Post-partum psychosis is a consistent source of new episodes of severe mental illness and its worldwide prevalence has remained unchanged at 1 in 1000 live births over the past 150 years. For some women, admission to hospital is necessary. In the UK special mother and baby units (MBUs) are available in some areas to allow mothers to remain with their babies during treatment. This can help avoid the potential detrimental effects of separation from the mother on the baby and the effect this separation would have on the mother's confidence and capability as a future carer.
While surveys have reported that many women strongly prefer admission to MBUs, there are concerns that admitting a baby to a psychiatric unit for long periods of time may be harmful in terms of institutionalisation of the baby, and the rarer potential risk of physical harm from severely ill mothers. Although MBUs are recommended as the optimal site for treating a perinatal psychosis in the UK, outside of some parts of Australia, Europe, Canada, and New Zealand, they are either virtually non existent or very limited. There is no real clarity in the literature to explain the reasons why there is such a difference in the treatment of women with mental illness around the world.
To assess the efficacy of MBUs we systematically searched for any randomised trials of MBUs compared to standard care. We found no trials involving either mothers suffering from post partum psychosis or severe post natal depression. Anecdotal results from a 1961 trial did suggest a beneficial effect, but non-randomised data from over 40 years ago is difficult to apply to today's care. Such lack of data is of concern as MBUs are expensive to set up and run. If they are to be the 'gold standard' of care for mothers and their babies, their effectiveness needs to validated. Good quality, relevant research is urgently needed.