The specialist Mother and Baby Unit at the Bethlem Royal Hospital has been recognised as providing an example of “best practice” in caring for women suffering with severe mental illness during pregnancy or post-birth.
An NSPCC report released last week suggests the wellbeing of more than one in 10 newborn babies in England could be improved if all new mothers with mental illness had equal access to good services.
The report states there is evidence to show that the work carried out at the Channi Kumar Mother and Baby Unit, part of the South London and Maudsley NHS Foundation Trust, leads to significant improvements in mental state in approximately three quarters of women, in the sensitivity of mothers with schizophrenia and postpartum psychosis when interacting with their babies and major improvements in the interaction of the babies of mothers with schizophrenia, psychosis and depression.
The 13-bed unit was set up for women who develop or have a relapse of serious mental illness during pregnancy or following the birth of their baby. The unit offers a wide range of treatment, therapy and care which is not offered on the same scale in any other unit in the UK.
One unique factor is the work of a developmental psychologist who works closely with the mothers and infants.
Dr Susan Pawlby works clinically as a developmental psychologist at the unit and academically at the King’s College London’s Institute of Psychiatry.
She said: “I think our unit stands out because we have a developmental psychologist to work with nursery nurses and nurses on the ward and most other units do not have that.
“It means we can give mothers and infants more support in forming and maintaining this early and most fundamental relationship. We have developed video feedback interventions so that mothers can see how their babies respond to them. Together we watch video clips of play sessions, talk about the communication between the mother and her baby in order to help mothers develop their relationship with their baby.
“We systematically evaluate this intervention and see how effective it is. Our work is to encourage mothers to respond to their babies’ cues, so that mothers become more sensitive and babies more co-operative in their interaction with one another. I am delighted our work has been recognised by the NSPCC.”
Alongside this support, the Mother and Baby Unit also treats mothers with medication where needed. The unit also offers various forms of therapy (psychological, art psychotherapy, cognitive behavioural therapy and cognitive analytical therapy), life skills, health skills, leisure activities, baby massage and dance therapy.
Following the release of the report the NSPCC is calling on health ministers to lead a drive to address major gaps in access to mental health services for pregnant and new mums.
Mental health problems including depression, anxiety, postpartum psychosis, obsessive compulsive disorders, eating disorders , schizophrenia, post-traumatic stress disorderand personality disorder can begin or escalate when a woman is pregnant or in her infant’s first year. They can have a damaging effect on family life, and in the worst cases, impact on babies’ health and welfare.
Evidence shows that the vast majority of these illnesses are preventable and treatable, and with the right support, the negative effects on families can be avoided.
Sally Hogg, author of the NSPCC report, said: “The Mother and Baby Unit at Royal Bethlem Hospital provides excellent support for mothers suffering from perinatal mental illnesses and their babies. They do fantastic work to help mums to care for and bond with their babies, which helps ensure these children have the best possible start in life.
“It is crucial that more units like this are made available across the country for all families who need them, as without access to specialist units such as this some mothers don’t get the right help and can be separated from their babies, which is traumatic for the whole family.”
For more information on the NSPCC report:
Read Susan’s story here
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South London and Maudsley NHS Foundation Trust is one of only two trusts in the country to have been awarded funding from the Department of Health to increase access to psychological therapies for people with psychosis and their carers.
The funding means that the Psychosis CAG is an IAPT-SMI (Improving Access to Psychological Therapies – Severe Mental Illness) Psychosis Demonstration Site. Expanding access to talking therapies services for people with severe mental illness is part of the Government’s four year plan for talking therapies (2011-2015).
SLaM has a long history of providing innovative and exemplary practice in psychological treatments for psychosis, Cognitive Behavioural Therapy (CBTp) and Family Intervention (FI). Indeed, staff members from the Trust and the Institute of Psychiatry were involved in the initial development and evaluation of both treatment approaches.
The additional funding from the Department of Health will be used to increase therapy provision by 50%. The IAPT-SMI service spans three clinical teams: an Early Intervention team (STEP), a specialist recovery service (SHARP), and a psychological therapy team (PICuP).
The benefits for service users and their carers is improved access to NICE recommended psychological therapies for psychosis (CBTp and FI) across all four SLaM boroughs, with clear referral pathways, including self-referral, reduced waiting times and regular assessment of progress to ensure that therapy is helpful.
Philippa Garety, Clinical Director and Joint leader, Psychosis Clinical Academic Group (CAG), said: “We are delighted that the Department of Health has selected the SLaM Psychosis CAG as a demonstration site. It reflects well on all the hard work and commitment of the staff in promoting access to psychological therapies, which we know to make a real difference in people’s lives.”
A demonstration site open day will take place on Monday 1 July for people to find out more about the IAPT-SMI service from clinicians, service users and carers. There will be presentations, feedback on progress and an opportunity for informal discussions and networking. The event is free, but you are asked to book your place beforehand.
When: 1pm to 5pm 1 July 2013
Where: Ortus Learning Centre at the Maudsley Denmark Hill Campus
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By Lorna Stewart
Use of an avatar can help treat patients with schizophrenia who hear voices, a UK study suggests
The trial, published in the British Journal of Psychiatry, focused on patients who had not responded to medication.
Using customised computer software, the patients created avatars to match the voices they had been hearing.
After up to six therapy sessions most patients said their voice had improved. Three said it had stopped entirely.
The study was led by psychiatrist emeritus professor Julian Leff, who spoke to patients through their on-screen avatars in therapy sessions. Gradually he coached patients to stand up to their voices.
“The avatar gradually changes to saying, ‘all right I’ll leave you alone, I can see I’ve made your life a misery, how can I help you?’ And then begins to encourage them to do things that would actually improve their life.”
By the end of their treatment, patients reported that they heard the voices less often and that they were less distressed by them. Levels of depression and suicidal thoughts also decreased, a particularly relevant outcome-measure in a patient group where one in 10 will attempt suicide.
Treatment as usual
The trial, conducted by Prof Leff and his team from University College London, compared 14 patients who underwent avatar therapy with 12 patients receiving standard antipsychotic medication and occasional visits to professionals.
Later the patients in the second group were also offered avatar therapy.
Only 16 of the 26 patients completed the therapy. Researchers attributed the high drop-out rate to fear instilled in patients by their voices, some of which “threatened” or “bullied” them into withdrawing from the study.
New treatment options have been welcomed for the one in four patients with schizophrenia who does not respond to medication. Cognitive behaviour therapy can help them to cope but does not usually ease the voices.
“As our Schizophrenia Commission reported last year, people with the illness are currently being let down by the limited treatments available.
“While antipsychotic medication is crucial for many people, it comes with some very severe side effects. Our members would be extremely interested in the development of any alternative treatments.”
A larger trial featuring 142 patients is planned to start next month in collaboration with the King’s College London Institute of Psychiatry.
Prof Thomas Craig, who will lead the larger study, said: “The beauty of the therapy is its simplicity and brevity. Most other therapies for these conditions are costly and take many months to deliver.
“If we show that this treatment is effective, we expect it would be widely available in the UK within just a couple of years as the basic technology is well developed and many mental health professionals already have the basic therapy skills that are needed to deliver it.”
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