A systematic review of research on psychiatric mother-baby units

Connellan, Kathleen; Bartholomaeus, Clare; Due, Clemence; Riggs, Damien W.

doi:10.1007/s00737-017-0718-9

Cited by 48 publications

(39 citation statements)

References 59 publications

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“…Shame, guilt and fear that the illness may have an impact on their child, the associated stigma of mental illness, increased rates of custody loss and a lack of services and supports are consistently identified issues [ 8 – 10 ]. Research on MBUs suggests positive outcomes for women [ 11 , 12 ]. However, there is little qualitative research undertaken within MBUs due to the severity of illness in the mothers, which means our understanding of this vulnerable group is limited.…”

Section: Introductionmentioning

confidence: 99%

Patient experience of a psychiatric Mother Baby Unit

et al. 2018

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BackgroundMothers with severe mental illness are vulnerable and engage with services cautiously due to fears of stigma and custody loss. To develop best practice standards and patient-centred services, the subjective experience of those who use it must inform service improvement and policy.MethodThis study utilised exploratory concurrent mixed methods design with primarily qualitative data. Women admitted between April 2015 and December 2016 to a newly developed psychiatric Mother Baby Unit (MBU) in New Zealand were invited to participate in this study. Qualitative data were collected in three ways: (i) semi-structured interviews incorporating Māori concepts of health and wellness by research assistants near discharge; (ii) invitation to provide anonymous feedback in writing using an open format; (iii) unsolicited verbal feedback provided during a home visit three months after discharge. Thematic analysis was undertaken. Demographic and clinical information was collected prospectively for mother-infant pairs during the course of admission and three months post-discharge.ResultsForty-five people participated in the study. High rates of satisfaction were described. Strengths of the service–as perceived by mothers–included co-admission of mother and infant, staff warmth and availability, transparent practice, inclusion of families, and having a comfortable environment. Mothers described intense distress and confusion, as well as negative self-perceptions when acutely unwell. Infant co-admission and the inclusion of partners and other family members alleviated mothers’ distress. Personal attributes of staff, practical support with caregiving, a range of therapeutic approaches and holistic care were all valued. Feedback collected three months after discharge was the most reflective. Significant inter-ethnic differences were not apparent.ConclusionsThe experience of inpatient care can have lasting influence on recovery and wellbeing. Employing a Māori model of health broadened the holistic nature of enquiry. The approach and timing taken in seeking the views of participants’ yielded different information, all of which is of value to service evaluation and refinement. The findings suggest that keeping mothers and infants together during health service utilisation such as MBUs should be a priority for policy makers and service designers. This approach is consistent with Māori values, combining the importance of whānau relationships (kinship), wairua (spiritual connectivity), hinengaro (the mind) and tinana (physical health). These findings suggest that ‘holistic care’–in this case following a Māori holistic health model–is important in mental health settings.

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Section: Introductionmentioning

confidence: 99%

Patient experience of a psychiatric Mother Baby Unit

et al. 2018

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“…The ambition is to provide care concordant with the Antenatal and Postnatal Mental Health Guidelines produced by the National Institute for Health and Care Excellence (NICE) 2 to all women needing it. In other countries, there have also been ‐investments in specialist outpatient and/or community perinatal mental health services and/or in mother and baby units 3,4 .…”

