Puerperal Psychosis

A carer’s survival guide

Craig Allatt
PO Box 2013
WODEN ACT 2606

[email protected]

Copyright 2011
 Contents
Introduction ........................................................................................................................2
Part 1 — To-do lists ..........................................................................................................3
1 Where to start ......................................................................................................... 3
2 Hospital Day 1 — Admission .............................................................................. 5
3 Hospital Day 2 — Thinking about the big picture ........................................... 7
4 Hospital Day 3 — Decide what to tell extended family and friends ...........11
5 Hospital Day 4 — Tell family and friends .......................................................17
6 Hospital Day 5 — Start organising support ....................................................19
7 Hospital — Planning for going home ..............................................................20
8 Hospital — Going home ....................................................................................21
9 At Home — Nice to be home ...........................................................................22
10 At Home — Second week at home — Routine ..............................................23
11 At Home — Depression can set in ...................................................................25
Part 2 — Overview ..........................................................................................................27
Perspective ....................................................................................................................27
Understanding your situation ....................................................................................27
About puerperal psychosis .........................................................................................29
Mental health acts ........................................................................................................31
The care system ...........................................................................................................32
Obtaining help from services ....................................................................................34
How do you care for the mentally ill? ......................................................................34
Getting help from family and friends .......................................................................38
Helping visitors cope ..................................................................................................39
Safety .............................................................................................................................40
Part 3 — Quick summaries ............................................................................................43
Caring for baby ............................................................................................................43
Dealing with abnormal behaviours ...........................................................................45
Dealing with a lack of normal behaviours ..............................................................47
Dealing with symptoms of depression ....................................................................49
Symptoms .....................................................................................................................53
Treatments ....................................................................................................................54
Role of professionals ..................................................................................................56
Role of carers ...............................................................................................................57
Suggested readings ...........................................................................................................59

1
Introduction
When my partner was discharged from hospital with puerperal psychosis I asked,
“What do I do now?” I was told, “Take her home and care for her.” I quickly realised
caring was neither simple nor straightforward. Finding the information I needed was
very difficult and some of it I only found months later. After many phone calls and
late-night internet sessions, I began to wonder why I was having to “reinvent the
wheel”.
In Australia around 400 women develop this illness every year. This booklet is for
their partners. I hope to help them care more effectively and avoid some of the pain
that I went through.
While everyone’s experience is different, this booklet roughly describes the pattern
yours might follow. When reading this booklet please remember that you cannot
predict the course of the illness; all you can do is prepare for a range of possible
futures. Puerperal psychosis can be very variable, with symptoms ranging from mild
to severe, and lasting weeks to many months. So please be accepting if your partner’s
illness progresses at a different pace to that described here.
To try and avoid giving you false expectations, I’ve organised the to-do lists according
to phase. However, sometimes it is necessary to use time cues. Following the to-do
lists is a more general overview followed by some quick summaries.
Finally, I’d like to thank Dr Anne Sved William and Dr Andrea Baas from Helen
Mayo House, Dr Catherine Hungerford from the University of Canberra,
Jocelyn Hungerford, family and friends for their input and patience. I could not have
produced this booklet without their help.
Craig Allatt

2
Part 1 — To-do lists
1 Where to start
Don’t worry, your partner is safe. Somebody from the mental health emergency
team should be with your partner and baby as you read this. What you need to do
now is stop and take some time to plan. This booklet will try and help you do this
effectively.
Someone has called in the mental health emergency team because they think your
partner has puerperal psychosis. Trust them. This is a serious illness that is usually
treated in hospital. Puerperal psychosis is a relatively rare condition that affects
about one woman in 500 births. It is not something that is usually discussed during
antenatal classes. So don’t worry that you have never heard of it. It is associated with
childbirth and usually affects first-time mothers. Women with the condition become
clearly unwell within 7 to 14 days of the birth, although over 50 per cent of the
symptoms are usually present within three days of the birth. Sixty per cent of women
who develop the condition have had a prior psychotic episode and 40 per cent have
not.
Symptoms include an inability to sleep, feeling full of energy, irritability, restlessness,
a belief she has special powers or strengths, being very disorganised, making plans to
save the world, and paranoia. Your partner may have some or all of these symptoms.
You may not see any of these; however, someone else has. If this is your first child,
you have nothing to compare your experience with. You may just think things are not
going well and not realise how bad the situation is.
To do
• Work with the mental health emergency team and your partner to make the final
decision on where and how your partner will be treated, and what will happen
with the baby. If your partner is refusing treatment, then your local mental health
act sets out a process that can result in her being forced to undergo treatment,
regardless of her wishes or yours.
• Find out how to manage at home whilst waiting.
o Find out how to provide basic care to a person with acute mental illness.
o Find out what risks you need to be aware of and how to manage them.
o Find out how to recognise if your partner’s condition is deteriorating and
what to do if it does.
• Ask one or two people to help you at home. Managing an unwell partner and
infant is too hard to do by yourself. Help is needed.
• Cancel immediate plans. Try to stay at home with no visitors. You don’t need to
explain why, or call family and friends at this point.
• Get some sleep.

3
If you want her to stay at home, or if she has to wait for a bed
Your aims are:
• Safety of mum and baby.
• Reduce stimulation.
• Cope with symptoms.
• Look after yourself.
Managing an unwell partner and infant is hard. You need help. Ask one or two family
members or friends you trust to come and stay. Plan on at least one person being up
all night and then needing sleep during the day.
Do a safety check of your home. (See page 40.)
You need to supervise your partner as much as you can. See page 43 for some
suggestions on safety of the baby.
Help your partner to get as much sleep as possible. This will be hard as you have a
new baby in the house. See page 57 for some suggestions on the role of the carer.
People experiencing acute symptoms of mental illness, have a lot going on in their
mind. Therefore it is important to reduce stimulation. Your partner’s ability to
focus on you and on what is being said, and her ability to respond, will be severely
restricted. You and visitors need to:
• Stay calm.
• Talk quietly and move slowly.
• Keep surrounding noise, such as TVs and radios, to a minimum.
• Keep the surrounding environment calm.
• Give her time. Everyone needs to slow down and be patient.
It is a good idea to sit beside your partner, rather than in front of her. This reduces
the sense of confrontation.
People experiencing acute psychotic symptoms (loss of touch with reality) have
delusions or hallucinations and believe that they are real. Below are some strategies to
help you cope with the symptoms you might encounter.
• Focus on her feelings. For example, use phrasing such as “It must be frightening
for you to believe… .” This will build trust and avoid useless arguments.
• Don’t dispute her sense of reality. You cannot counteract delusions with reason.
• However, do not encourage her delusions or paranoia.
Don’t take things personally. Create a positive, pleasant and supportive environment.
See page 45 for some more suggestions on how to deal with abnormal behaviours you
might be seeing at the moment.

4
2 Hospital Day 1 — Admission
Your partner has just been admitted to a psychiatric ward, most likely with your baby.
This is probably something you did not expect or prepare for. You may not have
even known that psychosis was a potential complication of childbirth.
Now you need to figure out what to do next. You have to balance care for your
partner, your baby and yourself.
To do
• Help settle your partner and baby into the hospital. Get some rest.
• Find out when your partner’s specialist will next be visiting and ask to see them.
• Find out about the hospital and its rules.
o How does the hospital plan to look after your baby?
o Can you stay overnight with your partner?
o When can you visit?
o When are visiting hours for other people?
• Read the available information on puerperal psychosis; some suggestions are
provided at the end of this booklet.
• Buy a notebook on the way home and start keeping a diary. You need to keep
track of daily activities, visitors, your partner’s symptoms, the sleeping patterns
of your baby and partner, and the baby’s feeds and toileting. Your partner also
needs to start keeping a diary, although at this stage you may need to keep it for
her. Your partner needs to keep track of her thoughts, feelings and sleep. A diary
is an important tool for you to keep track of what is happening over time, rather
than relying on memory.
To think about
• Call family tomorrow, not today.

I left the hospital and started

calling family to let them know
what was happening. This was
probably the worst thing I could
have done. I was tired and had
no answers.

5
Calling family now is a bad idea
If you have relatives close by, then they may have been helping you look after your
partner. However, if you have not kept your families updated about what is going
on, then it is probably a bad idea to call them right now. You are tired and suffering
from shock. Conversations with family may be difficult and emotional. You need to
be rested and have a clear idea of what to say before you start these conversations.
Waiting one day will give you some time to rest and think about what you will say.
Your families may be angry with you for not telling them immediately, but at this
stage you need to look after yourself. Get a good night’s sleep and don’t call anyone.
If you must call someone, read page 13 and talk to a nurse about what to say before
you make the call.
Working with hospital staff
Mental health staff intend well, but are busy. They may not return phone calls or
spend the time with you that you want or need. Be proactive! You are a key person.
Book in to see the specialist
You need to find out more about her condition and discuss treatment. The sooner
you ask to see the specialist, the sooner it will happen.
Care of your baby by nursing staff
As tempting as it is to leave, you still have an important role as the baby’s father. You
and the nurses need to decide how together you will provide care for your baby and
persuade your partner that this is a good idea. She is very vulnerable at the moment.
It is easy for her to lose confidence in her ability as a mother and very hard for her to
regain it. It is best if you can avoid this happening as this can exacerbate her illness.
Nursing staff may want to separate your partner and baby for some or all of the
day. This may be due to concerns about infant safety or to allow your partner to
sleep. Sleep is essential to recovery. Think about how this is presented. Language is
important. Try “it is dad’s turn to look after the baby now. How about you get some
sleep while he is doing that”.
Think about how the baby is cared for, how this is presented to her and who tells her.

The hospital did not talk to me

about baby care and I did not
think of it. So I just left my
partner and baby at the hospital
and went home. In hindsight
this was not the best thing to do.
My partner lost all confidence in
her ability as a mother.

