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The first thing we look for
is Rupert in the right mood for a massage?
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What do you think?
Well, he's quiet.
And he seems quite relaxed.
You okay?
Well done.
It's just Rupert's leg.
That's all it is, the same leg he's had all the time.
Same little legs that kicked you during pregnancy.
Okay.
How's Rupert doing, do you think?
- I think he's okay. - I think he's okay, too.
This is nice, Rupert.
How are you doing?
Okay.
Now I've got my hands on him,
it's actually not as bad,
as I thought it was going to be.
I was spending time with women
dealing with mental illness brought on by having babies.
Hello.
For all its joys,
new motherhood can be a time
of extreme psychiatric difficulty.
In homes and in specialized units,
I was with families and staff
working to find a way back to recovery.
Exploring the wrenching challenges
of caring for two people
in the most vulnerable states of their lives.
In South East London, I was on the Mother and Baby Unit
of Bethlem Hospital.
May I?
Hi, Catherine.
How are you doing?
Louis.
- Hello, nice to meet you. - Nice to meet you.
- This is Jake. - Hi, Jake.
- How are you? - You going to say hello?
Oh, wow.
He's just excited about life, isn't he?
He is.
- May I? - Yeah, of course.
He's just started sitting up, as well.
How old are you?
- He's six months tomorrow. - Oh, wow.
It's your six-month birthday.
Let's say hi.
How are you doing?
Ooh.
So, how long have you been here?
- Four weeks now. - Four weeks.
- That's quite a while. - It's very long.
- This is the nursery. - Yes.
- You can have a little quick look in there,
that's where all the babies sleep.
Oh, yeah!
So of a night, there'd be a few babies in there?
Yeah.
Yeah, Jake sleeps in there still.
And have they given you an idea
of how long you will be staying here?
No, I think I've added
a couple of weeks onto my stay
from a couple of things I did last week, so-
Oh, really?
- Are you under section? - Yes.
- So if you wanted to leave, it would be quite difficult?
I couldn't, they'd restrain me.
Or if I managed to escape,
the police would probably end up bringing me back.
And as I understand it,
you're on a one-to-one right now.
So, you've got your,
how are you doing?
- What's your name? - My name's Karen.
Karen.
Louis.
So, basically, in shifts,
someone will always be with Catherine?
That's right.
24 hours a day basically,
she's got somebody outside her room at night
and following her around all day.
- That's quite full-on, isn't it?
Yeah, 'cause I tried to take an over,
I did take an overdose.
So, that's why.
- When was that? - Last Wednesday.
- So, the idea is to prevent you doing anything
harmful to yourself basically?
- Yes. - May I?
Yes.
What is it?
Are you getting tired?
What happened?
Is that fun?
A project coordinator at a large business,
Catherine had a history of eating disorders
and self-harm as a teenager.
After Jake's birth, she'd struggled with severe feelings
of anxiety and depression.
Five months later, a psychiatric perinatal team
found her a bed at Bethlem.
I don't want to sound naive.
I would never have known you were unwell.
- No. - Are you just good
at hiding it, or-
Yeah, I'm very good at hiding it.
I think that's what, like, with postnatal depression,
you could stand next to someone in the supermarket queue
and you'd never know that they might go home
and completely fall apart.
Is that what it is,
postnatal depression, in your case?
Or is it something else?
I think I've had a lot of issues
bubbling under the surface for a long time,
for most of my life.
And it just exacerbates it.
Having a baby, it's such a massive change in your life,
as well, and no-one can prepare you for that.
And we had a termination last year,
about halfway through the pregnancy.
We had a diagnosis of a rare form of Down's syndrome.
So, we decided to terminate the pregnancy,
and then we got pregnant with Jake quite soon after,
and I think that anxiety in pregnancy was just so high,
like something was gonna go wrong,
we'd have to make the same decision again.
Once Jake was here, it was just such a shock
to have a healthy, living baby,
and even when we got him home, it didn't feel real.
When I had to go in and give birth to the last baby we had,
even though it was only 17 weeks,
it was still an actual real baby,
with fingernails and toenails and hair on his head.
And Jake was born three weeks after the first anniversary,
of his birth, as well.
So, And he was a boy.
So everything just merges together for both of them
and every time I think I look at Jake, I'm thinking,
"This is what I can't do for my last baby."
He's a reminder of all that grief?
Yeah.
And I think that's why I did struggle
to bond with him, as well.
Just because I couldn't differentiate between the two.
But do you enjoy cuddling him
and sort of nuzzling with him?
In all honesty, I don't.
And that makes me so sad to say that, as well.
I think that's one of the main reasons I took an overdose,
just trying to kill myself,
'cause I don't feel I can be his mum.
Or he deserves better than me,
or someone else should be looking after him
that can love him.
That was his four month picture.
Because he's a rainbow baby,
I decided to do a rainbow-themed picture.
- Really? - Every month until-
- What's a rainbow baby? - It's a baby born
after a loss.
So, it's like a rainbow after the storm.
- "Our beautiful rainbow is five months old.
He has a smile for everyone and is definitely a charmer.
Much like his dad."
"Baby Jake.
Cute baby.
Cute babies of Instagram."
It's almost like I've got to pretend
that everything's okay.
