Hopewood Hospital: Nottingham's Hub for Maternal Mental Healthcare

July 2021. I’m sitting on a sofa in the tranquil, clean reception of Green Haven, Nottingham’s purpose-built outpatient facility and inpatient ward for new and expectant mothers, admiring the positive images of smiling mums and babies on the wall. I’m waiting to interview two of its managers for this article. I’ve been here before.

January 2019. I’m sitting on the edge of a sofa in the Green Haven reception, scared and exhausted, tearfully feeding my three-week old son. I’m waiting for an urgent assessment by a psychiatrist after being referred that morning. 

“I am concerned about your state of mind,” the GP had said, a sentiment echoing that of my midwife the day before. “This seems like more than the baby blues to me,” she’d noted, shaking her head – much to my growing distress. 

It certainly seems like it to me. I’m plagued with hyper-realistic visions of my tiny son being snatched out of his pram and thrown off a bridge, into the road, off a cliff, unsure if it was me or some demonic stranger who had done this to him. I desperately need to sleep, but even during the brief intervals I’m able to lie down in my own bed, all I can hear is my baby screaming. But he’s sleeping peacefully on his dad’s chest. 

Put simply, I feel like I’m losing the plot – not ideal with a child to look after, dependent on me for everything. Following a long and complicated birth and a short stay in neonatal intensive care, I feel afraid of – and alienated from – my own son, with no idea how to look after him. Breastfeeding is agonising and I have no confidence in my own ability to even change a nappy – things that society tells us should come naturally. 

As the days go by, I long to die. I’m walking over Trent Bridge as my son’s father pushes his pram a few steps ahead of me. If only I could jump off this bridge right now. But who would feed the baby? What if the fall didn’t kill me? Then what? Surely, they’d be better off without me, anyway? I feel trapped, exhausted, and unsure of what’s real and what isn’t. I begin hearing, seeing and even smelling things that aren’t there. I’m terrified of life as I now know it. And I’m so tired that my bones ache. 

“I can’t cope,” I tell the psychiatrist.  He nods, understanding, without making me feel ‘mental’, judged or, as many mums fear, that I’m at risk of having my baby taken from me. He listens, gently asks questions, and makes me feel heard. Diagnosing severe postnatal anxiety exacerbated by pre-existing mental health issues, he puts together a care plan featuring some of Hopewood’s highly-skilled and experienced team of health professionals. 

In the days and months that follow, I start a course of medication, attend appointments with a perinatal psychiatrist and have weekly home visits from Nicola, a dedicated Community Psychiatric Nurse. A Perinatal Nursery Nurse, Megan, visits to help me bond with my son through baby massage classes. 

And slowly but surely, thanks to this team of caring experts, life as a new mum becomes bearable – and then better. 

Hopewood is a lifeline for expectant and new mothers experiencing severe mental health issues in the communities of Nottinghamshire and Bassetlaw, with a multidisciplinary team looking after women with babies aged up to one year. 

For the most acutely unwell patients, the eight-bed Margaret Oates unit (named after world-renowned Consultant Psychiatrist and Nottingham resident Margaret Oates) offers around-the-clock care, with a focus on keeping mothers and babies together. “One of our main aims is to empower mums to look after their babies, even when they’re very unwell,” says Ward Manager Debbie Sells, who’s been working as a Perinatal Psychiatric Nurse since 1992. 

“We share a message of hope. You will get through this, you will leave the unit with your baby – and you will feel better. We also provide consistent care in the community, supporting mums and their families during their recovery at home.”

The pandemic has had both traumatic and positive side-effects. “It’s not ideal having to wear several layers of PPE when you’re caring for women who already feel anxious and may be having paranoid delusions,” says Debbie. “We’ve had to work extra hard to gain their trust.” 

However, the fact that the facility was quieter during the lockdowns (as in other NHS settings, visitor numbers have been restricted) has had some benefits, Debbie explains. “The clinical team has been able to focus on each patient and do some really intensive nursing,” she says.  

“We’ve seen positive outcomes from the work we’ve been able to do in the last year. Women have recovered more quickly, and have been able to leave the ward sooner to continue their journeys at home.  

“We’re learning that a quieter, more focused environment can be better therapeutically, so we’re making changes to the way th

Community Care Manager Lisa Carter, also an experienced Psychiatric Nurse, reflects on how difficult life has been for many new parents during the last year and a half. “Lots of people have felt isolated, without the support of family members, friends and baby groups,” she says. 

