Academic journal article Indian Journal of Psychiatry

The Establishment of a Mother-Baby Inpatient Psychiatry Unit in India: Adaptation of a Western Model to Meet Local Cultural and Resource Needs

Academic journal article Indian Journal of Psychiatry

The Establishment of a Mother-Baby Inpatient Psychiatry Unit in India: Adaptation of a Western Model to Meet Local Cultural and Resource Needs

Article excerpt

Byline: Prabha. Chandra, Geetha. Desai, Dharma. Reddy, Harish. Thippeswamy, Gayatri. Saraf

Background: Several Western countries have established mother-baby psychiatric units for women with mental illness in the postpartum; similar facilities are however not available in most low and medium income countries owing to the high costs of such units and the need for specially trained personnel. Materials and Methods: The first dedicated inpatient mother-baby unit (MBU) was started in Bengaluru, India, in 2009 at the National Institute of Mental Health and Neurosciences in response to the growing needs of mothers with severe mental illness and their infants. We describe the unique challenges faced in the unit, characteristics of this patient population and clinical outcomes. Results: Two hundred and thirty-seven mother-infant pairs were admitted from July 2009 to September 2013. Bipolar disorder and acute polymorphic psychosis were the most frequent primary diagnosis (36% and 34.5%). Fifteen percent of the women had catatonic symptoms. Suicide risk was present in 36 (17%) mothers and risk to the infant by mothers in 32 (16%). Mother-infant bonding problems were seen in 98 (41%) mothers and total breastfeeding disruption in 87 (36.7%) mothers. Eighty-seven infants (37%) needed an emergency pediatric referral. Ongoing domestic violence was reported by 42 (18%). The majority of the mother infant dyads stayed for <4 weeks and were noted to have improved at discharge. However, 12 (6%) mothers had readmissions during the study period of 4 years. Disrupted breastfeeding was restituted in 75 of 87 (86%), mother infant dyads and mother infant bonding were normal in all except ten mothers at discharge. Conclusions: Starting an MBU in a low resource setting is feasible and is associated with good clinical outcomes. Addressing risks, poor infant health, breastfeeding disruption, mother infant bonding and ongoing domestic violence are the challenges during the process.

Introduction

The joint admission of infants with mentally ill mothers was pioneered by Thomas Main in 1948 at the Cassel Hospital in Surrey, England.[sup][1] The initial joint admissions were limited to patients with neuroses but slowly progressed to include severe mental illnesses in facilities across the United Kingdom (UK), Europe, Canada, Australia, and New Zealand.[sup][2],[3],[4],[5],[6],[7],[8],[9],[10]

The UK National Institute for Health and Clinical Excellence clinical guidelines for antenatal and postnatal mental health recommend that women who need inpatient care for a mental disorder within 12 months of childbirth should normally be admitted to a specialized mother-baby unit (MBU) facility, unless there are specific reasons to the contrary.[sup][11]

Mother-baby unit is an inpatient psychiatry service with at least four beds that are separate from other wards with a facility for joint admission of the mother along with the baby. They are staffed 24-h a day, 7 days a week, by dedicated multidisciplinary staff to care for both mothers and babies.[sup][6] MBUs encourage breastfeeding, are expected to have specific interventions for parenting, provide psychotherapy, enhance mother-infant bonding and offer an opportunity for education regarding the current illness and preventing future episodes. They are also expected to provide support to spouses and caregivers and also involve social services in case of risk to the infant.[sup][7] Admission to an MBU enables a mother to obtain care for psychiatric disorders and simultaneously receive support in developing her identity as a mother. This care is meant to prevent attachment disorders and mother-baby separation.

Most of the data available from countries such as UK, France, Belgium, Australia indicate that 75–80% of mothers have a good outcome.[sup][8],[12],[13],[14],[15]

Lack of dedicated MBUs may result in separation from infants causing mothers to refuse admission, problems with breastfeeding, difficulties in diagnostic evaluation, lack of dyadic psychotherapy, longer lengths of hospital stay, increased chances of relapse after discharge, and increasing the responsibility of caring for the baby on the spouse and extended family. …

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