6
3 Hospital Day 2 — Thinking about the big picture
Your focus is on your sick partner here and now, but you need to start thinking
about the bigger picture. You do not know how your partner’s illness will progress;
however, you need to start planning how to provide care for her when she returns
home. In making these plans you need to know that this illness often lasts six to
nine months, which is a long time, and sometimes it goes on for even longer. So it is
better to make long-term plans, and breathe a sigh of relief if your partner recovers
more quickly.
Do not delay in making these plans. They may take a while to sort out. Also you
don’t know how long your partner will stay in hospital. She may be out next week,
then again she may stay for several months. So start now and you will be more
prepared for whatever happens. Life is going to get busier as the baby grows and
your partner recovers. You have a little bit of time now while your partner is acutely
ill, so use it wisely.
Your partner will, if anything, be sicker today. She no longer needs to put on a brave
face and can show how sick she is. You have also had a break and are now seeing her
with fresh eyes. Remind yourself that things will get better.
To do
• Organise an appointment with a counsellor.
• Cancel major projects, such as house renovations, and any holidays you have
planned. Your partner will not be able to cope with the stress of these activities
for several months, maybe longer.
• Start thinking about what your role will be.
• Who else do you want around to help out?
• Think about how to manage phone calls.
• Talk to a nurse about what to say to your partner’s family, and then call them all.
• Check how your partner and the baby are going. Do they need anything?
• Stay at the hospital tonight. Your partner will be missing you.
To think about
• Ask the nurses to help you find help in adjusting to parenthood.

My partner threw a tantrum

when I turned up at the
hospital. It was quite spectacular
and scary. I wondered what had
happened to the woman I loved.

7
The father’s role?
You have this job as a carer because your partner is ill. Not because of your ability,
skills, knowledge or training. However, to successfully care, you will need some
knowledge, practical skills, supervision and support. You now need to start seeking
these.
You are trying to balance the competing tasks of caring for someone with a mental
illness, looking after the baby, adjusting to parenthood, looking after yourself,
educating family and friends, practical house and infant care, and resuming normal
life. Your responsibilities are not clearly defined; your role will change over the course
of the illness. Every caring situation is unique.
This illness usually lasts 6-9 months, but may last longer. This is a long time. You
need to make sure that you can survive this long, because you will be no help to your
partner and child if you exhaust yourself. You need to look after yourself and get
help adjusting to your new situation. The sooner you do this, the sooner you will be
able to care for your partner effectively.
Why should you get involved in looking after your partner?
Being actively involved in caring for your partner and her treatment will help her
get better sooner. This will also give you a sense of control, which may stop you
becoming depressed yourself.
Your partner’s parenting ability is impaired whilst she is ill. Being actively involved
in caring for your child will help reduce the effects of your partner’s illness on your
child.
Seek help in becoming a carer and adjusting to parenthood
This situation is a shock. You need to grieve for your lost dreams. You need help
dealing with the dramatic change in your relationship with your partner. You need to
change your expectations.
Parenthood is something everyone grows into over time and most people make
mistakes along the way. However, you must now cope with an ill partner as well as
adjusting to parenthood. These are both difficult tasks. You will want help coping
with the emotional, relationship, social, and psychological issues that arise during
early parenthood. You will also want help learning the practical aspects of being a
parent: for example getting the baby to sleep. So take any help you can get to make
this transition and learn the necessary skills.
Ask the nurses to help find someone to help you. This may take a few days to
organise.
(Note: Mental health workers and maternal and child health workers have different
areas of expertise and so neither service may be able to provide you with all the
counselling that you need. Coping with a mentally ill new mother requires support
from both the mental health services, and the maternal and child health services.)

8
In the meantime, simply aim to be a “good enough” parent. People can parent in
many ways, all of which will result in happy and well-adjusted children. There is no
one right way. Talking about being a “good” parent suggests there is one right way.
This is not helpful where your partner has a mental illness.
How are you going to care for your partner when she returns
home?
Your partner will require full-time physical, social and emotional care for the next few
months and maybe longer. She will not be able to run the household or look after the
baby without help. You need to figure out how to provide this, but you do not need
to provide her day-to-day care all by yourself. You have three main options.
• Do it all yourself.
• Ask family and/or friends for help.
• Pay someone.
You now need to sit down and think about what is possible and what you can afford.
You also need to think about the type of care each person will provide and how
appropriate that will be.
The choice will probably come down to either: you providing most of the day-to-day
care with support; or one of your parents or other trusted relative providing most
of the day-to-day care with support. Whatever happens, you are her partner and the
baby’s father, so be involved.
Discuss this with the counsellor or nurses, and then with your families.
What do I tell our families?
Before calling anyone, think about what you are going to say, to whom and when.
Who needs to know everything? Who needs to know a bit? Who do you need to
support you?
These conversations may be difficult as it can be hard for people to accept that a
person close to them is mentally ill. This lack of acceptance is complicated by the
fact that they are not present to see the strange behaviour or hear the odd thoughts.
You need to speak to your own and your partner’s family members at as close to
the same time as possible. You do not want inaccurate rumours going around. You
also do not want relatives calling the hospital with half a story and speaking to your
partner without being prepared. (Work on the assumption that hospitals do not
screen calls to patients and your job is to prepare callers for talking to you partner.)
You need to explain that your partner is not the same person she was before the
baby. She is mentally ill and behaving strangely at the moment. This behaviour is a
result of an illness and she cannot control or change it, even if she wanted to. You
probably don’t want to say much more than this about the situation, as you have not
yet spoken to the psychiatrist.

9
You also need to give your families some positive strategies for dealing with her. For
some suggestions, see page 4. Your partner is extremely vulnerable and suggestible at
the moment. She may take what is said to her and come up with some very strange
ideas. She may also reinterpret past events in odd and hurtful ways. Giving your
families positive coping strategies will help protect your partner and her family.
Discuss with the counsellor or nurses what you are going to say. They are a good
sounding board.
Manage phone calls from family and friends
One of the most time-consuming tasks, at least initially, is fielding calls and keeping
family and friends up to date on your partner’s condition. This will be very tiring and
may prevent you from getting the rest you need.
Plan how to do this now before you start telling more people. You could ask another
person to help, or use group text messages or emails to keep others up to date. You
could also leave a message on your answering machine.
Talk to the hospital about how they manage phone calls
Think about whether your partner is well enough to take phone calls herself. Talk to
the hospital about how to manage calls to your partner.

My partner’s sister heard from her

mum that her sister was ill, so she
called the hospital to speak to her
sister. My partner gave her an earful.
I spent the next six months trying to
settle ruffled feathers.

10
4 Hospital Day 3 — Decide what to tell extended family
and friends
Family may start arriving today to visit if they live out of town, and you may be able
to see the specialist.
You cannot hide this illness. People will see that something is wrong, even if they
don’t know exactly what. So today is a good time to start thinking about how you are
going to manage the situation and what you will say. As part of this it’s a good idea to
think about what type of help various people may be able to provide.
To do
• Stay at home tonight and get a good night’s rest. Last night will have been
difficult.
• Research what questions to ask the treating specialist.
• Think about what to tell your extended family, friends and work – try to discuss
this with your partner if at all possible. There is real stigma about mental illness
and she might not agree with your pathway at first. However, there is more
understanding in the community of mental illness these days, and the people you
know should be able to adapt.
• Book a first aid course (for example St John’s Ambulance or Red Cross) and
a mental health first aid course (talk to your nurse about where to find a local
provider).
• Ask the hospital for a copy of E Robertson & A Lyons (2003), ‘Living with
puerperal psychosis: A qualitative analysis’, Psychology and Psychotherapy: Theory,
Research and Practice, 76, pp 411–431.
To think about
• Discuss with a counsellor or nurse how to manage offers of support before you
tell extended family, friends and work about your partner’s illness.
Follow up
• Have you started the diary? You need to get into the habit of recording what
is happening. This will help you identify patterns over time and assist in your
discussions with the professionals
involved in your partner’s care. You My first night at the hospital was awful.
can also use it to remind you of what Nurses came into the room every 30 minutes.
the professionals told you to do. The baby was restless. I was on edge.
I held the baby to my partner’s breast for a
feed, and she slept through it. I felt so guilty,
but she was sound asleep for the first time
in a long time and I didn’t want the baby to
wake her.

11
Talking to the specialist?
When speaking to the specialist and other health professionals, your aim is to develop
a collaborative relationship. You have information they may want to know. They
are also relying on you to support their treatment. The specialist and other health
professionals have knowledge and experience you need. They also have access to
others who can help.
Having said all this, speaking to the specialist is a potentially tricky situation. The
specialist may refuse to talk to you on the grounds that the details of your partner’s
treatment are confidential. So the best thing to do is to get your partner to give
permission to the specialist to talk to you about her treatment.
If your partner doesn’t give permission then you can tell the professionals that
you understand that specific information about your partner cannot be disclosed;
however, you want to gain a better understanding of the illness, how to care and the
support that is available.
The thing to remember is that the health system is expecting you to take over
your partner’s day-to-day care when she is discharged from hospital. You cannot
competently do this without information and support. So it is in their interest
to provide you with sufficient information and support so you can do this job
competently once you get home. Remember once your partner leaves the hospital
your contact time will far exceed theirs. This time imbalance means that poor care on
your part could outweigh positive effects of their treatment.
Also remember that you will be monitoring your partner’s medication taking once
you get home; you need a minimum level of knowledge to do this competently. Once
you are doing this, you will know which medications she is taking and be able to
research on the internet their effects on both your partner and the baby
(www.pbs.gov.au, www.pubmed.gov).
Think about what questions you are going to ask the specialist. You want to get an
understanding of longer term treatments and expectations. Below are some questions
you could ask. Between you and your partner, you need to decide with the doctors
what treatment options are best for your partner. In making these decisions you need
to think about the risks and whether they are worth taking given the probability of
success. Choosing what risks to take is not a medical decision.
You also want to discuss leave certificates for your work.
Things to ask include:
• What is this illness? How long will it last? Will it recur?
• What are the treatment options (biological, psychological and social)? How can
they be combined?
• What are the expected outcomes?
• What is the likelihood of each of those outcomes?

12
• If your partner is breastfeeding, will the drugs go through the milk and what
effect will that have on our baby?
• What does it mean for me? Where can I find help for me in this situation?
• What training do I need to help me care for my partner? Where can I find it?
• What does it mean for the baby?
• What preventative interventions are there for the baby?
• Is there anything I should have asked and have not?
What do I tell extended family and friends?
Lots of people want to visit you at this point, as you have a new baby. It’s likely your
partner will be obviously unwell for many months. So you need to decide how you
are going to manage the situation. It would be a good idea to involve your partner in
this decision; however, this may not be possible.
It is probably better to tell everyone what is going on and give them some guidance
on how to deal with your partner. This will help stop rumours and comments behind
your backs, which in turn may help your partner get better more quickly.
Once you start telling people that your partner is very ill, your work and your
partner’s work are likely to find out even if you haven’t told them yourself. So, you
need a plan to deal with this.
You need to:
• Decide who needs to know that your partner is ill, and what to tell them. Who
needs to know everything? Who needs to know a bit? Who do you need to
support you?
You could:
o Give them some information about the illness. See page 29.
o Make suggestions on how to support your partner. See page 4.
• Decide how to tell them.
Email is the best way of letting extended family and friends know what has
happened. An example is below. Calling individual people is too draining and
slow.
• Decide when to tell them.
You could draft the email today, think about it overnight and send it tomorrow.
Or you could take longer. What you decide to do will depend on many things.
This booklet suggests you tell people tomorrow.
• Tell them.

