2002 International International Biennial Scientific Meeting

MOTHER-BABY JOINT ADMISSION FOR MENTAL HEALTH CARE IN DIFFERENT COUNTRIES

Co-ordinator: Nine Glangeaud-Freudenthal

Psychologist, Research Fellow at the French National Research Institut (CNRS), Secretary of the SMF, and member of the Executive Committee of the Marcé Society
glangeaud@vjf.inserm.fr

INTRODUCTION: JOINT ADMISSION OF MOTHERS AND INFANTS: PHILOSOPHICAL AND OTHER DILEMMAS
Bryanne Barnett

Professor of Perinatal and Infant Psychiatry, University of New South Wales, Past President of the Australasian Marce Society
Bryanne.Barnett@swsahs.nsw.gov.au

MOTHERS WITH SCHIZOPHRENIA AND THEIR ADMISSION TO A MOTHER AND BABY UNIT IN THE UK
Margaret Salmon* and Louis Appleby

* Department of Psychiatry, Withington Hospital West Didsbury, Manchester, UK and Project Co-ordinator of The Marce Clinical Audit
MSalmon@fs1.with.man.ac.uk

The Marce Clinical Audit now consists of over 1400 cases on the database. We have a vast amount of social/demographic, past and present clinical data as well as information on the outcome for infant and mother. The data includes information about women with a diagnosis of the three main conditions: Schizophrenia, Bipolar disorder and Depression as well as other diagnoses.

For the purposes of this presentation we have concentrated on mothers with a diagnosis of schizophrenia in comparison to the other 2 main diagnosis, Bipolar disorder and Depression.

The presentation will consist of factors which influence/predict maternal and infant outcome and also look at social and psychiatric history and mother and infant outcomes.

THE HISTORY OF MOTHER BABY UNITS (MBU) IN FRANCE AND BELGIUM AND OF THE FRENCH VERSION OF THE MARCÉ-CHECKLIST
O Cazas, N Glangeaud, B Durand, P Chardeau, L Morisseau, R Cammas, F Delain, O Rosenblum, A Chauvin, A Coen

Department of Psychiatry, Paul Brousse Hospital, Villejuif, France
ao.cazas@wanadoo.fr

Until fairly recently, mentally ill mothers have been separated from their new-borns because of the potential danger to the baby. Over the past 50 years, however, we have learnt more and more about the perinatal period, due partly to the development of the new clinical domain of child psychiatry and in part to an increased interest in maternal postpartum disorders. This knowledge has led psychiatric departments to develop new ways to provide care without separating the mentally ill mother from her baby.

Joint full-time admissions began in Great Britain in 1948. The first Mother-Baby Unit in France opened in 1979 and in Belgium in 1990. Today, there are 15 MBUs in France and 5 in Belgium. Other MBUs will also open soon in Germany and Luxembourg. MBUs in France range in size from 2 to 8 beds for mothers and 2 to 10 cots, that is, approximately 150 admissions per year for France. They are very often run by child psychiatrists who focus their attention primarily on the quality of the bound between mother and baby.

From 1995 to 1998, Odile Cazas and Nine Glangeaud, working with psychiatrists, child psychiatrists and psychologists (clinicians and researchers), adapted the Marcé-Checklist to the French and Belgian health and child protective systems and to the main domains of interest. We describe the changes and explain the reasons for them (i.e., events and trauma during childhood of the baby's parents, more detailed past and present symptomatology, past history of the baby's father and partner, etc.). Since 1999, 13 French and 3 Belgian MBUs have been using this French version of the Marcé Checklist.

MOTHER'S AND BABY'S ISSUES FROM JOINT ADMISSION IN A MOTHER-BABY UNIT: NATIONAL DATA COLLECTION WITH THE MARCÉ CHECKLIST IN FRANCE AND IN BELGIUM
N Glangeaud-Freudenthal, O Cazas, F Poinso, D Lerminiaux, C Rainelli, R Cammas, M Blazy, C Da Mota-Mattonet, B Durand, N Elbaz-Cuoq, S Nezelof, AL Sutter, P Tielemans, E Titeca-van Bogaert, MA Zimmermann and the MBU-SMF working group

16 Av. P.Vaillant-Couturier, 94807 Villejuif cedex, France
glangeaud@vjf.inserm.fr

Data collected with the French version of the Marcé-Checklist covered the 176 joint admissions to 11 mother-baby units in 1999 and 2000 that met the inclusion criteria: joint and full-time admission for at least 1 week, with a baby of less than 1 year. Mean age at admission ranged from 26 to 32 years for mothers and from 4 to 16 weeks for babies. Two units also admit older children. Mothers' diagnoses were mainly schizophrenia (n=44), acute transitory psychosis (n=20), bipolar disorders (n=20), postpartum depression (n=38), personality disorders and cognitive disorders (n=39). The mean duration of hospitalisation was 11 weeks. Units that also offered day-care admission in the same or a near-by unit had shorter mean admissions, of only a few weeks. Women with schizophrenia and personality disorders remained hospitalised longer, showed less improvement, and were more often separated from their babies than the other women with a different pathology. Risk factors related to the parents' childhood and family histories were also studied. The comparison between France and Belgium took into account differences related to child protection in their social and legal systems.

MOTHER-BABY UNITS: THE AUSTRALIAN EXPERIENCE
Anne Buist*, Jane Fisher, John King, and Klara Szego

*Austin and Repatriation Medical Centre, University of Melbourne
a.buist@medicine.unimelb.edu.au

This presentation presents a snapshot of Victorian inpatient units that cater for women and their infants. Victoria, population five million (three million in Melbourne, the capital) is unique in having three public inpatient psychiatric MB units, as well as a number of private MB units and three mother-baby hospitals which cater for infant and parenting difficulties, but which also manage some maternal psychological distress.

This presentation looks at data from a selection of each of these public MB units, private and mother-baby hospitals, to see who goes where - and what service they receive. Changes over time to the types of women referred will be highlighted, with the more straightforward depressions being successfully managed in general practice, and women currently admitted have chronic illness, comorbitity and protective service issues. Included will be preliminary findings of a prospective study examining whether two of these programs (Masada, a private MBU and Tweddle, a mother-baby hospital) assist maternal mood.

EARLY INTERVENTION FOR JOINT MOTHER-BABY CARE IN FRANCE: PREVENTIVE AND THERAPEUTIC APPROACHES
L Morisseau*, C Da Mota-Mattonet**, M Agman*, and A Frichet*

* Centre de Guidance infantile, Institut de Puériculture et de perinatalogie, Paris, France
** Institut Théophile Roussel, Unité Mère-enfant, Montesson, France
mlinda@club-internet.fr

Joint care in mother-baby units in France has developed in recent years (as other presentations will show), most often under the aegis of child psychiatry, a sub-specialisation of general psychiatry (Cazas et al, Glangeaud et al). Within this type of joint mother-child practice, several techniques have been developed, based upon different theories. Some of these techniques essentially rely on the nurses' close observation of babies relating to their mothers and, when possible, to their fathers. These techniques have been developed in the Mother-Baby Unit of Montesson (Da Mota et al, video) and are now practiced as well in other at-risk situations including high-risk pregnancies (social and medical risks) and for follow-up care after preterm birth.

Other techniques are based on Esther Bick's observation of the babies interacting with their parents and Loczy's observation of the baby "in action". Still other types of care are mediated through physical contact: a cold wrapping method, used when psychotic disorganization does not allow a mother-baby relationship; individual face-to-face therapy with the mother and the child within a warm bath, to enable regression.