- Do you think that's role-playing a little bit?
It almost feels like Instagram
has to portray a certain image.
- Mm-hm. - And I had to pretend
everything's okay and I can tell everyone I can cope.
When the reality at home was
such a massively different story.
The Bethlem Mother and Baby Unit
is part of a network of similar facilities around the UK
dedicated to helping mums
experiencing serious mental illness.
Mothers are admitted due to a risk
of doing harm to themselves or to their babies,
living together with their babies on site.
Treatment takes the form of medication,
along with therapy and classes in parenting.
- Do you think you know each other a bit more now?
Well, I know him.
I don't know if he knows me.
The lead psychiatrist at Bethlem
is Dr. Trudi Seneviratne.
- We're incredibly lucky in Britain, because we will have
21 Mother and Baby units in this country.
Actually, we know that it's good for both of them,
mother and baby, to be treated together.
To sever that biological connection
and psychological connection
would be a disaster at this point in time.
- How is it that pregnancy or new motherhood
can lead to mental illness?
Is it the physical trauma of the birth?
Is it hormones?
- It's an absolute perfect storm of all of those things.
It can be the most planned or wanted baby,
but then you have the most traumatic delivery.
You haven't slept for weeks,
days leading up to the delivery,
and then you don't sleep afterwards.
It's a very high-risk period when it comes to suicide.
At the worst end of the spectrum,
you have a dead mother and a dead baby.
Doesn't get more awful than that.
A new mum was on the unit.
The diagnosis was postpartum psychosis.
Hello.
Barbara, from Spain, had come in two days earlier,
sectioned by police after displaying delusional thinking
and worrying, high-risk behaviour.
As with many such cases,
she had no history of mental illness.
She was with husband Jordi and their daughter, Julia,
and was still experiencing confused thoughts.
So, how did you come in?
Can you tell me what happened?
Because Jordi got a job.
We, we decided to go, to go,
sorry, I'm not feeling comfortable.
No, no, don't worry.
Why don't I ask Jordi?
Jordi, what was it-
- Yeah, I'm just part of-
You're just listening.
Yeah, and now we're curious
because we've been talking to other people,
I don't want to interrupt you.
No, no, no, please stay.
Stay, I won't make you uncomfortable.
You stay, you'll be fine.
I want you, like, comfortable.
Mmm.
I'm very comfortable.
- I'm not. - Oh, no.
What can we do to make you comfortable?
I don't know.
Don't make me feel part of, yeah.
Okay.
Shall we not talk to you too much?
- No. - Okay.
Jordi-
- If I want to- - You'll chip in?
- Yeah. - Thank you.
Do you want to tell me, Jordi, what happened?
How is it that Barbara and Julia came to be here?
She's been going through some stress,
or maybe there's been too many worries,
which are part of maybe living away from family.
And then last week,
we had my parents over, for example,
and that was an extra worry for her.
I think just all of these together,
reached this boiling point when she kind of,
her brain snap or kind of broke.
- I would say- - I think I'm not making
him comfortable.
- No, I'm fine. - He's fine.
- I'm just trying to remember exactly what happened,
because I don't want to be saying lies
or anything like that.
It's fine.
So, she couldn't sleep, and during the sleep,
she was just worrying about all the things,
everything again.
That we were going to leave her.
That we were going back to,
we're going back to Spain without them,
and all this kind of things.
And she then ran away from home
and she went to the train station.
She said that she was going there because she wanted
to commit suicide or something.
She wanted to throw herself into the train.
And sometimes, like now,
she's also having these kind of thoughts.
Well, I was going to ask.
So, how are you doing?
You okay?
Yeah, yeah, I'm okay.
Was it okay listening to that?
- Yeah, that's okay. - Yeah?
Do you remember that?
Yeah, I remember, more or less.
Yeah.
How are you-
But I think he's having the postpartum,
how is called?
- Psychosis. - Psychosis.
- Who is? - Jordi.
- You think Jordi's having postpartum psychosis?
Yeah.
- It is part of all the confusions that she is having.
And, like, when we came here, for example,
she was saying that she wanted to leave
and go home, because I was the mother.
So, it was me, the one that had to stay here with the baby.
Jordi was saying there was a time
when you were distressed about his parents,
and also that you went down to the train station.
Do you remember that?
Yeah.
And you do remember that you,
was it your feeling then that you wished to harm yourself?
Yeah.
Because I'm not having like a postpartum-
Psychosis?
- I'm having, like, a depression of all of my life.
I had the thought that Jordi's going to be the,
I don't know, maybe the brother of Julia.
- As well as the father? - And the father, yes.
And then, for me, I've been the mum of Jordi.
Have they given you any idea
of what to expect here in the next
few days or weeks or however long it will be?
I don't think we have an expectation
of what we should be expecting,
apart from that she needs to get some rest
and she will get better.
But we don't know, like, when.
I don't know
how to find the way that this unit is helping me.
I haven't found anything.
- An average stay at a Mother and Baby unit
is around 10 weeks, though this can vary widely.
Mums are discharged when staff decide
symptoms are under control, or when the baby turns one.
How are you feeling?
I feel quite scared.