13
Example email
Dear family, friends and colleagues
Thank you for all your kind thoughts and well wishes on the birth of [baby’s name].
I was intending to respond to each of you individually; however, things have been
chaotic in the house over the past week. So I have had to do a group email.
Unfortunately [your partner’s name] is suffering from a rare post-natal complication
called puerperal psychosis (aka post-natal or post-partum psychosis) and has been
admitted to hospital for treatment. (If you want to know more about this condition
please have a look at the following website: www.wch.sa.gov.au/services/az/
divisions/mentalhealth/files/puerperal_psychosis.pdf .) Fortunately the prognosis
is good and we can expect [your partner’s name] to make a full recovery, however,
this will take some time. [Your partner’s name]’s doctor tells me that she will be in
hospital for the next 2–3 weeks, and will require further treatment and support for
another 3–4 months after that.
[Baby’s name] is fine. He is with [your partner’s name] and is breastfeeding, sleeping,
pooing and screaming in the right amounts. [Your partner’s name] is bonding to him
well. [Baby’s name] is not bothered by his mother’s illness, and evidence shows that in
the long term he will not be affected by this experience.
Me, I’m dividing my time between the hospital and home. I can visit the hospital at
any time and have stayed overnight several times. The hospital even feeds me, which
makes this possible. The situation is stressful so I’m making sure that I take time out
to look after myself. The few people I have told so far have been very supportive and
thank you to them.
People can visit [your partner’s name] and [baby’s name], and I would love you to do
that. The doctor has also suggested that visitors are good for [your partner’s name] as
they help bring her back to reality. However, part of [your partner’s name]’s problem
is over-stimulation, so at this stage I would like to limit the number of visitors to one
person or couple per day. Please call me if you want to visit [your partner’s name]
(my mobile is ### ### ###) and I will let you know which day is suitable for
visiting [your partner’s name]. Visiting hours are 8:30am – 9:30pm on the weekend
and 3:30pm – 8:30pm on weekdays. However, the best time to visit is between
4–5pm.
[Your partner’s name] is not her usual self at the moment. When you talk to her it is
important that you make her feel loved, included and useful, not just now, but on an
ongoing basis. If you have been depressed and want to talk about your experiences,
please limit yourself to what got you through.
Thank you to everyone who has been patiently waiting to visit. I only managed to
talk to [your partner’s name]’s doctor yesterday.
Regards

14
What do I tell my partner’s work? I did not give any thought to telling
It is not urgent that your partner’s work be my partner’s work and they found out
formally told of her illness as she will probably on the grapevine. This did not cause
be on maternity leave for the next few months. any problems at the time. However,
Your partner’s relationship with her work it caused problems later on because
will probably determine when and what your they did not realise they needed to
partner’s work is told. However, once you start manage my partner differently to
telling people your partner is ill then her boss will other women on maternity leave. At
probably find out. So you need to think about one stage my partner thought she
the consequences of her boss hearing about her had been sacked because there was a
illness from someone other than her or you. restructure and the new structure did
Note: Your partner’s ability to work and to not explicitly include a position for
cope with work will be affected by the illness. her. She was not completely recovered
Therefore it is probably best to formally when she returned to work and they
talk to her work about the illness before she expected her to cope with the same
returns from maternity leave as they may need level of stress as previously.
to restructure her job to give her the best
opportunity of a successful return to work.
At this point you could say nothing to your partner’s work or call them.
If you are considering talking to your partner’s work then, you may want to consider
the following.
Who do you talk to?
• Is it her boss, the personnel department or both.
What do you tell them?
• The diagnosis?
• How long the illness lasts? The illness usually lasts 6–9 months.
• Probability of recovery? Most people recover fully.
• What they may be asked to do to help?
o Your partner’s recovery may be aided by returning to work early, even
though she may not have completely recovered. Whatever happens, she will
need a graduated return-to-work program and appropriate low-stress work
to do when she returns. She may return to work at short notice, so they
need to be prepared.
o A sense of belonging is very important to people suffering from mental
illness. Work is a significant part of people’s lives, therefore it is important
for her work to try and maintain her connection to the workplace. Start
discussing how to do this.
You could also enquire about sick leave. This is a major illness, so your partner may
be eligible for sick leave.
Discuss your thoughts with a counsellor or nurse, and your partner if possible, and
think about your plan overnight before putting it into action.

15
What do I tell my work?
Think about letting your work know what is happening as you will need time off
over the coming months. It may also affect your ability to perform at work—you will
probably struggle to focus.
If you have decided to undertake the day-to-day care yourself, then you need to let
them know that at this stage you do not expect to be able to attend work for the next
2–3 months. In about 2 months you may be able to do a limited amount of home-
based work, and over the following months you will probably undertake a gradual
return to work. This all depends on how your partner’s illness progresses and what
your own needs (mental, financial, social) are.
Your gradual return to work may be slow. The exact pattern you follow will depend
on your partner, her specialist, and you. When making your decisions you need to
prioritise your partner’s and baby’s needs. A big concern is how well your partner is
coping without support at home.
You may decide to work shortened days for an extended period. Remember that if
you work an 8-hour day, then you may be away from home for 10–12 hours including
travelling time. This is a long time to leave your ill or convalescing partner alone with
a baby.
You may not be able to give much notice that you want to come back to work, so
they need to be prepared. Keep talking to them.
Discuss your thoughts with a counsellor or nurse and think about your plan
overnight before taking action.
Why should I do a first aid course?
You now have a baby and a mentally ill partner. It is best to be prepared for
emergencies. You have time to do a first aid course and a mental health first aid
course now. You will be very busy once you get home and you may not be able to get
away.

16
5 Hospital Day 4 — Tell family and friends
The shock is starting to wear off. You are getting into a routine of visiting the
hospital and you are probably getting tired of fielding questions from immediate
family about your partner.
To do
• Give the baby a big hug and play with them for at least 30 minutes. With
everything that has been going on you may have forgotten about the baby’s
social needs. You have a baby that wants to get to know you, and you want to get
to know them as a person.
• Stay at the hospital tonight.
• Start telling extended family and friends. Send out the email you drafted
yesterday.
• If you can, discuss with your partner how and what to tell her work. Call your
partner’s work and let them know what is happening.
• Call your work to let them know that your partner is very ill and you will need
time off work.
• Look after yourself.
Follow-up
• Have you talked to the specialist?
• Have you talked to a counsellor?

By about the fourth day I was so

stressed that I just needed to do
something physical, so I ordered new
carpets and a floating floor for the
house. I then proceeded to pack up
the house and rip out the flooring.

I felt much better after this, but it

was not the most sensible thing I’ve
ever done.

17
Playing with your baby
Both you and your partner should smile at your baby. Fake it if you have to.
Sing songs to your baby. Nursery rhymes are fine. Don’t worry about the bad singing;
the baby won’t care. Play “peek-a-boo”. Read a short story.
Don’t expect much response from your baby. You may get a gurgle.
The focus since the birth has been on your partner, and you may have forgotten
about your baby’s social and emotional needs, and your need to learn to love the
baby. Now is a good time to start working on this.
Looking after yourself
You need to take time to look after yourself.
You do this by:
• Making sure you eat properly, get as much sleep as you can, and exercise
regularly.
• Managing your stress. Get professional help for yourself or at least support from
the treating team.
• Talking to friends and family.
• Comparing your baby experience with other new parents.
Sorting out work
Have you organised a carer’s certificate for work and extended your leave?
Speak to Centrelink and find out what government assistance is available. For
example carers allowance.

18
6 Hospital Day 5 — Start organising support
At this point, many people start to realise the full implications of the situation they’re
in. Don’t worry. You can cope. Your partner will get better, but it could be a long
haul. You have a special opportunity to get to know your child during the first few
months of their life which many fathers do not have. Just take one day at a time.
Don’t forget the ‘red tape’ practicalities of having a new baby. You still need to
register the birth, get the baby put on your Medicare card and (if you have it) private
health insurance, register for government benefits and so on.
Apart from that, there are three important things you need to learn to do:
1. Meet the physical, emotional and social needs of the baby. To do this you need
to learn the practical aspects of looking after a baby: how to change a nappy,
feed them, put them to sleep and recognise their needs. You also need to
learn the ‘soft’ skills of recognising how the baby is feeling, comforting them,
entertaining them, playing with them and so on.
2. Adjust to parenthood. What is this parenting thing about? It is more than just
changing nappies. It is about relationships, values, skills, and time with your child
and partner.
3. Learn how to care for your mentally ill partner.
Most parents only have to figure out how to do the first two. You have to figure out
how to do all three. With everything that is going on it is very easy to start treating
the baby as an object, as you don’t have the mental space or energy to cope with
more than this. Your baby won’t mind; however, you really need to make the effort to
develop your whole relationship with your baby.
To do
• Stay at the hospital tonight.
• Start talking to family and friends about the support they might offer. (See page 38
for information on getting help from family and friends.)
• Speak to the nurses about where to find training on how to care for someone
with a mental illness.
To follow up
• Have you started finding support to help you adjust to having a mentally ill
partner as well as parenthood?

By this stage our families had arrived

from interstate and were visiting
daily. A few good friends had visited.
Everyone was very supportive.

19
7 Hospital — Planning for going home
Your partner is returning to reality and you are starting to plan for going home. Your
partner may have been in the hospital for a week or for several months. By this time
you are likely to have settled into a routine of visiting the hospital. You are probably
staying at the hospital most nights and going out during the day. You may also be
getting some visitors at the hospital.
You may be able to go for walks with your partner on or off the hospital grounds.
Your focus now is trying to figure out what will happen when your partner is
discharged from hospital. There are two parts to this: the professionals’ plan and
your plan.
To do
The professionals
• Organise your first appointments with the mental health professionals your
partner will be seeing once she is discharged from the hospital. (These could
include a psychiatrist, psychologist, infant mental health worker, mental health
caseworker and/or occupational therapist.)
• Ask the hospital to talk to the maternal and child health service to advise them
of your partner’s illness and to organise their intensive assistance and support
for you.
• Discuss with the hospital a referral to your local mothercraft hospital.
You
• Follow up on training on how to care for someone with a mental illness. Talk to
a social worker or nurse about this.
• Finalise your plans of how you are going to provide day-to-day care when you
get home.
• Ask the nurses for training on what to do if your partner talks about suicide.
• Ask the nurses about mother–infant therapies and preventative interventions for
the baby.
• Ask the nurses about family therapies, to help you and your partner cope with
this situation together.

