Maternal mental health provision - aibu

[custodial2]

I am wondering how many new mothers would feel safe in this scenario.
New mother has PND following on from ante-natal depression, and against a background of major depressive disorder before pregnancy.
Local town has a mental health centre. New mum is attending a follow up appointment with psychiatrist (not perni-natal specialist).
The centre has a small entrance lobby with receptionist behind glass. Then a large waiting room. New mum brings 5 week old baby in his lie down pram.
In the waiting room is a very ill seeming man, dressed in army fatigues. He is repeating "I am a paranoid schizophrenic", and other concerning phrases, he seems very disregulated and unwell.

AIBU to feel this whole scenario was concerning? New mum was rather unwell, and unable to advocate for herself - ie, ask for a chaperone - and there did not appear to be any alternative place to wait, just the consultation room beyond.

So is the other patient

I don't know their individual circumstances. I don't make those decisions. I do know that mother's I've been friends with that have had more severe forms of PND have been treated at home/had home visits. (Providing they didn't need hospital care ).

In the planet I am on : PND - new mother and baby care - it's not appropriate to mix this group in a waiting room with agitated mentally unwell men. I don't think that's appropriate.

Would you mix heroin users that had relapsed in the same room ? Because they're also vulnerable, mentally ill and in need of help. Mother and baby care and post pregnancy illness (including pyschiatric) is quite specific and specialised. And does include two people (baby as well) not just mum.

It’s not about who ‘has it worse’ or who needs access to services the most. It’s not a race to the bottom.

Anyway OP it’s not too late to provide feedback to the service if you/the person wanted to, I know this can take a great deal of energy but as a MH clinician and senior manager I genuinely welcome such feedback. There are ways this can be addressed without stigmatising or reducing access to services for patients. I very much view this as a service / organisational issue to deal with.

I previously worked in a service where frequent fights would break out in the waiting room if various patients were in contact, this is an extreme example but there are practical solutions to this that don’t disadvantage any group.

I mentioned that mum is unwell as a pp suggested mum's role is to protect the baby.

Not in any way suggesting that anyone else accessing mental health services is not unwell .

No it’s not ok and I would have felt very vulnerable and worried for my baby had I been In those circumstances. It just goes to show how massively underfunded and what an absolute dangerous mess the whole mental health provision is in this country.

Ah so it’s appropriate for my vulnerable young daughter after making a recent attempt on her life to be in this environment or my seriously unwell young autistic son in crisis too scared to go in sobbing to me on his phone.

Seriously are you for real? Simply having a baby should elevate you to the system actually giving a shit,giving you the care you need and jumping over others far more needy.

I mentioned that mum is unwell as a pp suggested mum's role is to protect the baby.Not in any way suggesting that anyone else accessing mental health services is not unwell .

My observation is that perinatal MH services can be particularly rigid and inflexible when it comes to access needs, including home appointments. This is baffling considering the whole purpose of specialist services is to best meet the needs of an identified group, in this case new mothers, who for myriad reasons may require home appointments.

It is most certainly an issue with a lack of funding / staff. Home visits take up considerably more time than clinic appointments, especially as two staff are required for these. So unfortunately it ends up with only ‘exceptional’ cases having home visits.

Lots of demographics need home visits.

Yes OP it would be nice if all of the sessions could be held at the maternal mental health clinic. But presumably there was a reason why that didn’t happen this time, likely because it was already booked with other new mums needing assistance. If the woman’s situation was as dire as you describe she would have needed the soonest possible booking even if it wasn’t at her preferred location.

In fact you keep emphasizing how very ill the woman was and how she couldn’t even speak up or take any action protect her baby from what she considered to be a dangerous situation. Is someone in such dire straits really capable of looking after a newborn on her own? What if there really was an emergency with the baby and she was too ill to speak up and get help? And what if the woman herself became to the baby? Severe PND can morph into psychosis and the new mum herself would be in no shape to realize it. Thankfully it’s very rare but we’ve all heard the terrible stories about what can happen.

Yes this thread is about perinatal services.

Yet you keep trying to derail it.

No it isn’t it’s about MH services and a town mental health centre.

The thread is literally entitled ‘maternal mental health services’. I won’t be engaging with you further as all you seem to want to do is be combative and argumentative, with no regard to the OP.

Yes, indeed. There was unfortunately some psychosis emerging in the mother.

Luckily, the community mental health crisis team were eventually involved , which prevented a hospital admission. Home visits 2 x per day for a number of weeks.

The op is literally referring to a town MH centre used by and with other people in it!