- Yeah. - In Melbury Lodge,
a Mother and Baby unit in Winchester,
I was with Lisa and her psychiatrist,
Dr. Catherine Bundle.
Lisa was close to being discharged.
- I don't want to be here, but I am terrified.
- Of going home? - Yeah.
What's your biggest fear?
That I'm not going to be good enough
- for my family. - Okay.
That I'm not going to get back to
me.
I think you have come a long way, Lisa.
I agree you're not 100% well,
and the rest of that journey needs to happen at home.
But, you are so much better, objectively,
than you were when you came in.
Oh, gosh.
Oh, gosh, yes.
Has she still got the baby smell, do you think?
Yeah.
Got the baby cheeks.
- Oh, yeah, she's got those baby cheeks.
Do you want a Mummy cuddle?
Lisa and Isabella, or Bizzy,
were the longest-term patients on the unit.
She'd had postnatal depression with previous children,
and had come to Melbury
after a series of psychotic episodes.
Is that your new buddy?
- Have we made friends? - I think you have!
- Can we talk about how this all started?
Yeah.
After I had Isabella,
I felt like I was absolutely nailing it.
I was taking all the kids out together.
When she was about three weeks old,
I took all three of them to the cinema.
And I'm like, "Yeah, I've got this."
So this sort of, I mean,
maybe, "Came out of the blue",
is a little strong, but it was unprecedented?
Yeah, it was.
Isabella had been exclusively breast-fed
and I had a hen do in Marbella.
She was being a real pickle with taking a bottle.
So, we almost had to go cold turkey.
And then when I came back, the Wednesday night,
I called Andy and said,
"You need to come home from work early.
I can't look after these children."
And then, from then on, I pretty much
stayed in bed for two weeks.
Well, so what was it?
There was, so, the hen, do you think the hen,
you're not saying a hen do had anything,
It was the drop.
So, what they're saying is
that because I dramatically stopped breast-feeding,
the drop in hormones, triggered psychosis.
Can you talk more about that feeling
of being overwhelmed when you got back?
There was a moment you called Andy,
did that just creep up on you, or was it,
It was instant.
I called him and said,
"I can't look after these children."
- Why did you say that? - Because I didn't want
to be near them.
There was a complete overwhelming of me.
I think there are lots of parents
who've had kids in the house and they've called
their other half and said, "I can't deal with this."
This was different.
This was like,
almost like a total breakdown.
I couldn't speak, I didn't wash for days.
I was eating dinner with Andy and I,
I just said to him,
"The house is about to be invaded by clowns."
Clowns?
Literally?
Clowns.
Like, killer clowns.
Killer clowns were going to come in, and rip us apart,
destroy our house.
Like, it,
and it was graphic, what I could see.
- At the time when this was happening, it made sense to you,
the idea of the clowns?
- It was real. - It felt real to you?
It was real, yeah.
- You're not in touch with why that made sense to you, then?
- No. - You can see now
that that was ridiculous, right?
But I can still feel the fear from it.
Yes.
- I'm interested in this thing you said about,
it was almost instantaneous when it happened.
In that moment, your life changed.
You had a life of being mentally well, and then,
and then, it sounds like in one moment,
you went through something that was transformative.
Something changed in that moment.
And
led me to the path where I am now.
The family home to which Lisa
would soon be discharged
is an hour's drive away in Horsham, Sussex.
I'd arranged a visit with her husband, Andy, an IT salesman.
- Louis. - Good to meet you.
We met when I was about 24, I think Lisa was 21.
We fell for each other.
We split up, we got back together.
That's a nice one.
Lisa looks beautiful in that.
Yeah.
Beautiful lady.
She said that when Isabella arrived,
for the first few months, she felt completely on it.
She felt like she was in control, as she described it.
You know, she was just nailing it.
Would you agree?
Yeah, I would.
I don't like using the phrase much,
I think it's a bit silly,
but Super Mum comes to mind with Lisa.
She's the most caring, motherly woman.
So, to suddenly see this behavior,
I knew there was something very, very wrong.
One evening, she phoned me up and said,
"I'm struggling.
Can you come home?"
And I didn't really think anything of it at that time.
You know, she's allowed to be tired.
She was looking after three children.
So, I just assumed she'd had a tiring day.
- She didn't seem completely out of character, or-
- No, no, she did just seem like she was tired.
But over the next two weeks,
the decline in her mental health
I watched was utterly alarming.
Watching her personality disappear and,
not really knowing what on Earth to do about it.
- How many months has it been that she was, at the unit?
- Three and a half. - Three and a half?
- How have you found that? - Really hard.
I've tried to play Mummy and Daddy to Amelia and Jake.
Obviously, Amelia being six, that means she's aware.
- What have you told her? - Mummy's unwell.
The illness is in her brain.
When she first went into hospital, I said,
"Have you noticed Mummy hasn't been fun Mummy
the last couple of weeks?"
She went, "Yeah."
I said, "That's why she's gone to hospital,
because fun Mummy isn't there at the moment,
and they need to try and help her to get back
to who she normally is."
Have they given you
an indication of what to expect in terms of recovery?
- No, there's no timescale associated to it,
but given the time and the support she needs,
she will get back to who she was beforehand.