This period is a bit of a blur. I was

trying to figure out what I had to do
next.
My partner was allowed to go for a
walk outside with me. We were both
very excited to leave the psychiatric
ward, even if it was only briefly.

20
8 Hospital — Going home
You’ll probably undertake a graduated return home, in which you leave the hospital
for gradually increasing periods, until you first spend a full day, then overnight, away
from the hospital.
Both you and your partner will be keen to go home; however, it is important not
to leave before your partner is ready. Ask nurses to explain the signs that indicate
whether or not your partner is ready to go home.
Play with your baby!
You are now putting the finishing touches on the plans to go home. You also need to
really start thinking about looking after yourself. Up to this point it is likely that you
have been running on adrenaline, but this cannot last indefinitely. Remember to take
breaks.
To do
• Meet your mental health case worker before you go home.
• Talk to a social worker from the maternal and child health service.
• Have a discussion with your mental health caseworker and the psychiatrist
regarding safety at home. Inspect your home from a safety perspective before
you start the graduated return to home. See page 40.
• Clarify and finalise your relapse prevention plan.
• Confirm you have sustainable day-to-day care organised for your partner before
you leave the hospital.

We were so excited to be going home

that, in hindsight, we rushed out of
the hospital too quickly.
Despite that, it was fantastic to be
home.

21
9 At Home — Nice to be home
You are finally at home, and along with the relief, you may be wondering what you
are doing and why you are there. Don’t worry. Just being there and spending time
with your partner is helping.
You will probably be doing most of the housework and cooking as well as childcare.
You may be starting to feel frustrated if your partner is not helping much. Stop. Take
a deep breath and remember that she is ill. Over time you will be able to negotiate
dividing the work more equally.
To do
• Expect to do the lion’s share of the domestic tasks. (This will change over time.)
• Remember to hug your partner and tell her you love her.
• Enjoy spending time with your baby and partner. Remember your partner may
be jealous of all the attention focused on the baby. This does not mean she is a
bad person; it is normal human nature.
• Enquire about starting psychological treatment, not just pharmaceutical
treatment, for your partner. By now she could be well enough to be debriefed
about her psychotic period. She could also start on psychological therapies to
help with bonding with the baby and give her the skills to cope with depression
if it should occur.
• Start to sort out any unrealistic expectations about motherhood that your partner
may have. She might believe she has to be a perfect mother. Ideas like this will
hinder her recovery. You only need to be “good enough” parents. Talk to both
the maternal and child health nurse, and infant mental health for support in this
area.
• Start working on your relationship with your partner. Formal therapy, such as
couple’s therapy, may help guide the conversation. Things may get rough later, so
pay attention now to your relationship.
• Look after yourself. Continue to get professional support for yourself.
• Start to show your partner that she still has a life separate from the baby. It’s
important that she does not feel trapped at home.
• Start checking with secondary carers about how things are going for them.

22
10 At Home — Second week at home — Routine
People often find that things are starting to settle down by this point. You are
probably developing a routine.
To do
• Check safety plans in light of current circumstances.
• Are you still being supported as a carer and a new parent?
• Has the mental health service established a visiting schedule?
• Has the maternal and child health service established a schedule of visits, either
at home or at the clinic?
• Start to establish activities and routines. It is important for you both to re-engage
with friends. You also need to seek out and engage with new groups of people
that your partner enjoys seeing. Do not do only baby-focused activities.
• Have you had the one-month baby health assessment? Have you sorted out
immunisations.
• Have you booked into a new parents’ group?
• Have you transferred specialists or do you still have the same one? If your
specialist has changed, how is that going? Ask for an assessment of how
treatment is progressing. Do some more research into treatments.
• Actively seek out experienced mums and people to play with the baby.
• Subscribe to child development emails. They will help give you some confidence
in looking after your baby.
• Seek help early with any feeding or sleeping difficulties your baby has. Remember
that good sleep is essential to recovery – if your baby isn’t sleeping, you and your
partner won’t be either.
• Check how well your partner is bonding with the baby.
• Continue to monitor your partner’s mental state as the manic or psychotic phase
is often followed by depression.
• Are you looking after yourself ? Are you managing your stress and getting breaks?
Follow up
• Have you obtained help adjusting to parenthood and becoming a carer?
• How are arrangements with secondary carers going?

23
Throughout this illness your partner is likely to have very disordered thinking. During
the psychotic phase she will have had some very weird thoughts and these may haunt
her. If she becomes depressed, she may be unable to express how bad she is feeling.
At this time your partner will need to learn the skills to cope with depressed thinking.
Your partner needs timely support to cope with these experiences, whether this is
training, debriefing or just having someone with her.
It is a good idea to start couples counselling as soon as you leave the hospital. It may
feel silly right now, but it will help keep you both talking when things get bad. If you
wait until things get bad, then it will be much harder to start talking.
Psychotic or manic episodes are often followed by depression. This can be weeks or
months down the track and sometimes can be quite sudden. If your partner falls into
depression she will need all your help and skills to cope. You will also need additional
support from friends and family, as this is exceedingly stressful.
You both need help with the social and emotional aspects of being a parent. These
aspects of parenting tend to be forgotten during this stressful time. Parenting is not
just about physical care of the baby. Play with the baby. Invite family and friends to
play with the baby. Talk to a professional about this.

24
11 At Home — Depression can set in
Your partner may have entered a depressed phase. Things will be hard, but they will
get better.
To do
• You may want to start home-based work, if this is possible. You may also be
starting to think about a graduated return to work. Although it may seem like a
bad time because your partner is so vulnerable, it is important to start
re-establishing normal routines. Speak to the specialist and then your work about
this. This will take a while to organise, so start early.
• Your partner may be agitating to go back to work. This could be a good thing
for her as it may help her focus on other things. Talk to your specialist about this.
• Are you looking after yourself ? Are you getting regular breaks and managing
your stress?
• Check safety plans in light of current circumstances.
• Continue to monitor your partner’s mental state and how well she is coping with
her role as a mother.

My partner’s depression was the

hardest thing for me to cope with. It
just went on and on. She was unable
to express how bad she was feeling.
Her sadness dominated the house.
The psychotic period was easy
compared to this.

25
26
Part 2 — Overview
Perspective
This booklet is written from a father’s and carer’s viewpoint, and works from the
following perspectives.
• The decision about which risks you and your partner take is a personal and
family one, not a medical one. You and your family are the ones who will have to
live with the consequences of your decisions, not the medical professionals. At
the end of the day they can leave it behind; you cannot. So the assumption is you
will be engaged with the process, actively assessing risks and making decisions.
• There is an expression, “It takes a village to raise a child.” It also takes a village
to look after someone who is ill. You cannot provide everything (physical,
emotional, social) that your child or partner needs. It is OK to ask others to help
or to leave jobs to others.
• There is no such thing as a “good” parent, only a “good enough” parent. The
phrase “good parent” suggests that there is only one right way to raise a child. In
reality, there are many ways. Which ones you use will depend on you, your child
and the circumstances. “Good enough” is fine. The same goes for caring.
• The family unit is the focus of treatment, not the mother. The mother’s illness
affects the whole family. How the family unit reacts to the illness will affect
recovery.
• Mental illness affects a person’s ability to reason. You may therefore need to
make some decisions on your partner’s behalf. Your relationship with your
partner will also change.
One of the most important things for you to remember is that you make decisions
based on the information available to you at the time. Do not feel guilty if hindsight
proves that a decision was a bad one. You made the best decision you could based on
the information you had.

Understanding your situation

To make decisions effectively you need to have a good understanding of the situation
you are in. You are on a journey where there are a number of different parallel
and competing processes occurring: mental illness, normal life, becoming a parent,
becoming a carer, and meeting the baby’s needs. You need to balance these processes
and not focus on one only or ignore one. This balance will change constantly.
Normal life
You need to balance your own needs with those of your family, job, extended family
and friends.

27
Transition to parenthood
Becoming a parent involves a number of emotional, social, psychological and
relationship changes. Household tasks will change, as will the way you divide them
with your partner. Leisure activities, your sense of companionship and the degree
of intimacy you have with each other all change. How well a parent copes with these
changes depends on:
• Your child’s characteristics, such as temperament and health.
• The characteristics you, the parents, as individuals have, such as temperament,
and your past experiences.
• The relationship between you and your partner, and things such as how well you
communicate and how anxious your temperaments are.
• Your social networks — things such as how many people you have in your lives
and how strong your relationships with them are.
Transition to being a carer
How well you cope with being a carer depends on what stressors you face, your
vulnerabilities and the resources you have access to. The course your partner’s illness
takes, your sense of control, your personality, your coping skills, your problem-
solving skills, what social supports you have, your self-esteem, your skills and
training, your health, your relationship with your partner, your past and whether you
have mentors all affect your ability to cope.
What your child needs
Your child has to develop physically, socially, emotionally and cognitively, and have
their needs met. They need to bond securely with one or more adults and develop a
secure base from which to explore the world. They need to have their needs met in a
sensitive and consistent manner.
Aspects of a carer’s life
There are a number of different parts to the picture that makes up a carer’s life. They
are:
• Working beside professionals. Managing your partner and baby. Looking after
your partner’s physical and emotional health.
• Educator. Educating the whole family system and friends about the illness.
• Patient advocate. Thinking about treatments and symptoms and dealing with
health professionals.
• Normal life. Housework and infant care. Balancing home, work and social lives,
and changing the balance as your partner’s condition changes.
• Looking after yourself.
• Coordination.
Whilst these aspects are presented as being clear cut, they are not. They are just a
guide to help you think about your situation, what you are doing and what help you
need.

