Your care during pregnancy with a severe mental illness

On this page

Your GP's role

Specialist perinatal mental health teams

Community mental health team (CMHT)

Psychological therapy services

Midwifery team and antenatal care

Health visiting team

Mother and baby unit (MBU)

Early help services

Parent-infant relationship teams

Family and friends

Social services

Worries about having your child removed

If you have a mental illness, all sorts of factors can mean that your symptoms can come back or get worse during pregnancy. 

As well as hormone changes this can include:

• added stresses that growing a family can bring
• housing worries or concerns about money
• reminders of a past pregnancy loss.

Symptoms can return even if your illness was very well managed before you became pregnant. 

That’s why it is important to get help quickly if your mental illness symptoms come back or get worse while you’re pregnant. 

At least 1 in 10 people have mental health issues during pregnancy, so you’re really not alone.

If your symptoms come back or get worse, it isn’t your fault. Health professionals want to make sure you get the support and treatment you need to stay well or get better. 

If you’re planning a pregnancy or are already pregnant, don’t stop taking your mental health medication until you have spoken to your doctor.

Your GP's role

You can talk to your GP about your plans for pregnancy and your mental illness. You could also talk to a doctor in a local sexual health clinic. Choose wherever makes you feel most at ease. 

Your doctor is there to help you, not to judge you in any way. 

You could try asking these questions: 

• how might pregnancy and childbirth affect me?
• what is the risk of my mental illness coming back or getting worse?
• should I keep taking my usual mental health medication?
• how might my mental illness, and its treatment, affect me during pregnancy and childbirth?
• how might my mental illness, and its treatment, affect whether I am able to care for and enjoy my baby?
• how could my symptoms be controlled if I stop taking medication?
• what mental health services are there during pregnancy near me?
• what support is there after my baby is born?

Your GP may refer you to a mental health service if you don’t already see someone. They may also arrange for you to have pre-conception counselling, which can help you plan your pregnancy.

Read about the 5 top things to think about before getting pregnant.

Specialist perinatal mental health services (PMHS)

Some places have specialist perinatal mental health services (PMHS) teams. Your GP or other health professionals can refer you to a specialist PMHS team before, during or after pregnancy, if there is one in your area. PMHS teams are experts in caring for people who have, or have had, moderate to severe mental illness.

‘Perinatal’ means the time from when you get pregnant to a year after the birth. However, specialist PMHS care may be an option for up to 2 years post-birth.

The PMHS team may include:

• doctors who diagnose and treat mental illness (perinatal psychiatrists)
• perinatal mental health nurses or midwives
• health professionals who specialise in talking therapies (perinatal psychologists)
• other specialists, such as occupational therapists, nursery nurses, social workers and pharmacists. 

The team works with other professionals to make sure you and your family have the care you need. They will work with you, and your partner or family if you agree, to put a plan in place for your care during and after pregnancy.

A member of the team should give you a copy of your care plan. They will let you know who to contact if you need support or urgent help.

Where you see your perinatal mental health team will depend on what happens where you live. You may have your appointments at an antenatal clinic, a children’s centre or at home.

The Royal College of Psychiatrists has information on perinatal mental health services.

Find out more about specific mental illnesses and how they are managed in pregnancy.

Community mental health team (CMHT)

If you’re already under the care of a community mental health team (CMHT), you should tell them if you’re planning a pregnancy or if you’re pregnant. You can carry on seeing your usual care coordinator or consultant.

You can still be referred to the perinatal mental health service if you are under the care of the CMHT. These teams can work together with you and your family.

Psychological therapy services

There are many types of psychological (talking) therapies that may help you before, during and after pregnancy:

• cognitive behavioural therapy (CBT) can help with depression, anxiety or trauma
• parent-infant therapy can help you build a strong bond with your baby
• couples therapy can help with problems in your relationship with your partner
• psychological therapy can also help with conditions such as post-traumatic stress disorder (PTSD), obsessive compulsive disorder (OCD), bipolar disorder, eating disorders, and substance addiction.

You may be offered individual or group therapy. Treatment may include psychological therapies on their own or along with medicines. Services vary, but many offer self-help, counselling and CBT. In some places there are groups for pregnant people or new parents.  

If you are under the care of a perinatal mental health service, you can have psychological therapy with the perinatal community mental health team. 

