notes will be reviewed to determine the primary and secondary outcomes, as well as the perinatal interventions that were offered.ResultsTo be reported.ConclusionsTo be reported.DisclosureNo significant relationships.

The aim of the research was to identify and develop midwives' skills to support women with mental health needs during pregnancy, using an action research approach. A review of perinatal mental health services in a large Dublin maternity unit revealed a high number of referred women who 'did not attend' the perinatal mental health service with few guidelines in place to support midwives in identifying and referring women for specialist help. Action research using cooperative inquiry involved a mental health nurse specialist and a team of midwives, who were drawn to each other in mutual concern about an area of practice. Data were gathered from three Cooperative Inquiry meetings, which incorporated one main Action Research Cycle of constructing, planning, taking andevaluating action. Data were analysed using a thematic content analysis framework. Participants experienced varying levels of uncertainty about how to support women with perinatal mental health needs. Cooperative inquiry supported participants in making sense of how they understood perinatal mental health and how they managed challenges experienced when caring for women with perinatal mental health issues. Participants developed a referral pathway, highlighted the significance of education to support women with perinatal mental health issues and identified the value of using open questions to promote conversation with pregnant women about mental health. Midwives value education and support to identify and refer women at risk of perinatal mental health issues. Cooperative inquiry, with a focus on action and shared reflection, facilitated the drawing together of two professional groups with diverse knowledge bases to work together to develop practice in an area of mutual concern. Perinatal mental health is a significant public health issue and midwives need support to make psychosocial assessments and to negotiate access to specialist services where available and when required.