28
As a person working beside the professionals, you are caring for your partner just as
the professionals are. You may be supporting professional care, such as monitoring
your partner to make sure she takes her medication, providing a supportive
environment, or reporting on changes in behaviour. You may be providing care the
professionals are not, such as supervision.
As a patient advocate you are trying to make sure that your partner gets the best care
possible and helping her to navigate the health system.
Looking after yourself refers to you needing help to cope with the situation. Whether
that means talking to a counsellor, getting a cleaner or learning new coping skills.
It also includes getting adequate sleep, eating properly, exercise and maintaining
friendships,
Normal life refers to everyday things, such as paying the mortgage, putting food on
the table, seeing family and friends.
Coordination refers to getting the balance right and making sure things happen when
they need to.

About puerperal psychosis

Course of the illness
Puerperal psychosis is a disorder of mood, like bipolar mood disorder. It begins
suddenly after childbirth and the early symptoms of mania, with delusions,
hallucinations, thought disorder and confusion, can last weeks to months. This is
often followed by depression, which can begin after several weeks or months. It is
important to watch out for depression, which may happen long after your partner is
out of hospital. The depression is part of the mood swing caused by the hormonal
changes of childbirth, even though it is weeks or months down the track.
What triggers the illness?
Puerperal psychosis is quite rare, and so there is still only a small amount of research
being done and information available. At the moment, researchers believe that where
a woman is predisposed to the illness, it can be triggered by sleep loss combined with
the big hormonal shifts that occur with childbirth.
Forty per cent of the women who develop puerperal psychosis have had no history
of mental illness. Sixty per cent of the women who develop puerperal psychosis
have a history of at least one episode of a psychotic mental illness, such as bipolar
mood disorder or schizophrenia. If your partner’s history includes a psychotic mental
illness, then the possibility of puerperal psychosis was probably discussed antenatally.
Symptoms
Psychosis is an altered perception of the world: your partner now sees the world in a
way that you consider odd. Her ability to think is affected and becomes distorted.
Psychosis has two types of symptoms: “positive” and “negative”. Positive symptoms
are characterised by abnormal “manic” behaviours such as being unable to sleep,

29
feeling full of energy, being irritable and restless, believing she has special powers,
and paranoia. Positive symptoms are relatively short-lived and respond well to
drug treatment. Negative symptoms are characterised by the absence of normal
behaviours – your partner may feel unable to get up in the morning, stop sharing
household tasks, stop washing and fail to show interest in anything. Negative
symptoms persist long after the positive symptoms go away and often do not
respond to drug treatment. Positive symptoms are found in the manic (psychotic)
phase of the illness and negative symptoms once the manic phase has passed.
Carers find negative symptoms more difficult to cope with than positive symptoms.
So don’t be surprised if you become frustrated with your partner’s lack of
responsiveness and help several months after the psychotic phase has passed.
The illness may affect your partner’s ability to meet the baby’s physical, social and
emotional needs. It may also affect your partner’s perceived relationship with your
baby.
What makes the illness worse?
Lots of things can make the illness worse – external factors, such as lack of sleep
along with stress and criticism, and internal factors, such as feelings of not belonging
and not being competent, and that she is a burden, as well as her internal dialogue.
Impacts on your partner’s recovery
There are many things that affect the course of a mental illness. These include:
• Therapy. This includes medications and talking therapies.
• Exercise, nutrition, and quality and quantity of sleep.
• Life events
• Personal factors, such as social skills, stress levels, coping strategies,
communication skills, sleep deprivation, perceptions of relationships within the
family, belief in ability to have control over events.
• Family and community factors such as rejections (real or perceived), quality
of relationship with baby and partner, involvement with family, friends and
community.
When obtaining treatment, it is worth remembering that:
• Wellness is not just an absence of illness, and vice versa.
• Maintaining and promoting wellness is different to treating a mental illness or
preventing a mental illness from occurring.
• Preventing a mental illness from getting worse is different to promoting
recovery.
• A treatment might not work for your partner, even though it works for others.
You both need to keep searching until you find treatments that do work for your
partner.

30
Just because you are doing something, it does not mean that it is the right thing or
more cannot be done. So keep researching the illness and treatments. Also, keep
discussing other ways of assisting your partner to recover. Your aim is to help your
partner overcome her illness, but wellness is the ultimate aim.
This illness can be treated in a number of different ways. This is because the brain is
biochemical and a network of neurons, which is connected to the body and outside
world. Treatment tries to get the biochemistry and network of neurons back to a
more usual state. The biochemistry can be treated directly by the use of antipsychotic
and antidepressant medications, or indirectly by looking at nutrition. The network of
neurons can be treated using psychological therapies or modifying the environment
(which is what the carer is doing). These activities try to minimise risk factors that
promote vulnerability to developing psychosis and maximise protective factors that
promote resistance to developing psychosis. It is best if a treatment plan can address
all these different aspects.
Each person’s mental illness will follow a different course. Consequently, treatments
vary over time and vary according to individual needs. So it is not possible to describe
a universal treatment plan. Treatment for the mental illness will probably include
drug treatments (antipsychotics and antidepressants) and counselling. However,
puerperal psychosis is as much about the transition to parenthood and coping with
the baby as it is about mental illness. So you need to ensure your partner’s treatment
plan includes therapies to assist her to successfully become a mother and you to
become a successful family, as well as treating mental illness.

Mental health acts

Each state and territory has a mental health act which covers the care of people with
a mental illness. All mental health acts allow a person to be treated against their, and
their family’s wishes. A person can be forced to have treatment where:
• the person refuses treatment;
• there is a concern about the person’s health and/or safety and/or the safety of
another person; and
• a court or mental health tribunal directs the person to be assessed and/or receive
treatment.
If you get caught up in this process, then it is probably a good idea to engage your
own lawyer, and possibly a separate lawyer for your partner, as this is a legal process.
It is important to remember that this process is meant to achieve the best outcome
for your partner, and that your views are still important and can be taken into
account.
If this happens, then the early decisions about place of treatment will be taken out
of your hands and your partner will probably be admitted to a mental health facility
for assessment. This may be hard if it is not the outcome you wanted; however, this
may be the outcome you wanted. If she is admitted and that is what you wanted, you
should try not to give into feelings of guilt.
31
The care system
You are unlikely to have all your needs met by one service. The care system is quite
fragmented; the focus of each service is different and they don’t necessarily talk to
each other. You need to understand this system to be able to navigate it to get the
help you need. You will probably have to deal with several different government-
run services as well as private sector organisations. Within the government there
are departments focused on health, families, law and order, and education. Within
the private sector are private hospitals and organisations that can provide you with
physical, emotional and educational support.
Within the department focused on health there will be the hospitals, the mental
health service, the maternal and child health service, and possibly infant mental
health, although your area may not have any of these specialised services.
• Hospitals are focused on caring for people who have acute problems. You may
encounter specialist accident and emergency wards, psychiatric wards, specialist
mother and baby mental health units, and mothercraft hospitals.
• Mental health services are focused on care within the community of people
suffering from a mental illness. They provide support and monitor the
symptoms of people with a mental illness. They provide emergency response
teams, which are similar to ambulances but deal exclusively with mental health
issues. They also provide treatment for people with mental illnesses.
• Maternal and child health services are focused on baby and mother related
issues. They monitor baby health and help parents learn how to care for their
babies. They assist with some parenting difficulties and help identify postnatal
depression.
• Infant mental health helps treat the psychological causes of parenting difficulties
and the consequent child behaviour problems.
Within the department focused on families there will probably be the child
protection unit and family programs.
• Child protection is concerned about the safety of the infant, whether that is due
to neglect, abuse, or some other cause.
• Family programs are focused on assisting parents to develop parenting and
coping skills. These programs are many and varied. Often they are not well
advertised.
Within departments focused on education there may be programs focused on
educating carers and providing them with skills. Often these programs are not well
advertised.
The police may become involved if your partner threatens violence or people
become concerned about their own safety, or hers. It is preferable not to involve the
police if at all possible. However, their involvement may be unavoidable.
The private health system provides many of the services that are provided by the
government health system. You have to pay for these services; however, you get to
32
choose the professional, and the services you receive. You may also be able to access
services faster. These services usually deal with people who are not as sick as those in
public hospitals.
Carer organisations provide training and support to carers. They may also provide
respite care. There are a number of different carer-focused organisations.
Support organisations provide peer support on issues of interest, such as postnatal
depression, or caring for someone with a mental illness.
A number of professionals will be involved in your partner’s care. They may include
psychiatrists, clinical psychologists, mental health nurses, midwives, maternal and
child health nurses, social workers, physiotherapists and occupational therapists. They
all play a different role.
• Psychiatrists are medical doctors who have specialist training in mental health
issues. They can prescribe medication, order medical tests and admit people to
hospital. They may also provide therapy. Psychiatrists can specialise in various
aspects of mental illness. So your partner may see several different psychiatrists
who each treat a different aspect of her illness.
• Clinical psychologists provide therapy. They cannot prescribe medication, order
medical tests or admit people to hospital. They may work with psychiatrists or
by themselves. Clinical psychologists have specialist training in psychology and
can specialise in various aspects of psychology. So your partner may see several
different psychologists who each focus on different aspects of her recovery.
• Mental health nurses are nurses who have received specialist training in mental
illnesses. Their focus is on monitoring and supporting people who have a mental
illness. This may be done in hospital or the community.
• Social workers try to improve the quality of life of individuals and groups. They
have specialist training in social work. Services provided by social workers may
overlap with psychologists, mental health nurses and counsellors.
• Physiotherapists help people with physical problems recover normal movement.
Your partner may have a number of physical problems as a result of the birth.
• Occupational therapists help people improve their ability to do day-to-day tasks
in all aspects of life and so influence their health and personal satisfaction. They
help people engage in and cope with daily life. In doing this they may help them
plan and carry out routine tasks and develop skills. They have specialist training
in occupational therapy.

33
Obtaining help from services
A number of services may be involved in your partner’s care. Often it might feel like
you are being offered the same service multiple times and you probably are. Your aim
is to get the services you need, not have too many people involved, and avoid double-
ups but not miss out. To achieve this you need to:
• Understand the range of organisations that exist and what services an
organisation provides.
• Understand the difference between the services an organisation provides and the
services they offer to you.
• Recognise that organisations may not be willing to discuss your partner and her
treatment with you.
If you think about these three things you may be able to work out whether you are
being offered the services you need only once and without too many people involved.
When obtaining help from services tell them you want to gain a better understanding
of the illness, how to be a carer, the support that is available and so on. If you focus
on specific information about your partner’s treatment, they may claim confidentiality
and refuse to help you. A better strategy is to observe treatment and then research it.
The following description helps you think about what is happening when obtaining
help from services. There are the services you need and the services you think you
need. Then there are the services an organisation provides and the services you are
offered. Finally, there are the services another organisation provides and offers to
you. You may not be offered the full range of services an organisation provides. You
may be offered services you don’t need or want. Some services may be offered by
multiple organisations, whilst others may be offered by only one organisation.

