A week after Cathrine became a mother in 2019, she was admitted to the closed ward at Sandviken psychiatric hospital in Bergen. – Then there was actually complete panic for me. And that’s when all the instincts and the bear in me woke up. Cathrine describes her time in a psychiatric hospital as chaotic and filled with trauma. Here she was admitted alone for two months and it took a month before she could see her son again. – I had to go through a lot, hell actually, adds Cathrine. She has called for a better offer and more information for those who find themselves in the same situation as her. – I think a kind of mother-child center where you can come with postpartum psychosis, breastfeeding problems and everything in between, could be a solution, Cathrine told news last year. But little did she know that such an offer already existed – only in Trøndelag. Hospitalized with children and partners For in Orkland in Trøndelag, an offer was created in 2018 where mothers can be hospitalized together with children and partners. – We also know that mothers who are not separated from their infants have a shorter course of illness. That’s according to psychologist specialist at Helgeland Hospital, Malin Olsen Johansen. In Norway, the vast majority of those who develop postpartum psychosis are admitted to an emergency psychiatric ward, such as Cathrine. But in Orkland they are quickly transferred to a family flat and reunited with their child. Psychologist Malin Olsen Johansen says they are now starting a clinical examination to find out if the offer works and has the desired effect. Photo: private Olsen Johansen explains that separating mother and child can worsen the mother’s condition. – It will be the ultimate confirmation that I will not be able to do this. But then it is also absolutely necessary for mother’s mental health that we start treatment aimed at her. This is precisely what Cathrine sees as the reason why she was admitted to the emergency psychiatric ward for the second time. – Then I was hospitalized because of a few other things. Then there was postpartum depression, anxiety and I started to have some suicidal thoughts because of how hard it was to come back. – It had been so much about the postpartum psychosis and that I was ill, but very little about the mother’s role and all the worries I had about it, Cathrine adds. In Orkland, the mother receives treatment for her illness and follow-up on the interaction and relationship with her child. From 2024, this offer will also be available at Helgeland Hospital in Mosjøen. In the family flat at Nidelv DPS, the mother can live together with the child and another carer. Cathrine was locked in such a room. She got a mattress in at night and the window was sooty that she couldn’t see out. The photo is from 2017 and was taken in connection with another case. With postpartum psychosis, the mother may become less sensitive to the child’s signals. – It can create frustration in the mother and fuel thoughts such as “I can’t do this. I don’t understand my child. I am a failure”. Which in turn reinforces the depression or psychosis that is developing, explains the psychological specialist. – It’s random what treatment you get In countries such as England, Australia and France, there are special wards where mothers with postpartum psychosis are admitted with their child. – It is considered best practice to have integrated maternity and mental health units where mothers and children are admitted together. Olsen Johansen also says that there is no separate specialization that deals with mental health in maternity in Norway. – Now it is treated as an ordinary psychosis, but it is not an ordinary psychosis. That is why someone in Orkland and Mosjøen has created an offer that combines child and adult psychiatry. Treatment options for mothers with postpartum depression and postpartum psychosis It is estimated that around 10–20 per cent of pregnant and new mothers who are affected by perinatal mental illness need specialized treatment. Postpartum depression affects around 10–15 per cent of all new mothers. Postpartum psychosis affects 1 to 2 out of 1,000 women after childbirth. Integrated maternity and mental health units where mothers and children are admitted together are seen as best practice, but in Norway this only exists in Orkdal and Mosjøen. The offer is based on a model that already exists and on the structure of Norwegian mental health care. The treatment consists of combining the admission that the mother receives anyway with a collaboration with child psychiatry. The mother, child and an additional carer are then placed in a family flat at the district psychiatric centre. The additional carer is responsible for the child, at the same time as the mother receives treatment. Adult psychiatry follows up the mother and child psychiatry follows up children, partners and the interaction in the family. Demand is high and there are only two places. This forces a prioritization of the sickest. Those who are offered these two places have often visited an emergency post first because they could be a danger to themselves or the child. The aim is for the mothers to spend as short a time as possible in the emergency department before continuing with the treatment, at the same time as they receive follow-up on the relationship with the child. – Here I am doing two things that I already do, only that in terms of time I do it at the same time. And that requires some cooperation. The idea is that this should not be extra work or cost that much more, because the beds already exist in adult psychiatry. – It is important to check that what I am doing has something to do with it, because it is such offers that it is easy to write off when it comes to budget cuts. Olsen Johansen believes that the offer can be started everywhere in the country where there is a district psychiatric center (DPS). – Today, it is somewhat random what treatment you receive depending on where you are, adds the psychological specialist. The Ministry of Health and Care refers to the National Health and Cooperation Plan, which was presented in the new year. – We are concerned that pregnant women, women about to give birth and new parents should have as good and safe an experience of the birth and maternity services as possible. This is according to State Secretary Karl Kristian Bekeng, who is positive about the development of these new treatment options. For Cathrine, the offer in Orkland and Mosjøen gives hope, but it is also difficult to think that it does not exist in Bergen or the rest of the country. – It’s a bit about will and priorities. Because the need I know is there. So the politicians have to wake up and they have to act. This is important, says Cathrine. Photo: private – I was like a bag of goodies for them. Cathrine experienced that they did not have enough knowledge about postpartum psychosis, and that there was a lot of trial and error with medication. Department head Jan Alexander Steier and Clinic head Eirik Johnsen answer that they at Sandviken have a high level of expertise in handling, protecting and treating women with postpartum psychosis. – We are focusing on insurance while providing treatment that will help them out of the acute illness as quickly as possible, write the superintendent. They are not aware of any plans to create such an offer in Bergen. But at Sandviken, they are constantly working on how to handle women with postpartum psychosis in the best possible way. Childbirth psychosis Occurs shortly after birth Range 1 to 2 out of 1,000 women In 2019, the year Cathrine gave birth, there were 53,788 births in Norway. This means that between 53 and 107 women had postpartum psychosis this year. Women with known bipolar disorder, previous psychosis, or a family member who has had it, have an increased risk of getting postpartum psychosis. Nevertheless, women get postpartum psychosis without known risk factors. Symptom: Confusion: “loses touch” with reality. Confusion, sleep difficulties, anxiety, restlessness and amvibalance. Fluctuations in mood: elated, depressed and emotional lability. Delusions and hallucinatory experiences: imagining things and claiming things that are not the case. Treatment: Admission to a psychiatric ward Drug treatment: antipsychotics, antidepressants, mood-stabilizing drugs, sedatives and sleeping pills are common. Electroshock treatment (ECT) may be relevant if other medicine does not have sufficient effect. There are good forecasts for those who get postpartum psychosis. Most people recover if treatment starts early. Source: psychiatrist Signe K. Dørheim, SSB, nhi.no, sml.snl.no, lommelegen.no
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Just two adapted places for those with postpartum psychosis – Orkland and Mosjøen – news Trøndelag – Local news, TV and radio