If you think psychological therapies could help you, your GP, midwife or health visitor can refer you to your local psychological therapy service. If you prefer, you can refer yourself if you live in England or Wales.

Midwifery team and antenatal care

Midwives always ask about any physical and mental health problems at the first appointment (booking appointment). 

Being honest about your symptoms and history will allow them to give you any support you may need. They can also refer you to your local psychological therapy service or to the perinatal mental health service if needed. 

Your mental illness means that you may be offered extra care in pregnancy. Ask at your booking appointment if they can provide ‘continuity of care.’ 

This means you can see the same named midwife or small group of midwives throughout your whole pregnancy. This builds trust and has been shown to be good for pregnant people and babies.

Some hospitals have a specialist mental health midwife, who you may see during your pregnancy. 

All hospitals have a doctor who specialises in pregnancy and childbirth (obstetrician). You may see an obstetrician during pregnancy and in the days after you give birth. 

Midwives and obstetricians work closely with perinatal mental health teams. 

Families are looked after by a midwife until about 10 days after the birth, or until you and your baby are well enough to move across to the health visitor team.  

If you have a severe mental illness or are thought to be at risk, the midwives may want to see you for up to 28 days. After this, you’ll be looked after by a health visitor instead. 

Health visiting team

Your health visitor will give you advice on caring for your baby. All families will see their health visitor at home 10 to 14 days after the birth. In some cases, you may meet them towards the end of pregnancy. This is more likely if you have a severe mental health problem.

You will then keep seeing your health visitor, either at home or in a clinic, until your child reaches school age. They will work closely with your GP and any mental health professionals you are seeing, to make sure you have the care and support you need.

If you are a young parent, you may also have support from a family nurse. You can find out more about this service on the Family Nurse Partnership website. 

Mother and baby unit (MBU)

Mother and baby units (MBUs) are specialist inpatient psychiatric units. They are a safe place for you to stay with your baby if you need inpatient treatment for severe mental illness. 

They look after people who are in the late stages of pregnancy or in the first year after birth.

Sometimes, you might stay in the MBU for a few weeks to prevent your mental illness getting worse, if you and your doctor decide this is needed.

If you’re not sure if you want to stay in the MBU, you can often visit the unit first to find out what it’s like to stay there. It’s also a chance to ask any questions you may have.

Some MBUs have made video tours for the trust website, which may be helpful. This one is from Yorkshire and Humber MBU:
 

Staff at MBUs are experts in treating mental health problems in pregnancy and after birth. They will also support your developing relationship with your baby. These professionals include:

• psychiatrists
• psychologists
• mental health nurses
• nursery nurses
• occupational therapists
• pharmacists 
• midwives, health visitors and social workers may also visit the unit.

When you’re ready to leave the MBU, a plan will be made with you, and your partner or carer if you have one. This will make sure you get the best treatment and support once you’re back home. 

Some parts of the country don’t have a MBU or, if they do, they may be full. If there isn’t a space in one near your home, speak to your perinatal mental health team about your options.

You may be able to travel to a unit in a different part of the country, but this may be a long way from your home. Or, you might stay for a short time in an adult psychiatric hospital until a space comes up in an MBU. In this case, your baby would have to stay with someone else while you’re in hospital.

Another option may be to have treatment at home until an MBU bed is free. In this case you may have support from the Psychiatric Home Treatment Team and the specialist perinatal mental health services (PMHS).

The Maternal Mental Health Alliance has a map showing all MBUs in the UK. 

Early help services

If you and your family need extra support on practical matters, you may be offered a referral to your local early help service.

Early help services combine support from organisations that focus on helping with issues such as healthcare, housing and education. 

They aim to find out, at an early stage, what support you need to look after your baby and any other children. This can help stop any problems getting worse. 

Support may include parenting classes, having a support worker, or help with special educational needs for older children.

Any professional who helps care for you or your child can refer you to early help services with your agreement. 

Parent-infant relationship teams

These teams are made up of professionals who will help you with your mental health and support you in building a strong relationship with your baby. They are sometimes called parent-infant mental health services, early child and adolescent mental health services (early CAMHS) or early attachment services.

There are only a few of these teams in the UK. If you don’t have one in your area, speak to your GP or perinatal mental health team to find out what support is available to you.