How do you care for the mentally ill?

How do you care for somebody who is mentally ill? This is not something that is
usually taught. You are often left to figure this out on your own.
Caring is a journey on which there a great deal of self-discovery and self-
management as you try to cope. There is no one right way to care. Below is a laundry
list to give you a place to start thinking about how you will care.
Your aim as a carer is to create a culture at home that is a positive, pleasant and
supportive one. Your partner needs to receive more encouragement than criticism.
You are trying to ensure your partner feels that she belongs and is not a burden.
You can do this through structures and routines. These make your day predictable for
your partner and help her succeed and feel loved.
People describe the caring role differently. Below are some tools and techniques to
consider when you think about what you will do in your caring role.

34
Medical
• Monitor her treatment.
• Monitor her symptoms.
• Monitor her medication. Make sure you don’t run out of medication. Make sure
she takes the right amounts at the right times.
• Alert the professional team to problems. You will need to discuss with the
professionals what they want you to look out for.
Practical
• Helping to keep the household running: cleaning, cooking, washing, shopping.
• Helping to care for the baby. (Don’t always leave your partner to deal with the
screaming baby at 1 a.m.)
• Manage visitors and social activities.
Caring
• Make her feel loved and wanted, accept her and give her approval.
• Spend time with her and have fun. Play
a board game or cards when the baby is I spent months trying to figure
asleep. Go for walks together. out what I was supposed to do. I
• Choose what you notice and comment on, was not given any guidance by the
and what help you provide. For example if professionals. The closest I came
your partner only feeds your baby avocado, to getting real support was my
then you could suggest other foods that may local carer’s association offering me
be suitable for your baby to eat. counselling by a person specialising
• Encourage hope, provide trust and accept in carer’s issues. I did not follow this
her as she is. Focus on strengths. up because I was over being offered
professional help and could not figure
• Learn about the illness and how to care for out the logistics.
your partner.
• Help her regain her life skills. Do this
gradually – help her do things for herself, but don’t overload her. Make her feel
competent and effective.
• Make her feel a valued part of the community.
• Protect her from people who might criticise her illness.
• Provide calm and quiet.
• Protect her from things that make her own death or self-harm seem possible,
such as violent television shows and movies.
• Allow her to express her concerns.
• Try to be someone she can rely on.
• Help her gain a more accurate and complete understanding of, or insight into,
herself.
• Provide understanding.

35
• Discuss problems and allow her to solve them.
Extended family and friends
• Manage non-professional carers, such as family and friends.
• Guide family and friends in how to deal with and cope with your partner and her
illness.
Look after yourself
• Eat, sleep, and exercise adequately.
• Manage your stress. Talk to professionals.
• Maintain your friendships and social life as much as possible.
The medical profession talks about risk and protective factors. “Risk factors” is just
a way of describing things that may make your partner’s illness worse. “Protective
factors” is just a way of describing things that help protect your partner from getting
sicker or promote recovery. Often risk and protective factors are at different ends of
the same line, so reducing risk factors may increase protective factors and vice versa.
Risk factors that could affect your partner include the following:
Personal
• Compromised social skills.
• A lack of strategies to cope with stress.
• Difficulty communicating with you and the outside world.
• Lack of sleep.
• Perception of a poor relationship with the baby or you.
• Substance abuse.
Family and community
• Rejection by others (real or perceived). Regularly debriefing with a
professional is really important. I
• Stressful relationships. was not offered this, nor did I realise
• Insufficient social support. that I needed to seek it out. There
Environmental were things I did not want to tell
• Major life events. friends or colleagues. And you start
to get really boring when all you talk
Protective factors can include the following. about are the ups and downs of
Personal caring. I think a professional may
• Medication. have given me some good strategies
and helped me cope better.
• Good coping skills.
• Good communication skills.
• Belief in her own ability to change her situation and influence her destiny.
• Ability to control actions, behaviours and emotional responses. This leads to the
ability to think clearly during stressful situations, delay gratification and control
impulses.

36
• A belief in something that gives a sense of meaning and purpose.
• Belief in her own ability to succeed in reaching specific goals.
• Therapy. This provides flexibility and more options to effectively deal with
problems.
• Good physical health.
• An easy temperament.
Family
• A stable relationship and quality communication between you and your partner.
• A warm and cohesive family interaction, where there is co-operation, mutual
support and a commitment to solving problems together. This is both between
you and your partner, and your partner and her family.
• Positive parent-child relationships. This is both between your partner and your
baby, and your partner and her parents.
• Social support/interpersonal interactions within the family’s social network,
including extended family, that provides emotional support, tangible help or
information.
Community interactions
• Involvement in the community. This provides access to larger social networks
and more resources, as well as a sense of belonging.
• Acceptance by peers.
• Supportive mentors.
At times you might wonder what you are doing. You may think you are not needed,
but you are helping just by being there.
Your relationship with your partner has changed due to her illness. It has also
changed because you are now parents. You need to negotiate how to care for your
child together. This will be hard due to your partner’s illness.
You will also need to talk about how you run the household together. You need
to help do this and to gradually release control as she gets better. You will need to
constantly renegotiate the division of labour as your partner gets better or relapses.
You need to have a plan for how to do this. It is hard to develop a plan on your own
and you may want to talk to an occupational therapist about how to go about this.
You need to find the right balances in your life. Think about:
• How much time together you need, and how much time apart.
• The balance in focus between her and the baby.
• Mum and baby time, dad and baby time, family time and time alone. You need to
find the right balance between all these.
• How much time you spend at home, and how much away from home.
• How much housework really needs to be done.

37
Discuss these with both the mental health case worker and the maternal and child
health social worker.
In amongst all this, you need to look after yourself. Looking after yourself means
taking regular breaks and doing things you like occasionally. However, sometimes
people can use this as a reason to avoid their partners, and you should be careful not
to let this happen.
You need to learn how to support the professionals. Ask them what you need to do
to support them.
Keep a daily diary of your routines. Regularly check both your routines with both
the mental health, and maternal and child health professionals to make sure they are
appropriate.

Getting help from family and friends

This area is a minefield. You probably don’t really know what you are asking people
to agree to. Similarly, people do not fully understand what you are asking or what
they are agreeing to. People will say “yes” when they mean “no”. People can fall
into helping roles, then find that too much is being asked of them but feel unable to
express that to you. People will try to help with the best of intentions, but sometimes
their “care” makes the illness worse because they don’t understand what they are
doing.
Some people will offer to help because that is the right thing to do, but may not really
expect you to take them up on the offer. They may be surprised if you accept and
unsure of how to retract the offer. Be cautious when accepting offers of help. Try
not to overload people.
You will need back-up plans. You need to give people graceful ways of saying “no”,
and you will need to be able to ask people to stop providing care if what they are
doing is not helping. You need to ask for help with caring, but also for help working
out how to negotiate these difficult social situations.
When you ask for help in caring for your partner, you should discuss boundaries.
• What are they willing to do? For example, cooking, cleaning, or giving social
support such as having afternoon tea with your partner.
• How often are they willing to do it? Daily, once a week, once a month,
occasionally?
• When are they willing to help? Mornings, afternoons, evenings, weekends?
• For how long are they willing to help? Will it be weeks or months?
You also need to stress that you are making your plans on the assumption that your
partner will be ill for at least the next six to nine months although you hope she will
recover sooner.
Once someone has agreed to help you, you need to regularly check that the
arrangement is working and fine-tune it as necessary. They are unlikely to do this
38
themselves. They may fear being honest with you when the arrangement is not
working for them. They do not want to hurt you or your partner’s feelings. You need
to stress to people that there is no shame in reducing or withdrawing their help. The
question is how that reduction in help is managed. If they are no longer happy to
help you and withdraw their help suddenly, then your partner’s care will suffer and
you do not want that.
When you realise that someone has taken on more than they can handle or they are
helping you and you have not discussed boundaries with them, you need to discuss
this with them.
You do need help. The difficulties described above are not intended to put you off
getting help, just to help you to be realistic about what you can expect and ask for.
Being aware of the potential problems should:
• Assist you to get the help you need.
• Assist you to prevent others “burning out” and withdrawing support at critical
times.
• Make you aware of the need for caution.
• Prepare you for potential disappointment when seeking help.

Helping visitors cope

All visitors, whether at home or the hospital need to:
• Provide messages of hope. They need to stress to your partner that she will get
well.
• Make your partner feel loved and included. (A hug is always enjoyed)Make your
partner feel competent. Your partner can still do things well. Focus on these and
praise her successes.
• Not give advice or suggest solutions. (This is very hard for men to do!)
• Focus on your partner’s feelings.
You will probably find that people want to talk about their own experience of
depression. If people do, then they should talk about what got them through. It is
fine for them to talk about how bad they felt and how they were unable to express
their feelings.
People should not do the following.
• Say things that will make your partner feel that she is a burden, such as “Stop
being a princess”, “You can look after yourself ”, “Why don’t you help your
husband?” or “Just get on with life and help.” Saying things like this make her
feel worse and make things harder. Her illness is real.
• Compare her situation with other people’s and suggest that “at least” she is not
as badly off as they are.

