The establishment of a mother-baby inpatient psychiatry unit in India: Adaptation of a Western model to meet local cultural and resource needs

Abstract

Background:Several Western countries have established mother-baby psychiatric units for women with mental illness in the postpartum; similar facilities are however not available in most low and medium income countries owing to the high costs of such units and the need for specially trained personnel.Materials and Methods:The first dedicated inpatient mother-baby unit (MBU) was started in Bengaluru, India, in 2009 at the National Institute of Mental Health and Neurosciences in response to the growing needs of mothers with severe mental illness and their infants. We describe the unique challenges faced in the unit, characteristics of this patient population and clinical outcomes.Results:Two hundred and thirty-seven mother-infant pairs were admitted from July 2009 to September 2013. Bipolar disorder and acute polymorphic psychosis were the most frequent primary diagnosis (36% and 34.5%). Fifteen percent of the women had catatonic symptoms. Suicide risk was present in 36 (17%) mothers and risk to the infant by mothers in 32 (16%). Mother-infant bonding problems were seen in 98 (41%) mothers and total breastfeeding disruption in 87 (36.7%) mothers. Eighty-seven infants (37%) needed an emergency pediatric referral. Ongoing domestic violence was reported by 42 (18%). The majority of the mother infant dyads stayed for <4 weeks and were noted to have improved at discharge. However, 12 (6%) mothers had readmissions during the study period of 4 years. Disrupted breastfeeding was restituted in 75 of 87 (86%), mother infant dyads and mother infant bonding were normal in all except ten mothers at discharge.Conclusions:Starting an MBU in a low resource setting is feasible and is associated with good clinical outcomes. Addressing risks, poor infant health, breastfeeding disruption, mother infant bonding and ongoing domestic violence are the challenges during the process.

A systematic review of research on psychiatric mother-baby units

“…Maternal mean age ranged from 24.25 years (Chandra et al 2015) to 33.5 years (Christl et al 2015), and infant mean age at time of admission ranged from 9.6 weeks (Glangeaud-Freudenthal et al 2013;GlangeaudFreudenthal et al 2011) to 7.82 months (Yelland et al 2015). Mean length of stay ranged from 6.93 days in a study in the US (Meltzer-Brody et al 2014) to 11.6 weeks in a study in Israel (Maizel et al 2005).…”

Perinatal mental health: a review of progress and challenges

“…Consensus on the structure and staffing of these units varies internationally, but individual jurisdictions have produced guidance on skill mix and the minimum number of beds needed to retain specialist skills 201,202 . There are differences also in the nature of care for the infant (which varies from care provided by nurses, families providing care also within the unit, to a lack of facilities to admit infants overnight, so that infants are cared for at home other than for a few hours each day on the unit) 203‐205 .…”

Mental Healthcare Act 2017, India: Child and adolescent perspectives

“…In this regard, MHCA does not provide any recommendations for mother-baby units in psychiatric inpatient facilities. Mother-baby units have been started in India[ 16 ] and have addressed risks, infant health, breastfeeding disruption, mother-infant bonding, ongoing domestic violence, among other challenges that come up in caring, especially for postpartum mothers. Older children and adolescents may also have mental health needs when either parent has a mental illness.…”