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.

I think an MBU with outpatient services and support would have been better

Quite possibly but they'd need to increase provision drastically in order for that to happen. I'm a 2 and half hour drive from my closest MBU. That would have made accessing weekly appointments an absolute nightmare. I believe there are 12 beds in Scotland and they're all in the central belt.

I'm not entirely sure what you think would have been better OP. If the lady had major depression prior to the pregnancy, the decision might have been made that it was better to continue with a local psychiatrist, possibly one she already knew and knew her. It may also have been that the mother and baby unit wasn't particularly accessible or was a long distance away or didn't have capacity. In terms of the waiting room incident, I'm sure the service do try and manage patients to some extent. It may have been the other patient was particularly unwell and they were not expecting such a deterioration. It may have been that he was vocal but that was it. I think the receptionist will be experienced enough to know when to make someone wait outside or get someone moved straight from reception to the consulting room. I'm also unsure whether OP you are the lady referred to and are recovering and now have anxiety and are thinking what ifs regarding your little one. Whatever the case, I'm glad the mum is on the mend.

I can understand this. The mother would be well within her rights to question her treatment at this time. She could go through PALS.

The more I read, the more I think the mother should not have been sent for an outpatient mental health appointment in the first place, and the crisis team would have been the most appropriate. But we’ve now got the benefit of hindsight and I don’t know all the clinical details and decision making of this particular case.

I am sorry she had such a terrible time. Feeling let down by services at such a vulnerable time compounds the trauma, and all feelings here are valid.

Thank you. There have been some very understanding people on here.

Yes, the mum in questions was me. And I can see a bit clearly since writing this that statistically, my baby was sadly probably most at risk from me, and not from the man in the waiting room.

So glad you’re doing better now @custodial2

We need to do better for women in the postpartum period. I hope you can heal from your experiences and have lots of joyful times with your baby.

That's extremely hyperbolic and nonsensical.

I never said anything of the sort.

Luckily others on this thread can read my posts and see exactly what I said

Please don't go away and question yourself. Ignore the callous ones on this thread.

I hear you.

I understand you. I think you have raised a fair and valid point (a mental health manager also thinks so on this thread)

Your motherly instincts are kicking in.

You were put in an alarming and inappropriate situation.

Don't question yourself or think you are in the wrong. Your opinion and experience matters ❤️

Nice bit of passive aggression

You got help though OP and you're on the mend. It wasn't your fault any more than it was the man in the waiting room fault, you were both ill. I was in a MH hospital at one point, it takes time to process that you've been ill and your experiences while you were. Be really kind to yourself. And be proud of how far you've come.

Some of these replies are getting worse by the page. It's a pile on and kicking a very vulnerable new mother when she's already not in a good place mentally. That's low. Very low.

She felt extremely vulnerable with an agitated paranoid schizophrenic near her and her baby in a room where she had to continue to be in.

Back in the real world, there's not many people who'd feel comfortable sitting with a 5 week old in that situation. Come on.

Please please don't think you're being paranoid and unreasonable op. You're being a good mum by being mindful of your babies safety. It's an unpredictable circumstance. He didn't sound well medicated and stable. He was presumably there because he was unstable. It poses a credible risk to the average mind!

The poster passively aggressively insinuating the op is more of a risk to her own baby all because the op had a valid concern about an agitated seriously mentally ill, vocal male present, is a particularly cold and callous one.

I think op should ask for this thread to be taken down to protect her MH further.

Our service sees everyone at home and do not require 2 members of staff to do so. We're extremely flexible (to a fault sometimes and patients then do take the piss a bit IMO!) with appointments.

NICE guidance is referrals up to 1 yr postpartum, our service can "keep" a patient until baby is 2 where appropriate.

Am surprised in this case that the mum was at a general OP clinic and not under the Perinatal psychiatrist, especially as baby was under 1

@NotSmallButFunSize That sounds brilliant, if only all perinatal teams were like yours!

It was a shambles but I unfortunately did keep many of my darkest feelings and fears inside.

You keep referencing mother and baby units and how they could have outpatient services. You’re lucky if there’s one mother and baby unit in a region. Our closest one is several hours away. It would be far more inappropriate for mothers to have to travel that far for outpatient care.

It's not an ideal situation, but without knowing the background it's hard to judge. It's really not the receptionists job to do anything. Ideally either the mum would have left the baby with someone else for the appointment, or there would have been somewhere else to wait.

I don't think it's the job of that clinic to find somewhere else for her to wait though. If her mental health problems are so bad that a social worker or other kind of caretaker organises her appointments and organises support for her with the baby anyway, then it's her job to organise a babysitter for the appointment. In the same way as it would be for any other mother going to a medical appointment.