- The physical and emotional trauma of giving birth
and coping with a newborn is, in many cases,
aggravated by a sense of unrealistic expectations
of what having a baby is like.
The gap between how society tells mums they should feel,
and a reality that may be more complicated.
I'd been spending more time with Catherine.
Hello!
Oh, Jake, you do stink.
What, has he done a poop?
Yeah.
You know you have.
You can change him if you want.
We can take a little-
Are you sure you're ready for that?
Yeah!
Been a couple of years, but the skills are still there.
Oh, my goodness.
That's it.
Get those wet wipes ready.
Here we go.
Oh, yeah.
I recognize that.
Not too bad.
At this age, it's not really poo.
It's sort of-
- There's been some awful ones.
Once you give him food, it's, oh, it stinks.
It made me gag the other day.
I take that back, it is a bit like poo.
It's not brown, though.
It's mainly milk.
- It's like a mustard. - Yeah.
- Was that you gagging? - Yeah.
Yeah, I know what I'm doing.
Yeah.
Willy's pointing down.
Okay.
Catherine was off her one-to-one.
She'd also received a new diagnosis
of emotionally unstable personality disorder,
a set of traits
often involving impulsive behaviour and self-harm
that can't easily be treated with medication.
A few days earlier, staff had filmed her playing with Jake
to build her confidence in parenting.
The developmental psychologist Robin Schacht
was offering her feedback.
- Well, the first time I met with you, I said,
"I think you have really good instincts."
It just seems that,
yeah, as you said, they can't come out.
So, what I wanted to point out here were a couple of moments
where I thought you were, doing it.
Oh!
What's it doing?
- So, I think what he actually really enjoyed here
was getting the eye contact with you.
You kind of got down in his line of vision
and connected with him.
It wasn't the toy.
It was you that brought the smile.
- That's quite sweet. - Yeah.
It makes me smile watching, actually.
- Can I chip in a tiny bit? - Yeah.
- We've spoken quite a bit, Catherine and I.
And what's always struck me is that she,
that you are really good with Jake, basically.
And that you know what to do.
And you know how to look after him.
But what's always struck me, as well,
is that you've spoken about not feeling connected.
So in a way, it doesn't surprise me
that Catherine's got the skills.
What I'm wondering is, how do,
does this help, can we help,
with respect to the feelings?
Does that make sense?
Yeah.
I've never had any doubt that practically,
I can care for Jake.
It's just the emotional connection, really.
- So you've got this fear that you need to grow the feelings
to make them enough to get well?
- Yeah, that's quite an accurate description, actually.
And hopefully that's what this will help.
And spending more time with him
and learning to love him, I think.
- And there's a part of me that always wants to say,
"Well, I think you do love him."
I think you,
I see that you love him.
And yet, if you don't feel that, then that's different.
So, it's complicated, isn't it?
I don't want to sort of invalidate what you're saying.
- I think what I'm expecting is a rush of love.
And I had that for the last baby,
when we saw him, there was a rush of love.
- The one that died? - And when Jake was born,
there wasn't that feeling there at all,
because there's still an overwhelming feeling
that something is going to go wrong,
because it did last time.
- So part of it is self-protection?
- Maybe. - The feeling of connecting
would then mean a risk of you feeling awful,
if and when something went wrong.
Like, yeah, my baby died before
and I had to make the decision,
and that's like the worst thing
that can possibly happen to someone.
And if I didn't get attached to Jake,
and the worst thing possibly happened to him,
then I won't be hurt.
- You said you felt a rush of love for the other baby.
The other baby,
was he dead when you saw him?
- Yeah, he was effectively stillborn.
Yeah.
- I mean, that's one of the saddest things
I could imagine.
And the feeling of love would be, in a way,
just very uncomplicated.
In the sense that it's a sense of grief
mixed with love, which is very powerful.
- And you've got all these feelings for a baby
that you haven't met properly or you don't know.
- Right, and there's strange feelings of sort of regret
and maybe, probably, a feeling of guilt.
Guilt.
Massive guilt.
And there's remorse.
And then when you see Jake, it's different.
You're not going to feel that.
It's a different feeling when Jake comes along.
And there's still guilt.
In that I don't feel the way I felt for the last baby,
and that is horrible, because Jake wouldn't be here
without having to make the decision we did, either.
And then Jake was such a wanted and planned-for baby.
And yet the feelings for him are completely different.
But I want, I do want to feel something for him,
and I do want that rush of love
and I want that overwhelming urge to protect him.
So that I don't,
so I then can say that I will do anything for him,
like most people would say that
they'd do anything for their kids.
And by the time I leave here, I hope that will happen.
- Listening to Catherine describe her difficulty
feeling a connection with Jake was sad and strange.
Part of me questioned if they were her real feelings.
But I also wondered about my urge not to believe
that a woman could be indifferent about her child.
- When people say they don't feel anything for their baby,
it is absolutely real,
because these things are on a spectrum, aren't they?
- And even some resentment, I suppose.
Resentment, yeah.
Feeling nothing.
Almost hating the baby, wishing the baby were not there.
Dead, sometimes.
It's because people hide what they're really feeling.
It's meant to be a happy time, isn't it?
The business of having a baby
is supposed to be a really happy time, so, because of that,
people put on all sorts of masks
to hide what's really going on.
