First appeared in The OT Magazine issue 12, September/October 2016

The second instalment in our series of articles looking at mental health problems and an OT’s role within them looks into the facts behind post-natal depression.

Mental health is an umbrella term. It covers a whole host of different symptoms and diagnoses.  Mental health problems are only recently becoming understood and accepted as a genuine illness that has very real and physical effects on the mind and body. On the large majority, they are no longer scoffed at as being made up or over-dramatised. According to the Mental Health Foundation: “Mental health problems are one of the main causes of the overall disease burden worldwide.”

Reportedly, one in 10 new mothers will experience a degree of post-natal depression (PND) and even more shockingly, 49% of new mothers with PND will not seek the professional help they need. A lot of factors can contribute to this. A new mother will feel that society not only expects her to take to motherhood like a duck to water, they expect her to do it all by herself and be deliriously happy with the lie she has created. PND, in her mind, is something that happens to other people. The societal stigma around becoming an overnight expert in childcare and some sort of “Superwoman” who other can only be in awe of, is a very real stereotype that women feel the need to live up to, like who they perceive every good mother is.

PND is a very difficult mental health issue to come to terms with and even more difficult to admit you need help with something you expected to be an innate master at.

Even if a mother conjures up the courage to tell someone how they are feeling, regularly it is merely waved off as a case of the “baby blues” and they return to the denial that these, sometimes, very dangerous thoughts will go away in time. But what happens when they don’t?

As a healthcare professional, occupational therapists are on the forefront of helping a new mother return to herself, in every sense of the word. They help her back to being the individual she was before her pregnancy and aid her in coming to terms with not only being a mother, but the a happy and fulfilled woman.

Clinical Specialist occupational therapist, Jenny Shaieb, who works in the Mother and Baby Unit at Bethlem Hospital speaks about her vast knowledge of helping women with PND. She said: “Along with the rest of the multi-disciplinary team, I would be trying to help the woman feel safe and cared for, whilst taking into account the reasons that she had been admitted to the ward.

“I would spend time with her and ask her for her perspective on why she is in hospital; how she feels about being a mother; what her usual day to day routine had been prior to pregnancy and how that has changed (this includes all activities of daily living); has she got accommodation and if so what; who does she live with, if anyone; financial situation; employment (whether paid or not); leisure activities; support systems; how she manages stress; anything else that she feels she wants to tell me. We make a treatment plan that is aimed at what the person wants to get out of her treatment, so that she can leave hospital feeling as well as possible and able to get on with enjoying time with her baby and the rest of her family.

“The whole team works with the individual’s family, and other people that the individual views as important in her recovery, as the support and encouragement of these people can be invaluable. We understand that the family, and in particular the woman’s partner, whether the genetic parent of the baby or not, are also going through a very difficult time and need support so various members of the team (including the OT) offer 1:1 sessions, usually with the partner and close family. If couple work or family work is viewed as a helpful intervention then this is offered, with possible referral to community services.

“By talking about it and encouraging the individual to remember that she is in the process of recovery so it is particularly important that she has periods of time for herself, away from the direct responsibilities of childcare. When someone is at the stage of considering how her time may be used when she leaves the hospital, the ongoing importance of time for herself is reinforced and how that may happen on a practical level is addressed.”

Bluebell is a charity built on the principles of supporting women and their families through the depression related to pregnancies and birth. The Bristol-based foundation has their own occupational therapist, Rachel Jenkins. Rachel has firsthand experience of PND and keeps this in mind when aiding the women in her care. She said: “I joined Bluebell right at the start of the charity and immediately saw the potential for using an occupational approach. Having experienced both antenatal and postnatal depression and anxiety myself I already had empathy for the subject. Most of us at Bluebell have lived experience of perinatal mental illness which helps us to relate to our client base. Families also tell us that they find it easier talking to someone who has lived through similar experiences.

“An occupational approach to treatment of perinatal mental illness is very relevant due to the number of life changes experienced during this time. Daily routines and roles all change dramatically and occupational imbalance and deprivation are common. Ironically I have found it is often those mums who have successful careers with lots of responsibilities who find the change in routine the hardest. Loss of the worker role and the identity attached to this are very common. Social isolation is also a big issue and I have found this especially the case for professional women who feel they cannot tell their peers for fear of being judged.

“Bluebell has a unique programme of support which utilizes a network of peer support workers and clinicians such as myself and counsellors. I facilitate a group programme called Mums’ Comfort Zone which runs for 12 weeks. Each week we look at a different aspect of anxiety and depression and then offer a practical tool for management of these conditions. The idea is that each person builds up their own unique toolkit to aid their recovery. Group numbers are small (6-8) and we run a free crèche alongside so that mums can have some time-out to really focus on their own recovery. We focus on anxiety management techniques such as breathing and progressive muscle relaxation, exploring daily routines and finding ways to a better balance, use of interest checklists, music and mood, food & mood, relationships, self-esteem, aerobic exercise, sensory exploration and introductions to CBT and medication. Mums are supported by their Bluebell buddy peer support worker throughout with either phone calls or individual visits. The groups are run from children’s centres in Bristol, which provide a supportive and normalising environment.

“An exciting development is Bluebell Place which will be opening in September. This is our high street office base in the centre of Bristol which will be a freely accessible space where we will provide therapeutic groups, counselling and drop-in coffee mornings for any family experiencing perinatal mental illness.”