Experiences of Mental Health Care Among Women Treated for Postpartum Psychosis in England: A Qualitative Study

Barriers to care and treatment experiences among individuals with postpartum psychosis

PURPOSE

Postpartum psychosis (PP) is a severe psychiatric disorder affecting 1-2 per 1,000 deliveries. Prompt access to healthcare and timely initiation of treatment are crucial to minimizing harm and improving outcomes. This analysis seeks to fill gaps in knowledge surrounding barriers to care and treatment experiences among this population.

METHODS

Participants were individuals with histories of PP who enrolled in the Massachusetts General Hospital Postpartum Psychosis Project (MGHP3). The MGHP3 Healthcare Access Survey, a cross-sectional questionnaire, assesses barriers to care, treatment-seeking behaviors, and experiences with treatment. Descriptive statistics were utilized to describe sample characteristics.

RESULTS

139 participants provided 146 episode-specific survey responses. Lack of available services was cited as the greatest barrier to care for PP. Among those who sought treatment, obstetric providers (34.5%) and emergency medical professionals (29.4%) were the most common initial points of contact. 82.2% of the respondents went to an emergency room or crisis center during their episode(s). Most (61.8%) reported being given insufficient information to manage their PP. Approximately half of participants were hospitalized (55.5%), the majority of whom had no access to their infant during hospitalization (70.4%). Of those breastfeeding or pumping at admission, 31.3% were not given access to a breast pump. 44.4% dealt with delivery-related medical issues during their hospitalization.

CONCLUSION

This report is the first of its kind to assess key public health domains among individuals with PP. Findings point to several directions for future research and clinical practice to improve treatment timeliness and quality, potentially improving long-term outcomes related to this serious illness.

The lived experiences of individuals with postpartum psychosis: A qualitative analysis

Postpartum psychosis (PP) is a severe psychiatric illness that occurs in about 1 to 2 per 1000 people in the perinatal period. To date, qualitative research investigating PP has focused on specific topics, such as treatment experiences or the impact of the illness on patients' lives and families. These studies have included small samples of women with histories of PP, often limited to certain geographical areas or treatment centers. Given the heterogeneity in presentations of PP and access to care, larger and geographically diverse samples are needed to broadly understand this complex illness. Initiated in 2018, the Massachusetts General Hospital Postpartum Psychosis Project (MGHP3) consists of a large, international sample of those who have experienced PP. In addition to the specific aims of MGHP3, which include to better understand the phenomenology and potential genetic underpinnings of PP, this investigation invites participants to qualitatively describe their narratives of postpartum psychosis. This analysis included 130 participants who reported on 133 episodes of PP. Participants' responses to the PP narrative prompt fell under several overarching categories: 1) broad psychosocial experiences surrounding postpartum psychosis, 2) impact on the mother-baby dyad, 3) treatment experiences, and 4) recovery experiences. Our findings shed light on a range of ways in which individuals' lives are impacted by this illness, and point to areas for future research and clinical directions to improve the support and care for individuals with PP and their families.

Postpartum Psychosis: A Review of Risk Factors, Clinical Picture, Management, Prevention, and Psychosocial Determinants

Postpartum psychosis is rare, but is a serious clinical and social problem. On its own, it is not included in DSM-5 (Diagnostic and Statistical Manual of Mental Disorders) or ICD-10 (International Statistical Classification of Diseases and Related Health Problems) as a disease entity, and current diagnostic criteria equate it with other psychoses. This poses a serious legal problem and makes it difficult to classify. The disorder is caused by a complex combination of biological, environmental, and cultural factors. The exact pathophysiological mechanisms of postpartum psychosis remain very poorly understood. There is a need for further research and increased knowledge of the medical sector in the prevention and early detection of psychosis to prevent stigmatization of female patients during a psychiatric episode. It is necessary to regulate its position in the DSM5 and ICD-10. Attention should be paid to the social education of expectant mothers and their families. This article aims to review the current status of risk factors, prevention, and management of postpartum psychosis.

The ambulatory treatment of postpartum psychosis in Israel

Postpartum psychosis is a severe psychiatric disorder that occurs following childbirth. Due to its severity, postpartum psychosis is generally treated in an inpatient hospital setting. In this original contribution, we present the ambulatory treatment of postpartum psychosis and advocate that an ambulatory setting can be feasible under the right circumstances. In this article, we provide an overview of the Israeli legal system and its implications when treating maternal mental illness. We present the process by which we treat a woman with postpartum psychosis in an ambulatory setting. We provide a case example of the successful treatment of postpartum psychosis in an ambulatory setting and list general strategies to utilize. We demonstrate that an ambulatory approach to postpartum psychosis is not only possible, but also has significant benefits. We suggest that the ambulatory treatment of postpartum psychosis was developed in Israel as a direct result of its liberal legal system. Specifically, because of the legal system's value on patient autonomy, acute psychiatric illnesses such as postpartum psychosis are at times treated in outpatient settings. Additionally, we posit that Israel's unique culture provides the framework to support its implementation. We review the challenges of the treatment in the case example as well as other anticipated challenges that may arise with a broader application of this approach. Our hope is that this novel presentation will lead to more nuanced and holistic treatment of postpartum psychosis.