Where Catherine was struggling
with the sense of not being bonded,
with other mums, the connection is there,
but feelings of depression and anxiety exist alongside it.
Come on.
Ah!
She won't stay asleep for very long.
- What's her name? - Poppy.
Poppy.
25-year-old Marie
had given birth to Poppy five weeks earlier.
She'd had no issues with her feelings for Poppy.
Nevertheless, she'd experienced suicidal impulses,
and admitted herself to the Mother and Baby unit.
So you've been here about two weeks?
What brought you in here?
- Basically, I had a very, like, traumatic birth,
so she's nearly five weeks in June.
And I think the first week after she was born,
I was in A&E four times, saying,
"Please help me, because I'm going to do something."
And I just was really low
and felt like I couldn't look after her and stuff, so-
Really?
So when you say traumatic, you don't mean, I thought
- you meant physically. - It was, yeah.
- Physically, what happened? - Physically and mentally.
I was in labor for, like, 36 hours.
Really?
- She had to be delivered by forceps, as well.
So I very nearly ended up having a C-section,
which I didn't want to have.
I didn't want to have pain relief,
in the end I had an epidural.
So everything I didn't want to happen happened.
- So, that was upsetting. - Yeah.
- And then that had an effect on your mental wellbeing.
- Yeah. - Which felt like what?
How did your experience that?
Just, I felt really low in myself,
I felt like I wasn't able to cope with her,
and then I was having suicidal thoughts,
thoughts about self-harm and stuff like that.
- Really? - Yeah.
One thing that's been explained to me
is the idea that, you know,
having a baby is a huge physical change,
and that that brings with it emotional and hormonal changes
that can be a lot to deal with.
The birth brought up a lot of stuff
that had happened in the past as well,
and that was kind of quite traumatic.
Stuff that hadn't been dealt with properly before.
- What kind of thing? - A couple of years ago
I was assaulted, and,
obviously, giving birth, there's a lot of people around,
that kind of part
that you don't really want people to be around.
Yeah.
- And so it kind of awakened feelings of-
The sort that I end up having, like,
flashbacks and nightmares and stuff,
about which I hadn't had,
That was nearly three years ago
and I hadn't had any of that for a little while.
And now it's all started again, which then obviously
doesn't make me feel great after that either.
- And the good part, though, is that
it sounds like your relationship with Poppy's strong.
Yeah.
I've never had a problem bonding with her.
And she is the most perfect, the most amazing thing
that I've ever done in my life.
Which is why it makes this so much harder,
because this isn't the way it was supposed to be.
With her partner James visiting,
Marie had her weekly catch-up with the clinical team.
The first topic was a recent home leave
she'd had to cut short due to a panic attack.
- So I'm just interested in what the crisis was,
actually, when you went back home for the day?
It was nightmares, wasn't it?
- Yeah, Marie had some pretty vivid nightmares
about our relationship.
And I think it really unsettled her.
- It wasn't just that. - Was it not?
- No. - Oh.
- So do you want to tell us what was-
- Everything that had happened before that as well.
- Oh. - Yeah.
- It's not- - Yeah.
- Can you tell us? - About being attacked
and stuff.
You should've told me.
Didn't want you to get upset.
- Well, look, one of the things we know is that
sometimes trauma from the past come back when,
when women have babies.
Yeah?
So it's just,
so I guess it's sort of working through that
and working out what you need at this point in time.
Just thinking, Louis,
is there anything that you wanted to ask at this stage?
I was just struck earlier on
when you were talking about your nightmares,
and then you'd said that you didn't tell James
because you didn't want to upset him.
- Yeah. - See, I don't understand,
'cause you told me the one about the relationship.
- Because I didn't want you to think,
I know how you feel about what happened,
and I didn't want you to think it's still-
Basically,
the night it happened, I was already at home.
Marie sent me a message saying,
"Can you come meet me from the station?"
And if I'd have been three minutes faster,
I'd have caught him before he could've hurt her.
- So it is actually my fault, - It isn't.
- That this happened. - It isn't your fault.
Don't say it was your fault because it isn't your fault.
- I should've stopped him. - Don't get upset,
because it's not your fault.
And you couldn't have stopped him,
because he was going to do it anyway.
I should've broken his legs.
I'm sorry.
Marie and James were a striking example
of the way in which a mental health crisis ripples out,
affecting relationships and families.
Recovery too is a joint enterprise,
requiring understanding and support from loved ones.
Hello.
Can we come in?
I was in Horsham, Sussex.
Ready for a cuddle?
It's Louis!
Oh!
Oh, look,
Two weeks earlier,
Lisa had been discharged from Melbury Lodge,
though she was still getting weekly visits
from the perinatal team.
She was now living back at home
with Bizzy and her two other children,
six-year-old Amelia and three-year-old Jake.
Look at that!
- Mummy, I've done a big poo! - You've done a big poo?
Oh, my goodness!
Look at the size of that bad boy!
Has he done a big poo?
Can I see Jake's poo?
Wow, look at that!
It's like a man poo!
Well done, Jake.
Since returning home,
Lisa had been relying on round-the-clock support
from family members.
Today, her parents were on hand.
