Specialised mother and baby units needed for perinatal mental health 

Perinatal mental health, particularly the absence of a specialised mother and baby unit (MBU) within the entire island of Ireland, was a major theme at the College of Psychiatrists of Ireland (CPsychI) and Royal College of Psychiatrists Northern Ireland Winter Conference 2025. Northern Ireland is the only region in the UK that does not have a dedicated MBU. The establishment of one was recommended by the Regulation and Quality Improvement Authority in 2017, while in the Republic, the same recommendation was made in the same year within the HSE’s model of care for specialist perinatal mental health services. Despite renewed commitments by authorities on both sides of the border to establish units in Dublin and Belfast, no timelines are in place for work to begin. This means that mothers with serious postnatal mental health issues are admitted to general psychiatric wards and, therefore, separated from their newborn infants.

According to Dr Trudi Seneviratne, Consultant Adult and Perinatal Psychiatrist, South London and Maudsley NHS Foundation Trust, and Perinatal Clinical Director, South London Partnership, UK, “the cost of separating mothers and their babies is far too great.” Dr Seneviratne – who has been awarded several honours in recognition of her contribution to perinatal psychiatry in the UK, including the President’s Medal from the Royal College of Psychiatrists – spoke at the first session of the conference, which was chaired by Dr Julie Anderson, Consultant Perinatal Psychiatrist, Northern Health and Social Care Trust, and titled: ‘Why MBUs matter’. She delivered an overview of the value of optimal perinatal mental healthcare, shared professional experiences from her 30-year career, and stressed the value of MBUs and perinatal teams in achieving optimal outcomes for mothers and infants.

Delegates then received a firsthand account of the true cost of separation when Ms Laura Orr, who was previously under the care of a perinatal community mental health team (CMHT) in Northern Ireland, addressed the conference. The mother-of-one talked openly and candidly with Dr Anderson about her need for an acute admission just 48 hours after her daughter was born. Without an MBU, the only pathway was to an acute general mental health ward.

 “I knew this meant separation from my daughter,” she said, adding that she had no previous history of mental illness. “My only risk factor was that I had a baby,” she told delegates, before describing the onset of post-partum symptoms like “intrusive thoughts” and “distressing lucid dreams” that led to her need for admission.

The conference heard that although the staff in the psychiatric ward “really did care” and provided the best service they could, a general unit is “not an appropriate place for a new mum” and was unable to meet specific postnatal needs, such as post-partum bleeding, expressing breast milk, and episiotomy care. “They were psychiatrists not midwives. They were not health visitors or lactation consultants. The physical element of recovery was very difficult,” Ms Orr said, before providing deep insight into the true impact of separation.

“My diagnosis was adjustment, panic, and depressive disorder. How do you adjust to being a parent if you don’t have a child there?… I thought at one point that she had died and they were keeping it from me. I was planning her funeral in my head…. Separation is the antithesis of what new mums need.

“I thought somebody else might be better placed to be her parent because I wasn’t getting the access I needed. Everybody else knew about her routines, they were the ones taking care of her. There isn’t just one person affected…. When I went home, I felt like a stranger. It was very hard to navigate functioning as a family of three with any hope for the future.”

The talk ended with an account of Ms Orr’s full recovery and her expression of gratitude towards the perinatal CMHT, who had just been established in the months prior and provided care during and after the admission for a total of seven months. “They gave me the opportunity to talk through and work through the reasons for my admission,” she said. “I had a team that really understood the reasons for my admission and had the answers others didn’t because they are a specialist team. They were very step-by-step with care and really took their time. It never felt rushed and I am very grateful for their intervention.”

After the session, Dr Karen O’Connor, Vice-President and Academic Coordinator of the CPsychI, described the talk as “really moving”, and thanked the past patient for making the session “so real” and relevant. Addressing her colleagues in the audience, Dr O’Connor added: “We all need to keep the pressure on and work together to make sure this [establishment of MBUs] actually happens.”

Perinatal mental health also featured among the parallel sessions at the conference. A perinatal workshop was delivered by Dr Catherine Hinds, Consultant Perinatal Psychiatrist, National Maternity Hospital, Holles Street, Dublin, and Dr Richard Duffy, Consultant Perinatal Psychiatrist, Rotunda Hospital, Dublin. The interactive learning session introduced a complex case to highlight a range of complicated perinatal issues such as pre-birth planning, child protection, and infant mental health.