“We’ve seen a lot of women whose mental health has been adversely affected by the pandemic – it’s been a really lonely time for a lot of people, and we’ve seen mums who might have been poorly for some time, who’ve felt unable to go and see their GP. We’d advise that they do this, because there’s always help available.” 

The team at Hopewood is currently looking into new programmes to help dads and co-parents cope with the stresses of a new baby, as well as projects to help families on the ward and in the community. If you’re interested in donating or raising funds for the vital work carried out at Hopewood, contact the team on 0115 9529477.

Testament to the fact that recovery is possible is Nottingham resident and mum of two, Cheryl McAulay-Wainright. She experienced severe mental health issues following the birth of her first son Joel, now sixteen. “It seemed to come out of nowhere,” recalls Cheryl. “I had so much energy, but couldn’t focus on anything – I didn’t feel I needed sleep. I was spending erratically and felt very ‘hyper’, with no off button. I was saying and doing things that didn’t make sense to anyone else. Eventually, my mother-in-law contacted my GP, as she was so concerned. I ended up in the QMC mother and baby unit (the previous inpatient site before Hopewood was built), and was there for three months.” 

 Diagnosed with postpartum psychosis, Cheryl underwent an intensive programme of medication, therapy and work to help her bond with her new son as she recovered. “The care I received was invaluable,” she says. “It inspired me to pursue a career in mental health, and I’m now very proud to work at Hopewood, supporting other mums as they go through what I did.”

Cheryl recently gave birth to her second son, Lockie – now aged four months. Aware of the elevated risks of Cheryl developing postpartum psychosis given her medical history, the team put a care plan in place early on in pregnancy. She saw a CPN (Community Psychiatric Nurse) and was prescribed antipsychotic medication immediately after the birth. “All this helped me have a much more ‘normal’ experience the second time around, despite having a baby in the middle of a pandemic,” said Cheryl. “Of course I was concerned about a relapse, but I also felt really supported and understood by the team and could get on with enjoying the newborn experience.

“My advice to anyone who’s concerned about their mental health would be to contact your GP. They have access to the right resources, and can really help. If you’re still not happy, don’t be afraid to request a second opinion.”

If you’re a new or expectant parent and concerned about your mental health (or that of your partner, friend or family member), there are resources to help you.

GP
In the first instance, contact your GP. Their role is to listen to your concerns, referring you to the appropriate secondary service where necessary (for example, the team at Hopewood).

Midwife
All midwives have training in mental health, and know to look out for the warning signs of illness. If you’re concerned, talk to your midwife.

PND Mummies
A group run by Doulas and mums, supporting women in Notts and Derby with their mental health both ante- and postnatally

Open House Nottingham
A self-help group that aims to create a safe, confidential and relaxed environment where people affected by postnatal mental health issues can support each other

What is postpartum psychosis?
Postpartum psychosis (PP) is a severe mental illness that begins suddenly following childbirth. Symptoms include hallucinations and delusions, often with mania, depression or confusion. Over 1,400 women experience PP each year in the UK (1 to 2 in every 1,000 mothers). An episode of PP can be very frightening for women and their families. Most women go on to make a full recovery, however the journey to full recovery can be long and difficult. Although it’s unclear exactly what causes the illness, experts believe that post-birth hormones, genetics and pre-existing mental health conditions can play a part. However, some women who experience postpartum psychosis have no history of psychiatric problems.

These are common symptoms, which can begin very quickly following childbirth

• Feeling excited, elated, or ‘high’.
• Feeling depressed, anxious, or confused.
• Feeling excessively irritable or changeable in mood.
• Being more talkative, sociable, on the phone an excessive amount.
• Having a very busy mind or racing thoughts.
• Feeling very energetic and like ‘super-mum’, or agitated and restless.
• Having trouble sleeping, or not feeling the need to sleep.
• Behaving in a way that is out of character or out of control.
• Feeling paranoid or suspicious of people’s motives.
• Feeling that things are connected in special ways or that stories on the TV or radio have special, personal meaning.
• Feeling that your baby is connected to God or the Devil in some way.
• Having strange beliefs that aren’t true (delusions).
• Hearing, seeing, feeling or smelling things that are not there (hallucinations).
• Having an unnaturally elevated (high) mood with loss of touch with reality (mania).
• Experiencing severe confusion.

Action on Postpartum Psychosis is a charity dedicated to helping people affected by the condition. Find help, information and links to peer support at app-network.org