Am surprised in this case that the mum was at a general OP clinic and not under the Perinatal psychiatrist, especially as baby was under 1

I'm not. I tried to kill myself when dc1 was in Nicu. Saw the perinatal psychiatrist who said I'd be fine. Was far from fine to the point my GP put in an urgent referral when ds was 8 weeks old. Spent the next 6 years under CMHT. When I got pregnant again, perinatal said to stick with CMHT rather than switch much to the annoyance of my consultant obstetrician. I imagine scenarios like that where either something isn't picked up properly or a woman is already receiving care happen regularly. From what the OP has said, I wonder if care predated pregnancy.

Services absolutely should be better though. This thread reminded me I filled in a survey about increasing Mother and Baby unit provision in Scotland years ago but it doesn't look as if anything has changed.

It’s wholly unreasonable to expect a mother with a newborn baby to leave the baby at home for an appointment for her postpartum mental health. In an ideal world, yes there would be someone who could watch the baby for her so she could attend the appointment uninterrupted. But in reality, the mother may be breastfeeding on demand so can’t leave the baby. She may not have a supportive partner or family/friends to babysit. She may not be able to afford a babysitter, or trust a stranger with her tiny baby. This is someone in acute distress with postpartum psychosis - services need to be reducing all possible barriers in order to support women so that they can live.

Also I attended many medical appointments when I had a newborn, it was never an issue. There is not an expectation in NHS health services that newborn babies cannot attend appointments with their mothers. Obviously I’m not including appointments which involve medical procedures, but a standard GP appointment, sure.

I agree that I don’t think a lot of these posts are helpful for the OP and I wouldn’t be surprised if she wanted this thread removed.

Clearly you haven't experienced mixed sex inpatient wards ( including secure ones) where vulnerable patients with physical and learning disability share space with agitated young men, some of whom have significant forensic histories. My point is that vulnerable patients are put in far riskier scenarios than mentioned in your post.

MBUs and specialist perinatal services are the ideal but practically aren't always achievable. Controversial but I would argue that too much funding may be directed to perinatal psychiatry ( for non psychotic illness esp) to the detriment of other very unwell patients. As others have mentioned puerperal psychosis is rare and as a result a stand alone unit is simply not viable in every locality. More broadly, there is a compelling case than increasing sub specialisation undermines the traditional CMHT model that can work well for the core constituency of SMI patients.

Finally I would agree with others that the language and tone does veer into stigma towards people with schizophrenia. The patient may have referred to himself as ' schizophrenic' but it is dehumanising terminology. And it doesn't mean it was necessarily his diagnosis either!

There was nothing stopping the op from taking her baby. Other far more vulnerable and younger patients have to manage it up. That’s mental health provision in this country.When children as young as 12 are having to be sent the other side of the country away from family for inpatient we absolutely should not be diverting money to maternal MH particularly for facilities not likely to be used that much. As it was the op was clearly in the right place and got the support she needed.

Yy re the stigma and MH - lots of conditions aren’t pleasant or pretty to look at. I’ve witnessed some highly distressing things whilst waiting for care for my children. It is what it is and the unpleasant tone towards patients clearly in the right place isn’t pleasant.

I agree re the stigma around certain conditions which shows on this thread.

I also think there is a stigma when it comes to male mental health compared to women’s and the assumptions of violent behaviour. The only experience I have had of violent behaviour (not just loud) in a waiting room at a MH clinic was actually a women who was obviously very ill. Being there with DS (9 and the patient - whole other issue there!) was scary but the staff dealt with it and hopefully she got the help she needed.

unfortunately mental health issues are unpredictable, some more than others.

The OP is just recounting her own experience at a time of crisis and her concerns over her care at that time are legitimate.

If she felt unsafe in the waiting room because a male patient was behaving erratically, that doesn’t mean she holds stigmatising attitudes towards those with psychosis. The OP herself states that she was diagnosed with post partum psychosis. Considering the amount of women who have experienced abuse from men, traumatised women are often uncomfortable around men, including in MH settings. This does not mean they are behaving in a discriminatory or stigmatising way towards men.

The tone policing on this thread is silly, people projecting their personal experiences of poor care aren’t helpful to the OP. It’s not a race to the bottom.

She hadn't 'simply had a baby', she had mental health problems, and quite severe ones by the sound of it, caused by the pregnancy.

Work works have to be done on the numbers that need help, and treatment outcomes in specialised Vs general mental health services.

Given the current focus (locally at least) on the first thousand days of a child's life, I would hope these questions will be asked.

I also wonder what CMHTs think of it, what percentage of their workload it makes up. Locally, as everywhere, CMHTs have long been under huge pressure, but the last 3 or 4 years have seen a massive increase in adult ADHD referrals, so a dedicated service is being set up. Now you can argue ND shouldn't come under mental health anyway, but I think you can equally argue that mental health issues caused by pregnancy and birth shouldn't be treated by general mental health services.

More money is needed of course. I've worked for a mental health charity (just closed after we lost funding) for 20 years and have a 12 year old who I'm scared is going to be turned down for help by CAMHS for the third time, because his anxiety, depression - and presumably now his self harm - is just to do with his autism and therefore fine. The whole system is a mess and is failing the most vulnerable.