She was also suffering the side effects of high doses
of anti-anxiety medication.
So, how was it coming home?
It's been quite a
- tricky transformation, or- - Transition?
Transition's the word, yeah.
- Up and down? - Yeah,
much more downs than ups.
There's been some days where I've not been able
to get out of bed at all, and-
Because of what?
Tiredness?
Like a severe,
well, yeah, I'm constantly tired but,
like, this severe anxiety,
the anxiety continues to be the main problem.
And, you go in and play in the other room, darling.
No,
I want to see Isabella.
We can wait,
if you'd prefer to wait and talk about this.
Yeah.
Do you understand why Mummy was in hospital?
Why was Mummy in hospital?
Because you weren't well.
Do you know why I wasn't well?
No, you don't really understand it, do you?
You just missed Mummy.
What's it been like having Mummy home?
Good.
All right!
It's coming, my little love.
You want to sit there?
- Yeah. - What do you want?
- Only ham. - Well, take the cheese
out, then.
I know.
Life's like that.
- Eat it properly. - Life's like that sometimes.
- Nicely! - Trap the car, trap the car,
Trap the car, trap the car!
Collapse.
Straight arm.
Here it comes.
Yay!
How are you doing?
You look tired.
- Yeah, I'm quite tired- - You're exhausted.
Yeah.
Quite exhausted.
I just feel really flat, just nothing.
But this is the time where I'd be screwed
if I didn't have support,
and I get a lot of anxiety, fluttery feelings.
- You're getting that now? - Yeah.
And I should be taking her places.
I should be getting her out for walks.
I should be playing with her more.
I'm not, I'm not.
I feel like I'm failing and I'm failing my family.
- Well, it's one step at a time, isn't it?
You're still,
you're still in the early stages of recovery.
Yeah.
Oh!
It's just, I see the children as, like, a complete,
complete hard work.
- You don't feel you're getting pleasure in them
the way you used to?
Is that what it is?
I mean, we've all felt that at times.
Yeah, yeah.
Yeah.
- Sometimes it just feels like-
Mega hard work.
- Mmm. - Yeah.
Thank you.
Hello, Mummy!
Hi, Daddy!
Daddy!
How you doing, mate, you all right?
Oh.
I left Lisa with a renewed sense
of the challenges that lay ahead,
marveling at the unfairness
of what she was being put through
and the reserves of strength she was having to draw on
just to keep going.
It's a painful truth of recovery
that it often involves hiccups and back steps.
At Bethlem, making the process even more complicated
was an outbreak of the norovirus.
Many of the mothers and babies
were confined to their rooms to contain the illness.
Catherine's baby Jake had been taken home to recover,
which was contributing to her feeling unsettled.
I joined her and her partner Chris
at their weekly clinical review.
I think the week hasn't been very good,
because Jake hasn't been here.
So my anxiety is just through the roof at the minute.
- I'm just trying to- - Because he's not here?
Yeah.
It's just because he's not here
and then being with him, reunited with him,
makes me a bit anxious again,
and it feels like it's starting again, really.
Yeah.
- I think what would be nice over this week
is to get Jake back in, get some normality.
Just some interactions, have some fun with him.
Well, you have been depressed,
and your Mirtazapine could go up a bit.
So I think we should increase that.
Millie, what do you reckon?
Increase it to 30, I would say,
because then you still have the sedating effects
at that dose,
but also a good effect on mood.
- And let's see if we can get Jake in today.
Yes, that'd be very good.
Did that go all right for you?
Yeah.
Still a bit weird.
It's always weird.
What was the weird part?
This all seems a bit, I don't know,
like no-one really knows what they're doing.
I think they know what they're doing.
But objectively, you've been doing really well,
in the sense that you went home,
didn't you, and that went smoothly?
- It didn't feel like it. - But you don't,
But it did, but it didn't feel like it.
- Why not? - To me, it felt really hard.
On the outside of it, it looked like it went fantastically,
compared to how other events have gone.
- It's more about your perfection of the idea
of what you think it should be.
What I've heard from Catherine,
over the sort of weeks,
is that she's a bit of a perfectionist.
- There is, that is a way of describing it, absolutely.
You're very lucky you've got Catherine with no make-up on.
I know.
That's unusual for us.
Later that day, Catherine was granted
some unsupervised leave around the grounds.
She failed to return on time.
Police, please.
It's a concern about an AWOL patient.
Staff were in crisis mode,
attempting to track her down.
Hello, Catherine.
It's Debbie from the Mother and Baby Unit here.
I'm wondering if you could give us a call, please,
when you get this message.
I returned to the unit.
- With Chris, she's said that she's communicated with him
that she wants to die, saying,
"I'm gone.
I love you, but I want to die."
That's the last communication he's had with her,
so we need to get back onto the police straight away.
Hi, Mother and Baby Unit.
Nicola speaking.
Hiya, Chris.
Right, okay.
What exactly has she said?
Yeah, we're literally on the phone to the police now,
we're trying to get through, so we'll get them to do that.
What did Chris say on the phone?
- That she's basically said, "That's it, it's done",
and she's taken 65 tablets.
And he has no clue where she is?
No.
Has she done this before?
Yes, yes, she has a history of it.