There is hardly any money as it is and what extra there is needs to be directed to individuals and sectors most in need, not a group of people who’ve simply had a baby.

So zero point to your op then. She got the help she needed but simply had to use the first point of access the same as everybody else.

I might add, baby was 8 months by then, and for some reason the care fell outside of perinatal (although i think NICE says 1 year)

I do take the point that it may sometimes be appropriate for distinct categories of mental health service users (such as new mothers with very young babies) to have distinct, specialist service. BUT I can't help thinking that what I see in the opening post is simply an example of the enormous stigma facing people with schizophrenia.

There is NO suggestion in the OP that the woman or her child were in any danger at all. It seemed simply that the sight of a person manifesting signs of schizophrenia was distressing to her. And there seemed to be an assumption that we should be protected from the distress of seeing someone with this type of illness.

That reminds me very much indeed of how people with all sorts of other illnesses and disabilities were shut away during my childhood, siphoned out of mainstream society. There really was a clearly present idea that 'ordinary' people shouldn't have to be exposed to the sight of someone who looked disturbingly physically different. It is hard to credit it now, but that is really how it was.

Today, we have banished a lot of that stigma, and we are also very exercised by the need to banish stigma associated with mental health conditions. But not all mental health conditions. Schizophrenics are invariably left out of all the de-stigmatising conversation around mental health. They are always treated as 'other', as the people talked about, not as part of the conversation.

Around one in a hundred people are diagnosed with schizophrenia. That is one child in every three classrooms at the school your children attend. It is a very common illness.

When it happens to a member of your own family you will see how passive, frightened, vulnerable most schizophrenic people are. You will see that they are just ordinary people who have become ill and need help. You will see how the fearful reactions that many people reflexively have to the signs of this illness are just as unenlightened as the fear that some people used to have at the sight of severe physical disabilities.

I used to see my psychologist weekly at a hospital specifically for mental health issues. I hated the general waiting area and often felt very unsafe especially in winter. I took dc1 once (to see a psychiatrist for the first time) when he was 8 weeks old and it absolutely fed negatively into my state of mind. Luckily for the rest of my appointments I had childcare. I also felt uncomfortable there when I was very pregnant.

However I don't think the NHS is in a position in many places to run a clinic specifically for postnatal women. Holding it in maternity hospitals could cause some women to self exclude due to birth trauma or other issues. Plus if it's a preexisting condition, better to stick with a psychiatrist you know/are comfortable with surely? With my 2nd child, I would rather have continued with the psychiatrist I'd been seeing for the past three years as opposed to a brand new perinatal one.

Actually the mother in the scenario did not feel unsafe due to the other patient.
She was significantly unwell and unable to really think clearly whatsoever.
(He was also unwell)

I mostly worry the situation was potentially unsafe for the baby.

The NHS do have some provision for maternal mental health.

I still dont understand? If the gentleman was not making the woman feel unsafe, and you are insinuating she is incapable of caring for her baby due to how unwell she was, then she was in the best place to receive assessment and then treatment and support?

The NHS do have some provision for maternal mental health.

I know. The very first psychiatrist I saw was a peri-natal one in the maternity hospital. He was a patronising twat. However certainly where I am, provision is very limited. Whilst there is a psychiatrist (although they struggle to fill the post here), any psychology input would have been at the specific mental health hospital not in a specialist peri-natal clinic.

Was she already under a psychiatrist prior to giving birth?

I think an MBU with outpatient services and support would have been better. This was not a first appointment nor was it the only one held there.

As it was it took many months to see a perinatal psychiatrist and identify psychosis. At which point the baby was too old and the mum went to under the community team.

I think there is unresolved trauma of such an awful time in the perinatal period and lots of incidents to unpick.

Peri and post natal mental illness is only a small % of those suffering from mental illness. There are specialist perinatal inpatient wards and while it makes good sense to have all peri/post natal outpatient appointments there, the %of women needing an admission is small, so these units are few and far between, meaning someone would need to travel miles if they wanted an appointment in such a facility. Therefore the appointments would need to be in generic mental health facilities. I'm not criticising the mum in this scenario at all,, I totally get she's anxious and wants to protect her baby, but it's difficult to cone up with an answer.

Those with schizophrenia are notoriously chaotic. So even if (for instance) his appointment is in Tuesday and the post natal clinic is on Wednesday, it's common for them to get the day wrong and come on a Wednesday, or not attend a routine appointment at all and present randomly in a crisis. The CMHT in such a scenario will often do their best to take the opportunity to fit that person in while they can, while they've got the opportunity.