Learning what the Mother and Baby Unit is like and how do occupational therapists work with mothers and their babies
Welcome to the fourth week of our Maternal Mental Health series. This week I wanted to bring you the perspective of professionals in the community that help mothers that are struggling with their mental health. We often think of GPs, psychologists or psychiatrists, but other professionals can complement their work and, as a team, bring mothers back to health and wellbeing.
Jenny Shaieb is a senior occupational therapist at the Bethlem Royal Hospital Mother and Baby Unit (MBU). In this inpatient NHS ward, mothers with severe mental illness and their babies are typically admitted together, to maintain the important contact between them even when the mother is not well.
I have spent some time as a researcher at the MBU; it is a tranquil one-story building in a very leafy hospital campus, with a nursery, a community kitchen, activity rooms and private rooms for each mother and her baby — very different from what someone might expect from a psychiatric ward.
Can you tell me about your professional journey and why you became an Occupational Therapist (OT)?
I left school at 17 and worked as a chef for a while. In my mid-twenties, I went back to college to do my ‘A’ levels and did human biology, fine art and chemistry. My mum was an OT, but she hadn’t returned to work by the time I left home, so I wasn’t aware of what she did. After I spent a day with her work (she was a community-based physical OT), I thought, “yes, this is interesting!”.
I wanted my future career to combine arts, creativity and human biology and to have some intrinsic value. I got into OT college and qualified. OTs are all dual-trained, and after my first placement in a community mental health team in Camberwell, I knew I wanted to work in mental health.
I started working at the Maudsley in a continuing care team; after a few years, I went to work in the rehabilitation ward. I’d always been interested in the challenges for women with mental health issues and how that affects the children and the rest of the family, so when a job came up at the MBU, I was fortunate enough to get it and have been here for the past 28 years.
OTs are trained to use activities to assess and treat people. We look at the person’s usual roles in life, how these may have changed and how they live their day-to-day lives. We look at this from mental health and physical perspective.
We also do much hands-on work with people. If you speak to OTs, you’ll often find that we are people who do activities ourselves, so we ‘get’ the importance of activities for balance and satisfaction in life. We are trained in adapting activities and environments so that people can do the activities they want and need to do; working hand-in-hand with the person we support is essential.
What kind of activities do you do with the mothers at the MBU?
We do baking, cooking meals, running, cycling, creative writing, maternal journaling, and gardening, among other activities. We also use the OT Dept for pottery, textiles, woodwork, drama therapy, music therapy, and other creative activities, as the OT Dept has specialist instructors who can teach these skills.
We also use the OT department’s organic kitchen garden, and we have gardens on the ward where we grow produce and spend time outside. We also do 1-to-1 sessions with patients, and home visits (for women that need rehousing or need the situation at home requires assessing). We also go out to the shops and on buses, with women and their babies, usually to improve confidence in taking babies out.
We involve the babies as much as possible; we are an MBU and getting used to caring for a baby whilst also doing an activity is an essential skill for a parent.
We also recognise and promote the importance of women having some ‘me time’. The OT department offers good opportunities for this. Being away from the baby for some periods of time can reinforce to a mother that she is still an individual and that however much she loves her baby, she will need a bit of her own space at times. A structure is helpful for most people, but within that scaffolding, there needs to be a level of flexibility. Hence, we adapt daily activities to the people on the ward whilst also keeping to a general routine.
We are a culturally diverse ward, and activities can help make sure that women whose first language is not English feel and are included in what is going on at the ward (we do have regular interpreters as well, though). For all the women on the ward, sharing, teaching and learning about other people’s traditions, foods, art and craftwork can be powerful ways of maintaining and reinforcing the individual’s sense of pride in themselves and their identity.
How do you feel the OT programme impacts the treatment of severe mental illness?
We meet people for a detailed initial assessment (if the person is well enough to do this). We find out from the person what they feel they need, what things they are worried about or are not confident in, and what they can do.
We offer them a structured program of activities that they can use to help reduce the symptoms that they are experiencing; this will be with a level of support that is useful at that point. We always support them, 1-to-1, if they need it.
OT activities are graded, and as someone gradually recovers, they will likely need less support and become more independent. People often talk about not being able to realise they are recovering but having concrete evidence of the progress they have made in activities can help the person realise that things are improving.
Do you have any stories of success stories from previous patients that you would like to share?
We had someone who was very confused due to her illness, and she felt she couldn’t concentrate and complete a task. However, she had always been an excellent cook. When this lady cooked on the ward, she regained some confidence and improved her sense of capability; her self-confidence also benefitted from the positive remarks people made when they ate the food she shared with them.
We’ve had people experiencing psychosis, and the simple act of watering the garden and talking about the plants gave them a moment of calm in the storm.
A while back, we had a lady who had been at the MBU with her first baby and came back with her second. She had been terrified of going to the shops with her baby during her first admission. Together we created a program to overcome this challenge, and the practical side of applying the program gave her evidence that she could do it. When she returned with her second baby, even though she was unwell, going to the shops was not such a source of anxiety for her.
Thank you for sharing so much with us, Jenny. Is there anything else you would like our readers to know?
OTs help people manage the stresses in life and help them find balance and satisfaction in day-to-day living. Looking at how you can do things that fulfil you as a person can improve your perspective on how things are currently and how they may be in the future; this can impact your relationship, baby, family and community.
To access the support of a perinatal OT, please talk to your GP or contact Community Mental Health and/or Perinatal Services directly.