Imagine a world where the government in power is committed to the long term future of the NHS. The energetic MP Luciana Berger enjoys a cabinet-level post with a brief to drastically improve mental healthcare, and ensure that every family gets the health and social care services they need. The Government has acknowledged the LSE report (http://everyonesbusiness.org.uk/wp-content/uploads/2014/12/Embargoed-20th-Oct-Summary-of-Economic-Report-costs-of-Perinatal-Mental-Health-problems.pdf) which found that undertreated mental illness amongst new parents costs the UK economy over £8 billion every year. And furthermore, the Government has fully signed up to the 1001 Critical Days campaign, calling for the best start in life for every child, to grow up in households free from the debilitating trauma of untreated mental illness.
Into this world, a baby is born. Jacob was much anticipated and planned for, the son of a young couple, John and Susan, with no history of mental illness. His birth was traumatic, and shortly afterward Susan was behaving erratically. Her family became worried. They consulted the pack given to every new parent upon leaving the maternity ward: in it, was a plain-speaking leaflet on perinatal mental illness, and a list of local resources. They called the local number and a specially trained midwife answered the phone.
The midwife Maya asked John a few questions, before arranging a home visit. By the time she came over, later that afternoon, Susan was delirious. Maya explained that Susan may be suffering from a condition called postpartum psychosis, and needed to be seen by a perinatal psychiatrist straight away. She advised John to pack an overnight kit for both Susan and baby Jacob, as most often a spell in hospital was necessary. She reassured him: don't worry, this is very treatable, with the right help Susan will be recovered very soon.
In this Dimension, Mother and Baby Units are the standard way of treating severe perinatal mental illness in the UK. The Government had invested enough money to ensure that there was an MBU in every region of the UK - including Wales, Northern Ireland, the South West and Highlands and Islands. This couple were fortunate: their local MBU was just a ten minute drive away. It had an international reputation for the quality of its care.
Maya patiently explained what would happen next. They would all drive over to the MBU, for assessment by the psychiatrist. They would likely be admitted, as a bed was available. John was very nervous, but he felt reassured by the midwife's kind words, and the written information she gave him to digest later.
They rang the bell of the MBU: from the outside, it looked like a slightly-larger-than-average family home. It had colourful paintwork and a well-stocked garden. Other than the double-locked entranceway, there was little indication that this was an acute psychiatric facility. They were greeted by a staff nurse, who showed them into a comfortable sitting room. Susan, by this stage increasingly agitated, was encouraged to sit in a nursing chair and she used the pillows to prop herself up and continue breastfeeding while the doctor came in.
"I'm Dr Brown. But please call me Matthew."
Matthew shaked their hands and sat next to the mum.
"From what I have seen so far, it looks like you may be suffering from postpartum psychosis. But Susan, please don't worry: you will get better here. And you and Jacob can stay here as long as you like until you are better."
"Here comes nurse Sarah, to give you the tour and help you settle in".
The young nurse Sarah took Susan by the hand, and showed her around the Unit.
"You've already seen the sitting room, where we tend to hang out in the evenings. Quite often the mums like a nice "adult" space away from all the baby stuff. Here we can stick the telly on, or listen to music. We've got a great DVD stash.
"And just down here is the nursery. We've got everything you might want for Jacob: toys, books, playmats, bouncers. Don't worry if you've forgotten anything - we've had a lot of donations from former residents over the years, we can always find clothes to fit or toys you are looking for. Here are the nursing chairs, and you see our resident Yolanda over there? She's using one of our hospital-grade breast pumps. Our breastfeeding counsellor comes in every day, and she can show you how to use it if you like?
"We've also got the baby sleep zone: you'll see some of the babies sleep in there, so their mums can get a full nights rest. It's all monitored and of course if Jacob is in there you can pop in and check on him whenever you like."
Sarah opened various brightly painted doors: to the baby changing station, the milk storage room, and the resident's kitchenette (with tea and coffee maker, toaster and microwave). There was a beautiful dining area with French doors out to the garden. On the large oak table was a big bowl of fruit, and pots of jam one of the mums had made in the OT cooking class. Some of the residents were sat outside on the patio chairs, drinking tea. Their babies were rolling around on picnic blankets.
"We have ten bedrooms here, and you'll soon get to know everyone. The mums out there are Kate and Daphne - they are both due to go home soon, but not that long ago they were both very poorly themselves. I've checked and they are both very happy to chat about their experiences, and what helped in their recoveries. We find peer support here to be invaluable, and we also encourage everyone to attend group therapy sessions and to log in to the online Twitter support group every week.
Here is your room. I'm sorry it's on the small side, but we used the space to make sure all the rooms had en suite bathrooms. We really value our residents privacy, and ability to relax, here. We do have to make regular observations, but we will explain the procedures carefully so that you understand what and why we are doing certain things. I know a psychiatric hospital is a scary place to be, but I promise we will try to allow you to feel at ease."
Sarah continued the tour, by showing Susan and John the nurses station and notice board.
"This is the real hub of the MBU, right here. I know it looks confusing, but here on this big board is everything you might want to know: who is on duty, their names and job descriptions, who is your named nurse, when the doctor is next available. You'll also see all our different timetables: we have one for relaxation and mindfulness activities, one for the group exercise programme run over in the OT gym especially for new mums, and one for the mum and baby activities. Right now, we have Rhyme Time, baby massage, postnatal yoga, and Monkey Music. We encourage the Dads to join in with these too, so some of the classes take place at the weekend. Talking about dads, we believe in the whole-family approach here. Two of our bedrooms are actually self-contained family units, which might be suitable for the three of you once you are feeling a little better. You're a family now, and we treat you as a family!
"So, back to the timetables. We try to encourage our residents to pick just one or two activities, to fit around their regular psychology and psychiatry appointments. As you start to feel better, you might want to do more - and perhaps explore all the other activities put on by the OT department and patient-led groups.
"I can see this is all a bit overwhelming! Don't worry, you don't have to sign up to anything just yet. And all the information is also in your welcome folder, just there by your bed.
"The first step is to start getting you better. John told the doctor that you haven't really slept since Jacob was born? Ok, so this is the priority for tonight. Will it be ok with you to take Jacob to the nursery, so you can have a lovely bath and an early night?"
Susan nodded. As John took Jacob down to the nursery, she felt a wave of relief. She sank down onto the comfy bed as nurse Sarah drew the bath and added a liberal handful of lavender bath salts. She felt safe, for the first time since Jacob was born. She knew she was in the right place.