39
• Say or do things that make her feel incompetent or not as good as she was
before the baby. She is already thinking these kinds of thoughts and they
contribute to her illness.
• Say or do things that make your partner feel isolated, such as stop phoning or
inviting her (or both of you as a couple) out.
• Talk about their own experiences of wanting to kill themselves or traumatic
events. This can exacerbate her own feelings about suicide, or can sound like
they’re comparing themselves to her and trivialising her suffering.
See page 47 and page 49 for some suggestions on how to deal with the lack of normal
behaviours and symptoms of depression that you might encounter as your partner
recovers.
Safety
Unfortunately suicide and infanticide are real possibilities with this illness. So it is
important to think about safety, and about what you are willing and able to do to
manage these risks.
There are a few areas that you can monitor to give you the best chances of
preventing suicide. These are the physical environment, medications, your partner’s
mental state, and the care you provide.
Physical safety
It is harder for your partner to hurt or kill herself if things that might help her do
this are not accessible. It is a good idea to make your home as safe as possible for her.
However, you don’t want to make life at home too inconvenient. This is a balance
you’ll need to strike.
The two most common methods of suicide in the UK (figures are not available for
Australia), within the first year after birth are suffocation (which includes hanging)
and jumping.
• Suffocation: Think about ropes, hanging points (such as baby bouncers, tree
branches, railings, hooks and shower roses), plastic bags and hoses.
• Jumping: Do you live in a multi-storey building? Is there somewhere close by
from which she could jump?
• Poisons: Your partner may be given sleeping tablets. Discuss with the nurses, her
case manager or her doctor where they should be stored.
• Bleeding: Think about knives, sharp tools and firearms she could have access to.
However, you should also be aware that sometimes people choose other methods
such as stepping into traffic, burning and drowning.
The weather
Think about environmental factors that might increase suicide risk. Hot weather
increases the risk of suicide, So if night-time temperatures are over 26°C, then think
about cooling the bedroom or sleeping somewhere cooler such as the basement or an
air-conditioned hotel room if this is feasible for you.
40
Medications
Changing or starting medication can be dangerous, even if it helps in the long run.
It can take up to six weeks for antidepressants to stabilise a person’s mood. Not all
antidepressants are effective for everyone, and some antidepressants can actually
increase suicidal feelings in some people.
Be vigilant whenever your partner changes medication. Discuss with her psychiatrist
any extra safety precautions you should be taking at this time. You may need to take
additional time off if you have returned to work.
Your partner’s mental state
There are several things that affect your partner’s mental state: her biochemistry,
thought patterns, and environment.
Feelings of depression, and the likelihood of suicide, can vary across the day in
predictable patterns. The most common ones are:
• Depression is worst in the morning with mood lifting throughout the day.
• High mood in the morning, and depression increasing over the day until it peaks
in the evening.
• Depression fairly constant during the day.
This is related to daily changes in hormone levels. Identify the time of day when your
partner feels most depressed and aim to be there during that time.
Suicidal feelings can also be related to stress. Try and identify the stressors that
increase her suicidal feelings and then try to keep them away from your partner.
Your partner may have unhelpful thought patterns. Fortunately there are some
straightforward techniques such as cognitive behavioural therapy, or mindfulness
training, to help your partner manage or prevent these thoughts.
If your partner starts to develop suicidal feelings, you want her to have the
mental skills to cope with the strong emotions associated with this. It helps if she
understands that her suicidal feelings, though intensely painful in the present, will not
be around forever. She can “ride out the wave” of suicidal desire.
Your partner’s treating team will be able to advise you and your partner about
techniques to manage unhelpful thoughts and strategies to cope with crises. It is
better to have these conversations earlier rather than later. If unhelpful thoughts
occur, make sure your partner’s treating team know what she is dwelling on.
Remember that even socially advantaged, well-supported women with higher
education are vulnerable to suicide. Some research suggests that they are even more
at risk than women from other types of backgrounds.
Your care
Suicide can be seen as the culmination of a long series of events. So when you’re
thinking about safety, think about how to intervene early, as well as what to do in a
crisis.

41
The best way of preventing suicide in the longer term is to minimise suicidal feelings
in the first place. So you are looking for effective pharmaceutical and psychological
treatment. At home, you want to try to ensure your partner feels that she belongs, is
competent, and is not a burden. You also want to prevent her from developing the
ability to take her own life.
To do
Long term
• Have a discussion with the mental health professionals about suicide and
infanticide. What signs are you looking for? When should you call someone?
• Discuss with the mental health professionals what to do in the event your
partner feels suicidal. (These conversations are difficult and you are under a lot
of stress, and you may find it hard to recall what was said if you eventually need
this information. Ask them to write it down for you.)
• Make sure your partner keeps taking her medication; people can sometimes
quietly stop doing so as they don’t like the side effects or have decided they are
better.
• Make sure your partner keeps her appointments with members of her treating
team.
Crisis situation
• Stay with your partner and make sure she is safe.
• Call your mental health caseworker if the crisis is during working hours.
• Call the mental health emergency team if outside working hours. Tell them that
your partner has been diagnosed with puerperal psychosis and is now actively
contemplating suicide.

42
Part 3 — Quick summaries
Caring for baby
Phase of illness Helpful interventions
Psychosis • Consider the safety of baby.
o Regularly check your partner and baby, or stay with her as
much as you can.
o Monitor your partner’s delusions and seek help if they
start to involve the baby.
• Assist your partner to care for baby.
o Help your partner feed baby. For example fetch baby
to her, make sure she has a glass of water and enough
cushions. You might also consider taking over one night
time feed and giving baby a bottle using expressed milk or
formula.
o If baby is crying, help your partner figure out why
baby is crying. For example, hungry, dirty nappy, wrong
temperature or wants to be held. If all else fails or your
partner is becoming distressed, you can try you settling
baby in another room or taking them for a walk outside.
o Assist your partner with the practicalities of looking after
baby, such as dressing, changing baby’s nappy and bathing.
* Notice the weather and help your partner pick
appropriate clothing for baby.
* Check baby’s nappy regularly so baby is not in a pooy or
wet nappy for long periods.
* Run baby’s bath and always check the water
temperature. Check that washer, towels and cloths are
ready and handy before putting baby in the bath. Be
in the room when your partner baths baby in case she
loses concentration or has trouble holding baby.
o Always check baby’s capsule is put into the car correctly.
• Have the baby sleep in another room so they don’t disturb
their mum. (Babies are noisy sleepers.)
• If baby is asleep, try to get your partner to also rest. You
could try having everyone going to bed.
• Try to limit the number of visitors at any one time and on
any one day.

43
 Phase of illness Helpful interventions
Psychosis • Help your partner interact appropriately with baby.
(Continued) o Encourage her to use appropriate facial expressions even
though she may not feel like it. (Fake it till you make it.)
o Encourage her to hold baby, such as cuddling or carrying
in a baby pouch.
o Encourage her to sing songs, for example rock-a-bye baby
or twinkle twinkle little star.
o Encourage her to play simple games with baby, such as
peek-a-boo.
Depression • Consider the safety of baby.
o If your partner is suicidal you need to discuss care of
baby with a professional.
o Think about change table safety. Baby will become more
active and your partner may be distracted. Consider
changing baby on the floor.
o Monitor bath temperature and bathing.
• Assist your partner plan her day so that goals are realistic.
Assist your partner to prepare for her day.
• As for psychosis, but giving your partner more
responsibility.

44
Dealing with abnormal behaviours
“Positive” Associated behaviour Helpful interventions
symptoms of
psychosis
Delusions and • Hearing and responding to • Do not engage your partner
hallucinations voices that are not there. in an argument about her
• Talking about the content of delusions. The delusions are
the delusion or hallucination. fixed and difficult to change.
• Behaving in a way that is • Connect with the emotion of
consistent with the delusion the delusion or hallucination
or hallucination e.g. hiding e.g. “it must be frightening
her baby because she thinks to…”
someone is trying to steal • Limit stimuli – reduce the
them. number of people and
• Being distracted and unable to surrounding noise.
concentrate. This may mean • Show compassion for the
she fails to provide adequate content of the delusion
care for her baby. She may without encouraging it.
start a task, such as feeding the
baby, but not complete it.
Paranoia • Behaving as though she is • Do not engage your partner
(delusions) being followed, tricked or in an argument about her
spied on, e.g. by you or the delusions.
baby. • Focus on the feelings
• Being overly sensitive and associated with the paranoid
suspicious. delusions, not the delusions
• Behaving in a way that is themselves.
consistent with the content of • Avoid confrontational body
the paranoid belief. language – sit beside rather
• Irritability. than in front of her.
• Aggression – your partner • Stay calm.
could be afraid (of the baby, • Consider the safety of
for example) because of yourself, baby and your
the delusion and may act partner.
aggressively as a result.

45
“Positive” Associated behaviour Helpful interventions
symptoms of
psychosis
Disordered • Reflected in disorganised • Communicate in a clear and
thinking and speech. simple manner.
behaviour • Not appearing to cooperate • If necessary, repeat things,
—“vaguing out”. talking slowly and allowing
• Difficulties in performing daily plenty of time for your
activities of living, such as partner to respond.
caring for the baby. • Give step-by-step
• Dressing herself or the baby instructions.
inappropriately or in an
unusual manner e.g. lots of
clothes on a hot day.
• Failing to meet the baby’s
needs regularly or consistently.
• Treating the baby
inappropriately e.g. feeding
inappropriate foods or
expecting the baby to talk.

46
Dealing with a lack of normal behaviours
“Negative” Symptoms Associated behaviour Helpful interventions
of psychosis
A reduced range of • Her face may appear • Be aware that this is a
emotional expression immobile and symptom of the illness.
(affective flattening) unresponsive. Don’t take it personally.
• She may be unable to • These behaviours will
make or sustain eye cause problems bonding
contact. with the baby, so seek
• Her body language may help with bonding early
be reduced. Talk to skilled staff about
this. A common strategy
suggested is “fake it till
you make it”.
• Try not to get frustrated
or hurt by the lack of
emotion that she is
displaying.
• Be aware that just
because she is showing
a reduced range of
emotions, it does not
mean that she is not
feeling anything.
Poverty of speech • Reduced communication. • Keep verbal
(alogia) • Brief and empty replies. communication simple
• Decreased fluency of and accept simple
speech. communication in return.
• She may appear to have • Keep communicating
diminished thoughts. regardless of response.
Don’t assume she cannot
understand your message,
even if her response is
limited.

47
“Negative” Symptoms Associated behaviour Helpful interventions
of psychosis
Inability to initiate and • She may sit for long • Understand and
persist in goal-directed periods of time doing acknowledge that these
activities (avolition) nothing. are again symptoms
• She may display little of the illness and not
interest in participating in deliberate acts.
any sort of activity. • Try not to become
• She may lack motivation. frustrated with the
behaviours.
• Provide gentle
encouragement for her to
undertake activities.

48
Dealing with symptoms of depression
Symptoms of Associated behaviour Helpful interventions
depression
(These are not negative symptom of psychosis but are often secondary to
psychosis. Also psychotic symptoms can be part of depression.)
Depressed mood, loss • This is characterised • Be aware that depression
of interest or pleasure in by expressions of is a very real condition
nearly all activities helplessness and reflecting changes in the
hopelessness. chemicals of the brain
• She is depressed most of and that it does not mean
the day. she is weak. You cannot
• There is a loss of interest jolly a person out of this
or pleasure in activities state.
and she may not move • Connect with the
much at all, just sits emotion of the
staring into space. experience rather than
• Fatigue and loss of trying to change her
energy. mind.
• Sometimes she can • Reinforce your love for
articulate having no her.
feelings, but a depressed • Try to sit beside and be in
mood can be inferred her space – often people
from her facial expression who are depressed do
or demeanor. not like to make demands
• Sometimes depressive on others but appreciate
mood can be exhibited company. Likewise, you
in irritability rather will need to do the talking
than sadness, including rather than expecting her
persistent anger, to do so.
overreaction to events, • Keep up good levels
angry outbursts and of communication
blaming others. even when she doesn’t
• Social withdrawal. respond.
• Her skin may become
coarse and dry, and hair
limp and greasy or sparse.

