MBUs in the UK: value and cost

As academics, clinicians and leaders of UK charity Action on Postpartum Psychosis (APP), we campaign for mother and baby units (MBUs) for women with postpartum psychosis. We hear daily of their importance and the devastating consequences of units not existing.

The methodological limitations of this study are laid out by the authors and must be borne in mind when interpreting the findings. Owing to the small sample, the control group consisted of women who received treatment from general psychiatric units (GPW) and women receiving home treatment, which typically provides care for women with less severe illness. Therefore, as the authors explain, the inclusion of home treatment is likely to mask differences between MBU and GPW care. This is confirmed by the study's findings showing differences between the home treatment group and in-patients: women with severe and relapsing illness are underrepresented. When these groups are examined separately, readmissions are in the expected direction (22% MBUs, 32% GPW, 21% home treatment).

Twelve-month relapse rates are a problematic outcome measure for several reasons. In patients with postpartum psychosis and pregnancy-triggered bipolar, relapses are common and represent the expected illness course rather than indicating care quality. MBUs have a lower threshold for readmission than GPWs. Women admitted to MBUs are willing to be readmitted when struggling with mental health, whereas those separated from their baby for non-specialist treatment will not return willingly.

Many hidden costs associated with GPW admission have been included, up to 1 month post discharge – services that are integral to MBUs but whose costs are born elsewhere during GPW admission. Costs may occur later; the quality of these services cannot be compared. The personal stories of mothers admitted to GPWs demonstrate later hidden costs: counselling following the trauma of GPW admission; legal aid to regain custody of children; and financial hardship when fathers, co-parents or other family become the baby's primary caregiver.

Women in this study were more satisfied with MBU versus GPW or home treatment. This is consistent with a 2010 APP survey showing that mothers felt safer, more satisfied, informed, confident in staff, supported with recovery and confident with their baby. In addition, there is evidence of fewer suicides to women admitted to MBUs versus GPWs.¹

GPWs are inexperienced in providing postnatal care, causing shame and indignity for mothers. They lack facilities and safe spaces for babies and siblings to visit. During a several-month-long admission, the impact on family life can be catastrophic. MBUs provide holistic care, supporting attachment, feeding and parenting skills. Mothers treated alongside other mothers benefit from informal peer support.

The costs and outcomes of perinatal psychiatric care are broader than clinical recovery and include outcomes for the infant, partner, family dynamics, and the long term psychological well-being of the woman and her legal and human rights. The early months of motherhood are precious. Women have a right to adequate maternity care that should be acknowledged and supported by mental health services.

This is a long overdue but challenging attempt to understand the value of MBUs – an area of international importance. Powerful stories, case series and qualitative work show their importance.^{Reference Clarke2–Reference Heron, Gilbert, Dolman, Shah, Beare and Dearden4} MBUs contribute to system and societal change: building capacity, changing attitudes, and increasing knowledge and skills. The UK leads the world in their development – and should continue to do so with further investment, to ensure all women can access lifesaving services.