- Yeah, yeah. - The reason she's here
is because of her relationship with her baby.
Yeah.
Her family believe if she's saying she's taken an overdose,
then she has taken an overdose.
10 hours after she'd gone AWOL,
at about 3:50 a.m.,
Catherine was found by police in a nearby hotel,
drunk, having consumed an overdose.
She was taken to A&E.
So, Hannah is with her at the minute.
Catherine is very regretful of her actions from last night,
very worried.
Yeah.
We haven't had any further update,
but she is awake and up-to-date
and talking with staff about how she's feeling.
She will likely be in hospital for a few days.
She's on IV fluids currently.
While Catherine remained in hospital,
psychiatric staff would be keeping an eye on her
round the clock.
Hiya.
Buenos dias.
- Buenos dias. - Que tal?
Meanwhile, elsewhere on the unit,
Barbara, the mum from Spain
who'd been experiencing postpartum psychosis,
had made a marked improvement.
So, look, you are our Christmas miracle,
basically.
Another one.
How are you feeling?
Yeah, much better.
Yeah.
I've been seeing, like, a good improvement, yeah.
From my point of view I feel like,
Yeah, now I'm aware of everything, I'm back.
Yeah, I would say I'm back to where I was before,
more or less 100%.
Nearly there, nearly there.
You're nearly there, aren't you?
Yeah.
- It was really nice for you to start talking a little bit
about the whole experience that you'd had of becoming a mum,
and everyone had been really busy working
and focusing on their own lives,
and then suddenly this baby had arrived
and perhaps both parents
didn't feel quite prepared for that.
You're aware that you don't tend to
talk about your feelings so much,
and we were thinking about
whether the two of you could benefit
from just talking a little bit more as a couple about,
I guess, about being a new family.
- It was less than four weeks ago, wasn't it,
that you were at sort of the depths of your illness,
and you were at Balham Station,
and to be that profoundly ill, and then now,
from what I can tell, so, so much better.
- Yeah. - It's kind of exceptional.
At least it seems from the outside
that it's completely fine
from when she wakes up until she goes to sleep.
She's been taking care of Julia day and night
for almost a week now.
So, at least she's on the right track, I would say.
In cases like Barbara's,
where there's no previous history of mental illness,
postpartum psychosis nearly always leads
to complete recovery.
The only significant cause of reoccurrence
is coming off medication or having another baby.
Conditions like anxiety and personality disorders
tend to be more deep seated, and recovery more difficult.
He seems happy.
He does like being a Christmas pudding!
There we go.
- Catherine was back, having been discharged
after four days in A&E following her overdose.
Are you a Christmas pudding now?
Yeah, I want a piece of Christmas pudding.
We'll be the Christmas pudding guys!
Look at you standing up.
All right, hang on, let's see how this goes.
No, no, no.
Just careful.
- Puddings, puddings! - Jake!
Paparazzi!
Puddings!
How are you doing?
Better.
I mean, I'm out of bed and I'm dressed, so-
You are.
You had quite a time of it?
Yeah.
- We were worried about you. - Yeah.
It wasn't,
I don't even know what happened.
I was, like, suicidal anyway, I think.
I was quite on the edge.
Well, I'd seen you that morning.
Is that day clear to you?
We had the ward round, do you remember?
Yeah.
Although I'd been on leave that weekend, everyone said,
"Oh, it's gone really well," because there was no drama,
I didn't feel like it had gone very well.
I think, after a drink, I just thought,
"This is my opportunity," whilst I was out.
- Opportunity to do what? - To kill myself, really.
And so, yeah.
This guy's getting restless.
Come on.
What is it?
Are you tired or are you just being a silly billy?
Are you being a silly billy?
You're making some funny noises.
So, basically,
having done it, you had second thoughts?
Yeah.
I think once you've done it you kind of think,
"Oh, crap."
Like, "What have I done?"
'Cause you never really know if that's definitely the end.
And then afterwards when it doesn't work, you think,
oh, you've failed again.
Especially when you're lying in a bed in A&E, and then,
I was quite ill.
It sounds like, I mean,
at the risk of oversimplifying it a bit,
there's all sorts of ambivalence, isn't there?
- Sometimes it just feels so horribly overwhelming,
the whole thing of just being a mum
and the responsibility that you have
of raising a little human with their own issues.
- I don't know, maybe there's- - Sometimes I,
I can see where I want to be.
I can see where I want to be at home and how I want to be.
But it's like a weird mental block
of actually getting to that point.
How are you doing, Jake?
Jake?
What?
You all right?
I do think, 'cause the first five months of his life,
I just pretended everything was okay
and tried to manage at home.
And if I admitted earlier that things weren't right,
and I had come here when he was a lot smaller,
perhaps things would've been a lot more different now.
And I think that the love,
or let's say the connection,
that there is there,
sometimes you struggle to feel it, to see it,
that it, that it is there.
And with time you will come to
see it more clearly.
Yeah.
Or I'm not allowing myself to feel it, maybe.
I think that's half of it as well.
Catherine's expression of feelings
was encouraging to hear.
At the same time, I couldn't help recalling
it was just a week earlier
that she'd attempted to take her life.
Recovery may be in part a process
of not pushing too fast
and recognizing how much is realistic.
