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Table 5 Clinical implications for managing postpartum psychosis and facilitating recovery

From: Psychological interventions for managing postpartum psychosis: a qualitative analysis of women’s and family members’ experiences and preferences

Subtheme

What is needed?

How should this be delivered?

Women

Family

Professionals

Service/policy

1. Seeking safety and containment

“What is wrong?”

Prompt assessment and recognition of postpartum psychosis (PP)

Support to boost their understanding of PP, signposted to credible information, such as APP literature

Complete timely assessment and provide factual information regarding prognosis once diagnosis is made

Specialist training for staff in how to respond and manage PP and increased awareness e.g., through antenatal classes and midwife

“My greatest hour of need”

Emphasis on feeling safe and supported. Ideally inpatient care provided in an MBU

To be involved in decision making and informed of treatment plan

Emphasis on building a relationship and devising a care plan

Need for local MBU provision and specialist community mental health team input

“Ploughing through fog” - Need for hope and reassurance

To be given optimistic and realistic messages about the future

Existing strength and resource recognised and utilised within the family

Need to promote hope, drawing on prognosis literature

Clear clinical pathways. Clarity about how to involve family

2. Recognising and responding to the psychological impact

“It wasn’t me” - Externalising the experience

Support to develop a balanced understanding of PP

To enhance women’s understanding e.g., through own reading and involvement in acute phase

Develop psychoeducation with woman and family. Help to externalise experience and reduce self-blame

Ensure provision of specialist knowledge available in services e.g., through perinatal team

“Somebody else has got through this”

Connecting with peer networks to help normalise experiences

Linking to other family/partners, share experiences and coping

Help to build up confidence and address potential barriers to peer connection

Develop links with wider peer networks e.g., APP

Validation – Recognising and responding to the emotional impact

Emotional impact of PP recognised, utilise both formal and informal support

Family consider their own emotional needs e.g., liaising with MBU staff, GP and personal networks

Complete a flexible and holistic assessment, drawing on biological, psychological and social aspects

Ensuring streamlined clinical pathways, including increased access to psychological therapies

Making sense and processing

Have someone who is knowledgeable about PP to talk to and to make sense with. Allow time to do this

Be guided by the woman e.g., if they want to create a timeline, fill in gaps, then support this process

Recognise long term impact. Promote techniques to enhance coping skills, self-care, self-compassion and acceptance

Ensure pathways consider all areas of need, including access to psychological therapies

Responding to changes in the relationship

Opportunity for joint input to talk through any concerns

Professional guidance, including best ways to support, when to withdraw

Provide guidance to family, help allay their fears and anxieties

Consider family intervention, drawing on evidence-based approaches

3. Planning for the future

“Too good to be true”

Information regarding symptoms to monitor and how to manage

Support how to respond, e.g., when experiencing increased stress

Provide relapse prevention planning – identify triggers and early warning signs

Future plan for when perinatal team withdraws one year postpartum

“It lives with you”

Opportunity for pre-conception counselling

To be involved in counselling, opportunity to share own concerns

Pro-actively offer advice to inform decision making

Further develop clinical guidelines re: pre-conception counselling

Contributing and giving back

When appropriate, utilise opportunities to ‘give back’ and share story

Facilitate involvement and incorporate into service development, e.g., developing peer support networks

Recognising internal resource and seeking acceptance

Strengthening resource, facilitated in earlier stages

Utilise therapeutic approaches that draw upon pre-existing strengths – acceptance and compassion based approaches could be considered.