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. |