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confidence: 99%

Perinatal mental health: a review of progress and challenges

2020

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Perinatal mental health has become a significant focus of interest in recent years, with investment in new specialist mental health services in some high‐income countries, and inpatient psychiatric mother and baby units in diverse settings. In this paper, we summarize and critically examine the epidemiology and impact of perinatal mental disorders, including emerging evidence of an increase of their prevalence in young pregnant women. Perinatal mental disorders are among the commonest morbidities of pregnancy, and make an important contribution to maternal mortality, as well as to adverse neonatal, infant and child outcomes. We then review the current evidence base on interventions, including individual level and public health ones, as well as service delivery models. Randomized controlled trials provide evidence on the effectiveness of psychological and psychosocial interventions at the individual level, though it is not yet clear which women with perinatal mental disorders also need additional support for parenting. The evidence base on psychotropic use in pregnancy is almost exclusively observational. There is little research on the full range of perinatal mental disorders, on how to improve access to treatment for women with psychosocial difficulties, and on the effectiveness of different service delivery models. We conclude with research and clinical implications, which, we argue, highlight the need for an extension of generic psychiatric services to include preconception care, and further investment into public health interventions, in addition to perinatal mental health services, potentially for women and men, to reduce maternal and child morbidity and mortality.

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“…This will be the first study to examine the feasibility and acceptability of conducting a RCT of a manualised parenting and psychological intervention for women admitted to one of two inpatient MBUs. It is also the first feasibility RCT to examine the possible benefits of a manualised parenting intervention in an acute inpatient setting with this population [ 18 , 70 ]. The intervention is first offered in the MBU and, depending on admission time, it continues following discharge, offering continuity of care to participants whose care has to be transferred from inpatient acute psychiatric care to community care following MBU discharge.…”

Section: Discussionmentioning

confidence: 99%

Enhancing maternal and infant wellbeing: study protocol for a feasibility trial of the Baby Triple P Positive Parenting programme for mothers with severe mental health difficulties (the IMAGINE study)

Wittkowski

Cartwright

Emsley

et al. 2018

Trials

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BackgroundThere is a strong evidence base for the benefits of parenting interventions for parents without severe mental illness (SMI). As the impact of maternal SMI can be significant on child development, mothers need support to maximise outcomes for themselves and their children. Some mothers with SMI require admission jointly with their baby to a Mother and Baby Unit (MBU), a psychiatric inpatient ward, for assessment and treatment. However, MBUs do not yet offer formally evaluated, evidence-based parenting interventions as a matter of routine. This paper describes a study to investigate the feasibility and acceptability of conducting a randomised controlled trial (RCT) to evaluate a parenting and psychological intervention targeting the mother’s and infant’s wellbeing for mothers admitted to a MBU.Methods/DesignThis study is a multisite, single-blind feasibility trial with half the participants randomised to the Baby Triple P Positive Parenting Programme plus treatment as usual (TAU) and the other half randomised to TAU alone. Self-report and observer-rated assessments are collected at baseline, 10 weeks post-baseline and 6 months post-baseline. Participants are mothers admitted to a MBU in the Northwest of England or the Midlands. Participants are included if they are fluent in English to provide informed, written consent. Our objective is to determine whether we can recruit 66 women, randomise 60, and retain them in the intervention and study, and whether the intervention and study procedures are acceptable. As part of a nested process evaluation, qualitative interview data from trial participants and MBU staff will inform feasibility and acceptability. The feasibility of collecting data required to conduct an economic evaluation of the intervention will also be explored.DiscussionAlthough research has been conducted in relation to mothers with severe mental illness and MBUs, to our knowledge, this is the first controlled trial to test the feasibility, acceptability, uptake and retention alongside the potential efficacy of a parenting intervention for this population. This study is essential to examine the contextual challenges involved in this setting with this population and to identify any refinements required.Trial registrationISRCTN12765736. Date of first registration: 2 February 2017.Electronic supplementary materialThe online version of this article (10.1186/s13063-018-2869-z) contains supplementary material, which is available to authorized users.

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A systematic review of research on psychiatric mother-baby units

Cited by 48 publications

References 59 publications

Patient experience of a psychiatric Mother Baby Unit

Patient experience of a psychiatric Mother Baby Unit

Perinatal mental health: a review of progress and challenges

Enhancing maternal and infant wellbeing: study protocol for a feasibility trial of the Baby Triple P Positive Parenting programme for mothers with severe mental health difficulties (the IMAGINE study)

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