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A National Survey of Psychiatric Mother and Baby Units in England

Dr. Elkin is affiliated with the Suffolk Mental Health Partnership NHS (National Health Service) Trust, Bury St. Edmunds, Suffolk, England. Dr. Gilburt, Dr. Slade, and Dr. Howard are with the Health Service and Population Research Department, Institute of Psychiatry, King's College London, De Crespigny Park, London. Dr. Howard is also with the South London and Maudsley NHS Foundation Trust and Institute of Psychiatry, King's College London National Institute for Health Research Biomedical Research Centre. Mr. Lloyd-Evans and Professor Johnson are with the Department of Mental Health Sciences, University College London. Dr. Gregoire is with the Department of Psychiatry, University of Southampton, Southampton, England. Send correspondence to Dr. Howard at the Health Service and Population Research Department, Institute of Psychiatry, King's College London, P.O. Box 29, De Crespigny Park, London SE5 8AF United Kingdom (e-mail: l.howard{at}iop.kcl.ac.uk). An earlier version of this article was presented at the perinatal section meeting of theRoyal College of Psychiatrists, London, United Kingdom, November 21, 2007.

OBJECTIVE: This study identified all mother and baby units (MBUs) (defined in this study as inpatient psychiatric units where mothers and babies could be admitted that had at least four beds and were separate from other wards) in England and established the operating procedures of MBUs and the clinical characteristics of their inpatients. METHODS: A national cross-sectional survey of alternatives to standard acute inpatient care was conducted in England in 2005. Multiple methods, including telephone inquiries and consultation with relevant experts, were used to identify services. All MBUs identified were contacted and invited to participate in an interview with a researcher. RESULTS: Twenty-six facilities that accommodated mothers and babies were identified. Thirteen were excluded from the final analysis, because they did not fulfill the study's operationalized criteria for a MBU. Twelve of the 13 facilities with an MBU agreed to participate. Nationally, MBUs had fewer beds than needed and marked geographical variation. Ward size ranged between four and 12 beds, average occupancy was 78%, and the mean length of stay was 56 days. On admission, 45% of women were experiencing psychotic symptoms, and 18% were detained compulsorily. A significant proportion of MBUs did not offer psychological treatments (42%). CONCLUSIONS: The provision of MBUs in England is inequitable, and the clinical and operating characteristics of these services are highly variable. However, this study demonstrated that MBUs are serving women with severe mental illness. If services are to expand and develop in the future, more qualitative and quantitative studies are required to identify the most effective components of MBUs and examine for whom the MBUs are most helpful.

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