49
Symptoms of Associated behaviour Helpful interventions
depression
Inability to concentrate • Poor concentration and • Attend to safety issues
poverty of thought. that poor concentration
She may have difficulty can cause.
putting sentences and • Set realistic tasks.
thoughts together. She • Have realistic
may give monosyllabic expectations.
responses and need
prompting.
• She may appear easily
distracted or complain of
memory difficulties.
• She may be less able to
achieve intellectually
demanding tasks than she
was previously.
Suicidal ideation • She may think about • Be aware of suicide risk.
death frequently or If you are concerned, do
constantly. not be afraid to talk to
• She may talk about death her about suicide – this
or suicide. will not make her act
• She may attempt suicide. on possible thoughts of
suicide. Communicate
with her treating team
about this issue. If it
becomes very persistent,
you may need to
hospitalise her.
• If she expresses
unexpected happiness
and begins to give
possessions away and
organise her affairs,
be aware that can
indicate she is thinking
about suicide and seek
assistance immediately.

50
Symptoms of Associated behaviour Helpful interventions
depression
Decreased energy, • She may report sustained • Avoid placing unrealistic
tiredness and fatigue fatigue without physical demands on her.
exertion. • Be patient.
• The smallest tasks can • Notice and recognise
require substantial effort. small achievements.
• May take twice as long as
usual to do things.
Sense of worthlessness • Feelings of worthlessness • Connect with the
or guilt and guilt, which, at the emotion of the
psychotic level translate experience.
into the belief that she • Notice and recognise
has done something small achievements.
terrible and needs to be • Avoid trying to do too
punished. much problem-solving.
• She may believe She probably will not be
unrealistic negative ideas ready.
about her self-worth. • Avoid long, self-effacing,
• Guilt about or self-defeating talk from
preoccupation with past her.
failings.
• Misinterprets neutral or
trivial day-to-day events
as evidence of personal
defects.
• Exaggerated sense
of responsibility for
untoward events.
Changes in appetite • Sometimes her appetite • Be aware of hydration
may increase but more and nutrition issues.
usually people experience
cravings for particular
foods, particularly sweets
or carbohydrates.
• Significant loss or gain in
weight.

51
Symptoms of Associated behaviour Helpful interventions
depression
Changes in sleep • Insomnia and early • Try to do some exercise
patterns waking. with her. For example,
• Not sleeping at all or walking around the block.
waking early in the • Medication.
morning.
• Less frequently, over-
sleeping.
Reduction in libido • Reduced or absent sexual • Express intimacy and
interest or desire, often communicate physically,
for long periods. for example by cuddling
or giving her massages.
This helps keep you
connected without
placing demands on her.

52
Symptoms
Acute illness Recovery begun Recovery established
• Behaving out of • Lacking energy. • Return to more normal
character. • Poor concentration. behaviours and moods.
• Irritability. • Depressed.
• Believing things that are • Reduced range of facial
not true. expressions.
• Hearing voices. • Not want to talk.
• Seeing things that are • Not able to concentrate.
not there. • Feelings of helplessness,
• Being confused, hopelessness, and/or
forgetful, and/or very worthlessness.
disorganised. • Tearful.
• Moods change very • Not able to eat or sleep.
quickly. Can be elated • Suicidal thoughts.
and then confused very
quickly.
• Difficulty caring for
the baby or doing other
tasks.

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Treatments
Acute illness Recovery begun Recovery
established
Biological • Sedating • Psychotropic • Sedating
medication. medication. medication.
• Psychotropic • Antidepressants • Psychotropic
medication (larger and/or ECT. medication (larger
doses). • Mood stabiliser. doses).
• Antidepressants • Antidepressants
and/or ECT and/or ECT.
(Electro • Mood stabiliser.
Convulsive shock
Therapy).
Psychological • Emotional • Supportive • Supportive
support. counselling. counselling.
• Psychological • Psychological
treatments which treatments which
teach coping, teach coping
problem solving and parenting
and parenting skills, and start
skills and start addressing
addressing underlying
underlying problems that may
problems that may affect recovery.
affect recovery,
such as adverse life
events, low self-
esteem, negative
thinking patterns,
perception of own
childhood.
Environmental • Reduce • Increased • Increase
stimulation. stimulation. independence.
• Reduce stress. • Reduce stress. • Increase
• Increased levels of stimulation.
responsibility for • Reduce stress.
herself. • Enhance
• Work on relationships with
relationship with extended family
baby and partner. and friends.
• Link into support
networks.

54
 Acute illness Recovery begun Recovery
established
Environmental • Enhance • Enhance
(Continued) relationships with relationship with
extended family. baby and partner.
• Link into support Do a program
networks. such as PAIRS,
• Help your partner circle of security,
to feel that she is triple P parenting,
competent and parents as teachers.
belongs. Attend couples
counselling.
• Help her to
feel that she is
competent and
belongs.
Place • Hospital. • Hospital or home. • Home.

55
Role of professionals
Acute illness Recovery begun Recovery
established
Biological • Prescribe • Ongoing review • Ongoing review
medication. and adjustment of and adjustment of
medication. medication.
Psychological • Monitor • Intensive case • Reduced case
management. management.
• Deliver • Deliver
psychological psychological
therapies. therapies.
• Develop wellness • Monitor and
recovery plan and modify wellness
implement. recovery plan.
Environmental • Help family learn • Monitor recovery. • Monitor recovery.
about illness. • Help carers • Help carers
• Help family manage social and manage social and
acquire coping and environmental environmental
problem solving risk and protective risk and protective
and practical factors. factors.
skills required for • Continue to • Continue to
caring. provide support provide support
• Help family learn and information and information
about the system. for families and for families and
• Refer family friends. friends.
to appropriate
supports.

56
Role of carers
Acute illness Recovery begun Recovery
established
Biological • Make sure she • Ensure adequate • Ensure adequate
is drinking and supply of supply of
eating. medication. medication.
• Maybe take her • Ensure medication • Monitor that
out for a walk. has been taken. medication has
• Help her get some been taken.
sleep at night if
you can.
Psychological • Provide • Ensure that • Ensure that
information to appointments are appointments are
professionals to so kept. kept.
they can identify • Monitor • Monitor
appropriate treatments, treatments,
psychological identify problems identify problems
treatments. and assist to and assist to
find appropriate find appropriate
services. services.
Environmental • Assist with care of • Assist with care of • Assist with care of
baby. baby. baby.
• Learn practical • Care for partner. • Care for partner.
parenting skills. • Monitor risks. • Monitor risks.
• Learn about • Continue to • Continue to
illness and service seek appropriate seek appropriate
system. training. training.
• Learn practical • Manage family and • Manage family and
strategies of self- friends. friends.
care. • Help maintain • Help maintain
• Learn practical connection to connection to
strategies of caring family and friends. family and friends.
for your partner. • Find and utilise • Find and utilise
• Learn coping and support services. support services.
problem-solving • Try to make • Try to make
skills. partner feel loved partner feel loved
• Identify risks and and competent. and competent.
decide which ones
to take or modify.
• Manage family and
friends.

57
 Acute illness Recovery begun Recovery
established
Environmental • Help maintain
(Continued) connection to
family and friends.
• Find and utilise
support services.
• Try to make
partner feel loved
and competent.

58
Suggested readings
Family related
Barker R (2005) Baby Love. Sydney, Pan.
Biddulph S and Biddulph S (2007) The Complete Secrets of Happy Children. Sydney,
HarperCollins Publishers.
Chapman G (2000) The Five Love Languages: How to Express Heartfelt Commitment to Your
Mate. Sydney, Strand Publishing.
Feeney J (2001) Becoming Parents: Exploring the Bonds Between Mothers, Fathers, and Their
Infants. Cambridge, Cambridge University Press.
Grose, M (2010) Thriving! Raising exception kids with confidence, character and resilience.
Sydney, Random House Australia
Milgrom J, Ericksen J, et al. (2009) Towards Parenthood: Preparing for the Changes and
Challenges of a New Baby. Camberwell, VIC, ACER Press.
Raising Children Network www.raisingchildren.net.au
Child youth health – SA www.cyh.com
Royal Children’s Hospital www.rch.org.au
Circle of security www.circleofsecurity.org

Health
Ashfield J (2009) Taking Care of Yourself and Your Family: A resource book for good mental
health. Norwood, SA, Peacock Publications.
(Can be ordered for free from www.beyondblue.org.au)
Johnston M and Johnston A (2008) Living with a Black Dog: How to Take Care of
Someone with Depression While Looking after Yourself. Sydney, Pan.
Joiner TE, Jr. (2005) Why People Die by Suicide. Cambridge MA, Harvard University
Press.
Parker G (2004) Dealing with Depression: A Commonsense Guide to Mood Disorders. Crows
Nest, Allen and Unwin.
Rose L (2000) Learning to Love: The Developing Relationship between Mother, Father and Baby
During the First Year. Camberwell, VIC, ACER Press.
Schneider SH (2006) The Patient from Hell: How I Worked with My Doctors to Get the Best
of Modern Medicine and How You Can Too. Cambridge, MA, Da Capo Press.
Williams M, Teasdale J, et al. (2007) The Mindful Way through Depression: Freeing Yourself
from Chronic Unhappiness. New York, The Guildford Press.

59
Mental Illness Fellowship www.mifa.org.au
SANE www.sane.org
Black Dog Institute www.blackdoginstitute.org.au
beyondblue www.beyondblue.org.au
Children of Parents with a Mental Illness www.copmi.net.au
PANDSI – Post and Ante Natal Depression Support Inc www.pandsi.org
PANDA – Post and Ante Natal Depression Association www.panda.org.au
Helen Mayo House www.wch.sa.gov.au/hmh
Lifeline 13 11 14

Carers
Carers Australia www.carersaustralia.com.au
Princess Royal Trust for Carers www.carers.org

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