Northern Ireland’s Mothers Plead for Crisis Aid

A Systemic Failure: Northern Ireland's Mothers in Crisis Without Specialist Care

A profound gap in mental health provision is leaving new mothers in Northern Ireland in desperate situations, kept apart from their infants during a period of immense vulnerability. While the rest of the United Kingdom provides specialist facilities for women experiencing severe perinatal mental distress, Northern Ireland does not have a single one. This forces women into standard psychiatric wards, a practice that families and medical experts describe as traumatic, outdated, and life-threatening. The repercussions of this systemic failure are devastating, impacting maternal wellbeing, infant development, and, in the most tragic cases, resulting in preventable deaths.

For years, advocates, clinicians, and bereaved families have campaigned for the creation of a maternal and infant facility. Despite repeated promises from a succession of health ministers and a clear, identified need, the project remains stalled by funding disputes and political inertia. This ongoing delay perpetuates a two-tier system of care within the UK, leaving mothers in the region to navigate a crisis without the essential support that could save their lives and preserve their families. The human cost of this inaction is mounting, told through the harrowing experiences of women who have been failed by the system.

The Trauma of Separation

A new parent’s introduction to a psychiatric ward is a deeply isolating experience. For Shelley Browne, it was a moment of profound loneliness and fear. Following her child's delivery three years prior, she developed postpartum psychosis, a severe but treatable condition. Her admission to the Ulster Hospital's psychiatric ward required her to be away from her infant daughter. This situation, she explains, created a feeling of being a captive, stripped of her identity as a mother when she needed that connection most. Each morning without her baby broke her spirit anew.

Shelley Browne’s story is not an isolated incident. Annually, around one hundred women in the region who need inpatient care for perinatal psychological distress are placed in adult psychiatric facilities. This means they receive attention in an environment not designed for their specific needs, and are not accompanied by their infants. Experts argue this practice can be deeply detrimental, potentially hindering recovery and damaging the crucial early bonding process between a parent and child. The very system meant to provide help is, in these cases, inflicting additional trauma.

The argument for specialist centers is not just about comfort; it is about clinical necessity. Challenges with perinatal mental wellness demand expert understanding and a therapeutic environment that supports the maternal role. Standard psychiatric wards are often unable to provide this nuanced care. Staff, while doing their best, may lack the specific training to manage the complexities of postpartum psychosis or severe depression in the context of new motherhood. Shelley Browne's feeling of being a parent without her infant highlights a fundamental flaw in the current model.

A System Lagging Decades Behind

Northern Ireland stands alone in the UK in its lack of a dedicated facility for mothers and babies. Across England, Scotland, and Wales, a network of 22 such centers provides integrated care, allowing parents to receive psychiatric treatment while staying with their infants. These facilities are designed to be therapeutic, non-clinical environments where women are helped by a multidisciplinary group of experts, including perinatal psychiatrists, mental health nurses, and nursery nurses. This model is internationally recognised as the gold standard for treating serious perinatal psychological conditions.

The case for such a center in the region is not new; it has been discussed for nearly two decades. The concept has received endorsements from seven different health ministers, who acknowledged the clear benefits. In November 2023, a confirmation came from government health officials that Belfast City Hospital had been chosen as the location for a regional facility, a move welcomed by campaigners. The Belfast Trust was tasked with preparing a business proposal. However, this positive step was immediately undercut by warnings that the project's delivery depends entirely on securing funds in a dire financial climate.

This persistent failure to allocate money has generated immense frustration among clinicians. A leading psychiatrist with the Royal College of Psychiatrists in Northern Ireland (RCPsych NI), Dr Julie Anderson, describes the situation as "embarrassing." She points to the hypocrisy of acknowledging a problem for twenty years without taking meaningful action. The consequences are stark: women who would likely accept help if it meant staying with their infants are instead refusing treatment, or the system is failing to identify them, leading to potentially tragic outcomes.

