Kathleen's journey: improving mental health outcomes for women with bipolar affective disorder
For most women, pregnancy and the postpartum period are times of great joy and expectation. However, for women with a diagnosis of bipolar affective disorder, there is an exceptionally high risk of deterioration in their mental health. There is the real possibility of developing postpartum psychosis, possibly requiring acute psychiatric admission and being separated from their baby. This can have devastating consequences for a woman, her baby, the family and society. Multiple services/disciplines across primary, secondary and tertiary care settings need to work together to enhance outcomes for these women. In Ireland, a relatively new collaborative way of working is emerging, as specialist perinatal mental health teams are developed. This case review aims to illustrate the complexities of and potential in collaborative team working to support a woman with a pre-existing a mental health disorder, and her family, during pregnancy. This was done through a specialist perinatal mental health teams collaboration co-ordinated by a clinical nurse specialist.
The British Journal of Midwifery's September editorial, ‘perinatal mental health support in the UK’ (Allkins, 2023), highlighted the need to support women with mental health problems during pregnancy. This article focuses on a collaborative approach to supporting a woman with a pre-existing mental health condition.
The development of perinatal mental health services in Ireland is guided by their counterparts internationally, particularly in the NHS. The National Institute for Health and Care Excellence (NICE, 2020) stated that the population risk for bipolar affective disorder is approximately 1%. Nevertheless, for women who have a diagnosis of bipolar affective disorder, there can be significant impact on both the individual and their family. The condition is characterised by periods of depression and periods of hypomania or mania; in some instances there can be features of both depression and mania during the one episode. Common symptoms associated with these mood changes are listed in Table 1.
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