Case study summary
Devon Partnership NHS Trust has opened the first of four new Mother and Baby Unit (MBU) in the country, funded by NHS England as part of a national transformation programme for perinatal mental health. The trust has re-purposed space at its Wonford House HQ in Exeter as a four-bed temporary MBU, allowing expectant and new mothers with serious mental health needs to be cared for with their babies. Before this interim service opened, mothers in the South West in need of specialist perinatal mental healthcare often had to travel long distances, as did their families.
One in five women will experience a mental health problem during their pregnancy and in the first year after birth, with depression and anxiety disorders being the most common. As well as being crucial to new mothers, new-borns and their families, perinatal services, alongside other treatments for common mental illnesses like depression and anxiety, can play an important role in ensuring mental health is integrated into overall healthcare at the earliest possible stage of life.
NHS England is investing £365 million in specialist perinatal mental health services as part of a five-year programme. This is aimed at increasing access to expert treatment and support for an extra 30,000 women each year, closer to home, when they need it. By April 2019, new and expectant mums will be able to access specialist perinatal mental health community services in every part of the country.
As part of this national programme, Devon Partnership NHS Trust received funding to build a brand new MBU, which is due to open in 2019. In the meantime, the Trust was able to re-purpose unused space at Wonford House as a four-bed temporary unit which allows expectant and new mothers with serious mental health needs to be admitted for care with their babies. Until the opening in April 2018 of the interim service, mothers experiencing severe perinatal mental ill health in Devon, Cornwall or Somerset had to travel outside the region to receive specialist inpatient care at a mother and baby unit.
Dr Jo Black, NHS England’s Associate National Clinical Director for Perinatal Mental Health, is Consultant Perinatal Psychiatrist for Devon Partnership NHS Trust. She describes the difference the opening of the interim MBU has made to service users in the South West.
“If you look at our geography, we have long distances to travel, very commonly, for healthcare, but in the perinatal period when a woman is heavily pregnant or has just given birth to her baby, and has a serious mental health problem, some of those women were travelling hundreds of kilometres away from their families and friends, away from their partners, to access specialist care,” she said. “Or they were electing to stay closer to home to receive care in an urgent inpatient mental health environment, but separated from their new-born baby. That separation is so damaging for both mum and baby, so where possible and safe to do so, the evidence tells us that mums and babies should be together.”
Mothers admitted to Wonford House unit receive the support of around 30 staff, including doctors, nurses, nursery nurses, occupational therapists, psychologists, peer support workers and healthcare assistants. Dr Black added: “For the first time, this unit provides an opportunity for mums from Cornwall, Devon and Somerset to receive that specialist perinatal mental health care as an inpatient along with their baby.”
Women admitted to the mother and baby unit will be experiencing a range of serious mental health issues, such as severe depression, severe anxiety, including obsessive compulsive disorder, and post-partum psychosis, or relapses in pre-existing mental health illnesses such as bipolar or psychosis. Admission to the unit may be planned or managed as an emergency for women experiencing a mental health crisis and for who care and support offered at home is no longer safe or appropriate.
Devon has a well-established perinatal mental health team which works with health and social care professionals to identify women at risk of perinatal mental ill health and provide specialist care and support for them and their families. This ensures women who need inpatient care can be supported as quickly and seamlessly as possible. Outreach practitioners work in the three counties to provide specialist support from the community, through admission to the MBU and discharge back into the community.
The permanent, bespoke MBU that is currently being built in the grounds of Wonford House will have eight beds. Managed by Devon Partnership NHS Trust, it is due to open in early 2019. Along with other families who have lived experience of perinatal mental health issues, Jo Bond and her husband Steve, from Devon, helped the Trust to bid for NHS England funding for the new MBU in their home county.
Jo and Steve have first-hand experience of the vital role of such units after Jo experienced perinatal mental ill health following the birth of their daughter, Summer. Prior to the opening of the temporary MBU at Wonford House, Jo was admitted to Florence House MBU in Bournemouth, which is run by Dorset HealthCare University NHS Foundation Trust. The physical distance from her husband and two other young children added to Jo’s emotional stress.
“I had three weeks without contact with my family. I wouldn’t let them visit and I wanted to leave,” Jo explains. “I discharged myself and my husband came to pick me up. I pretended it was all fine, but I was terrified. Within 24 hours my mood was really low and I became fearful for my own life. It was like an out-of-body experience, thinking I had completely messed up and shouldn’t have come home, but I didn’t want to go back. I had to accept I needed to return and that was horrific.”
Jo returned to the unit in Bournemouth in a St John Ambulance because no family member was able to take her that far. But having accepted she needed the ‘wrap-around’ care that the unit could give, alongside the support of her family, she worked with Florence House staff to create a care plan which included visits from her family and home visits.
“I look back on my journey now and I’m really proud to have gone on that journey and it was pretty amazing – they are amazing places to be”.
Jo Bond, after her support and recovery in a mother and baby unit.
As well as helping Devon Partnership NHS Trust to bid for funding for the new MBU, Jo and Steve have worked with the Trust’s perinatal team to identify what help and support should be offered through the unit. Their ideas have been incorporated into the design of the new eight-bed unit opening next year, which will include a flat for families who have to travel longer distances, allowing them to shower, sleep and have some privacy. They have been immensely helpful and supportive with a range of issues related to perinatal mental health and their input is hugely appreciated by the staff team.
Dr Black added: “It is difficult to overstate the difference this new unit will make to the lives of new mums from across the south west region – and their families. A new mother and baby unit in Exeter means that we can provide the support and treatment that mums need in a good, accessible central location, and that they can continue to be with their babies. This is a huge step forward for everyone involved in perinatal mental health in the south west.”
Dr Jo Black, NHS England’s Associate National Clinical Director for Perinatal Mental Health, describes the difference the opening of a new Mother and Baby Unit in Devon has made to service users in the South West.
Jo experienced perinatal mental ill health following the birth of her daughter Summer. She was admitted to Florence House Mother and Baby Unit in Bournemouth, far from home and her family. After her recovery, she worked with Devon Trust’s perinatal team to bid for a new MBU and identify what support new mums with mental health issues need.