Family and friends

Your partner, if you have one, plus family and friends, are a vital source of support. They can help you after the birth by:

• cooking healthy meals for you
• looking after other children so you can get some rest
• taking the baby for a walk so you can get some sleep
• doing any household chores for you, such as cleaning or laundry
• spending time playing with the baby while you take a break – even if it’s just to have a bath or shower.

Make sure your close family and friends know about your condition and how it affects you. You could talk to them about:

• your main symptoms
• what medication you take
• how to spot the triggers and signs of an episode of depression or mania
• who they need to contact in case you become unwell.

Having a newborn is tiring and causes lack of sleep, which may trigger mental illness. Family and friends can help you spot the early signs of a relapse so you can get help quickly.

If you’re having symptoms of a mental illness, you may need help to look after your baby. Remember, this isn’t your fault and there is support there for you.

Read more about relationships and support networks when you're pregnant with a severe mental illness.

Organisations such as Family Lives and Family Action have information about getting support after your baby is born.

Social services

Most people with mental illness are able to care for their babies at home with support from family, friends and health professionals. But some will need further help from children’s social care, also known as social services. 

Sometimes people worry that if social services are involved, it means that professionals think they can’t look after their baby. This is rarely the case. Social services want to get you the support you need to care for your baby at home.

A professional would usually ask for your agreement before referring you to social services, unless they think your baby is at risk of harm. 

You or a family member can ask for help from social services by contacting your local authority. 

If you are referred to social services, a social worker may arrange to visit you at home. This gives them a chance to talk to you about how you are coping and how your baby’s needs are being met. 

Your social worker will assess yours and your baby’s needs, and will want to work with you to arrange the right support.    

A social services assessment will:

• check what support you have from family, friends and professionals
• make sure there is a plan for your baby if you are too unwell to care for them.

If you don't have any extra help from family members while you are unwell and during recovery, social services may be able to help. They can also find a temporary carer for your baby if you need to go into hospital and you don’t have any family or friends who can look after your baby.

You can find out more about what to expect from social services from Family Lives and the Royal College of Psychiatrists.

Worries about having your child removed

Many parents worry that if they have, or have had, a mental illness, health professionals will want to remove their baby. 

This is not the case. Removing a baby is rare and always a last resort. Only a court can decide whether or not to remove a baby from their parents, unless a baby is deemed to be in immediate danger. 

Health professionals are there to help you stay well during and after pregnancy. They can ensure you have the right help and support so that you can care for your baby. 

Sometimes people with a mental illness say they've heard negative comments from health professionals about their plans to have a baby, or feel judged. If this is the case, it should not have happened. 

It is your right to have a child when you choose, and health professionals should respect this. If you have been in hospital recently, your doctor, may recommend that you take time to recover so that you are well before trying to have a baby. However, this is your decision.

Most families affected by mental illness will not be referred to children’s social services. If any professional thinks that a referral to social services is needed, they will talk to you about the reasons for this. 

If a referral is made, an assessment by a social worker may or may not be needed. The social worker will talk to you about any concerns they have. They will discuss with you what extra help and support there is so that you can care for your baby, and any other children you have, safely. 

Read more about how social services can help you and your baby.

More information and support

Action on Postpartum Psychosis (APP)
Information and support on postpartum psychosis, online chatroom, peer support network.

Bipolar UK
Information and support, local groups and an online chatroom for people with bipolar disorder.

Bipolar Fellowship Scotland
Information, support and advice for people with bipolar disorder.

Maternal Mental Health Alliance
Information and signposting for mental health support before, during and after pregnancy.

MIND
Mental health charity providing information, support, local groups and an online chatroom

Mumsnet
Although they do not provide advice Mumsnet has a very supportive mental health forum.

Netmums
Runs a Maternal Mental Health forum, where their expert Parent Supporters can help with worries or concerns.

PANDAS (Pre and Postnatal Depression Advice and Support)
Provides telephone support, online information and local support groups for pregnancy depression and postnatal depression.

Rethink Mental Illness
Supports people across England to get through mental health crises, to live independently and to realise they are not alone. Find a support group in your area.

Royal College of Psychiatrists
The official website for Psychiatrists in the UK, providing information on all aspects of mental health, including before, during and after pregnancy. 

Samaritans
Confidential service offering emotional support to those in need. Call free at any time on 116 123 or email [email protected]

Find more support with everything from mental health to relationships and money worries.