Hi, guys!
Hi, Jake.
How are you?
Don't you know there's no such thing as a Gruffalo?
It was now two months since Lisa had been at home,
and six months since her first symptoms.
I love you.
Do you want me to take that?
- Her continuing feelings of anxiety
meant she'd largely been confined to the house.
Today would be the first day
of her doing the school pick-up.
Her best friend Charlie was coming along to offer support.
What's he doing?
He's getting closer!
- He's doing something with that camera thing up there.
That construction thing.
- But he might actually do something to us?
No, he's absolutely fine.
We're nearly past him.
- No, I don't like- - I know.
You're all right.
You're all right, okay?
I promise you, you're fine.
Do you want to stop for a minute?
- Yeah. - Yeah?
I don't know where the children are.
They're up with Louis.
She just needs five minutes, sweetheart.
Okay?
I know I'm ridiculous.
And that is the worst thing, because I know I'm ridiculous.
- But you're not, and you've handled it really well.
- Lisa and Andy were still relying on family support
throughout the week.
She was also having regular visits
from her local mental health team.
While Lisa's in-laws did the night-time routine,
I had a moment with her and Andy.
Lisa had mentioned there were a tough couple of weeks,
sort of over the holidays,
where she was not in a good place, mentally,
wishing to do herself harm, among other things.
- Yeah. - Throughout all of this,
I'd always said I'm not suicidal.
- Yeah, but then when you did feel it, you did.
- When I did feel it, I was like-
- It was, I can't remember exactly where we were
or how it happened now, but you literally turned to me
and said, "That's it.
I now feel that way."
And I just thought, "Oh."
What way?
That she wants to end herself.
- Suicidal. - Really?
You're also aware you have a husband who loves you.
You've got three children who love you and need you.
That these are things that you need to consider.
Was that in your head?
No, not at all.
Going through that, I understand why people kill themselves,
whereas I've called people selfish.
I totally get it.
- But some, but I was- - But why?
Is it just an overwhelming irrational-
It is, almost like a craving, desire,
this strong, overwhelming desire
that didn't leave me
- for nearly three weeks. - I was going to say,
it was a period of two or three weeks.
- Is it still reasonable to expect a full recovery?
- Yep. - That's still basically
what they're saying?
- That's what they're going for, yeah.
- I'd be lying if I said I didn't have moments of thought
where I think, "Crikey, will it?"
It's just a case of managing how we try
and get you back there, because, as you say-
- Well, I don't think I'm ever going to be the same Lisa,
because I don't think I can be after this.
I mean, you'll be a different person.
You're someone who's lived through a serious,
sort of emotional or mental episode.
Do you think you'll be reduced in some way?
Is that what you mean?
Or are you just-
Time's creeping on, and,
I'm still bonkers.
- It's an illness, and it means that you're not,
not where you were.
I just want an end date.
I don't know.
I just want to wake up and feel
not scared of everything and,
this is really crap.
Like, really crap.
- Lisa's continuing issues were a reminder
that the road back to health could be long and difficult.
And yet it was also true that even in the most trying cases,
there were reasons for hope.
People often come in and ask me,
"How long is it going to take?"
I always say, you know,
"I haven't got a magic ball here."
These are not quick win conditions.
It's also important to say that actually,
even when mothers do have mental health problems,
they do their utmost to make sure the child is okay.
So just because they've had a mental health problem
does not mean that they will be
an adverse effect on the child.
Although we're dealing with
the most severe mental health problems all the time,
and the most severe end of risk,
you know, it is joyous to see new babies
arriving all the time, and it's, you know,
utterly joyous to see people getting better and going home.
There had been some good news.
- Look out! - Trouble.
Escape attempt!
Prisoner has been apprehended.
How are you doing?
Good to see you.
Catherine was back living at home with Chris and Jake,
having made a remarkable improvement.
So are you living here now?
- Yes. - What do you think
was the turning point?
They did increase the medication.
That did help massively.
Really?
Anti-depressants.
Yeah.
And I think there has to come a point
where you have to change your thinking.
And a lot of the work they've done in there is, you think,
"Oh, it's never gonna change, it's never gonna help.
I don't know why they're doing this."
And sometimes before you know it, like, things have changed.
- Does that make sense to you as well, Chris?
I mean, what does it look like from where you're sitting?
We're clearly in a much healthier place
in terms of coping
and the tools and the support that we've been given.
It is one day at a time,
but it is clearly night and day difference.
Absolutely.
- You know, a lot of what we talked about from the beginning
was, you know, connection.
I mean, how do you feel about that now?
- With Jake? - Mmm.
Absolutely fantastic now.
- Really? - I think we have really
good relationship.
- Yeah. - Isn't that something?
Now, I think coming through this,
I can actually say, "I love my baby."
Catherine's apparent recovery
was heartening to see,
a testament to the possibility of change.
Aw, that's nice.
In speaking to all the mums I'd met,
I'd seen the most extreme versions
of feelings familiar to many new parents,
but that had tipped over into acute mental health crises.
Making it worse was a weight
of expectation about motherhood.
But I'd also been struck by the courage of mums
opening up about their worst fears and anxieties,
doing their best for their children
in situations of the utmost adversity.