Image Credit - AOL

A Preventable Tragedy: The Death of Orlaith Quinn

The devastating consequences of this service gap were laid bare by the death of Orlaith Quinn. In October 2018, the 33-year-old mother of three ended her life while at the Royal Jubilee Maternity Hospital in Belfast, just two days after she delivered her daughter. Her family recounted how her behaviour changed dramatically after the delivery, exhibiting symptoms consistent with postpartum psychosis. Despite their pleas for help, the system failed her at every turn.

A 2022 inquest delivered a damning verdict, finding that Orlaith Quinn’s passing was both foreseeable and could have been averted. A catalogue of failings related to the attention she received was detailed by Coroner Maria Dougan, including an inadequate mental health assessment and a failure to listen to the family's concerns. The coroner found that a psychiatrist had incorrectly determined she was not a suicide risk and that a correct diagnosis would have led to a care plan that could have saved her life. The inquest directly connected her passing to the non-existence of a specialist facility and strongly recommended one be created as a matter of urgency.

In the wake of the inquest, the Belfast Health Trust issued a full and profound apology to the Quinn family. The Trust stated its commitment to absorbing the lessons from her death and has since implemented a training program to equip personnel to better recognise serious perinatal psychological disorders. However, for Orlaith’s family, the apology rings hollow while the fundamental issue—the lack of a dedicated unit—remains unresolved. Her mother, Siobhan Graham, spoke of the unimaginable pain of a parent entering a hospital to deliver a child and leaving with a casket.

The Impossible Choice

Faced with the prospect of being away from her new baby, Joe, Danielle Sands made a difficult decision in 2022. She refused hospital admission. Officials were unambiguous that if she went into a general psychiatric ward, she would have to go without her son. Trapped by persistent and negative voices in her head that reinforced feelings of inadequacy, she chose to rely instead on the assistance of community-based specialist teams. Her story illustrates the impossible choice that the lack of a proper facility forces upon mothers: sacrifice your mental health or sacrifice the bond with your child.

Thankfully, assistance for Danielle and Nial, her partner, came from a community nurse with expertise in perinatal mental health. All five of the region's health trusts now have these community teams, which offer vital interventions for women from pregnancy through the first twelve months following delivery. These services are a crucial lifeline, and their establishment represents significant progress. However, they are under-resourced and over-stretched, a problem compounded by a wider mental health workforce crisis in the area.

The community teams get in excess of 250 requests annually per trust, but personnel shortages mean their capacity allows them to handle approximately 70 cases simultaneously. This leaves a significant portion of women without specialist support. Furthermore, community care cannot replace the necessity of inpatient treatment for those with the most severe conditions. Dr Julie Anderson of RCPsych NI projects that the quantity of women needing hospitalization might increase by two or even three times if a dedicated facility existed, as women would be more willing to seek help knowing they would not be parted from their infants.

A Model for Care: The Jasmine Lodge Example

What Northern Ireland is missing can be seen in action in Devon, England. There, Jasmine Lodge stands as a testament to what is possible. The purpose-built, eight-bed facility, where consultant perinatal psychiatrist Dr Jo Black was a key figure in establishing it, offers a non-clinical, welcoming environment. Dr Black, who hails from Cookstown, finds it "extraordinary" that no comparable facility exists on the entire island. The design of Jasmine Lodge centres on an enclosed courtyard garden, filling the building with natural light and creating a sense of openness.

The center includes spaces where relatives can gather and has a dedicated group of experts on staff. Crucially, it allows mothers to receive intensive psychiatric care while learning to care for their babies in a safe, supported environment. The focus is on preserving the maternal bond, which is fundamental to both the mother's recovery and the infant's healthy development. This integration of care is what is sorely lacking in the region's fragmented and inadequate system.

Dr Black underscores a stark reality, stressing that such facilities are life-saving. The evidence shows that a mother ending her own life is a leading cause of death during the perinatal period. A report from MBRRACE-UK, which investigates maternal deaths, found that from 2021 to 2023, mental health struggles were a factor in 34% of late maternal fatalities. A late maternal death is defined as a death occurring from 42 days up to a full year following the end of a pregnancy. The existence of dedicated units in the rest of the UK is credited with reducing these tragic outcomes. Northern Ireland’s mothers are being denied this vital provision.

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The Overlooked Crisis in Data

The true scale of the perinatal mental wellness crisis in the region may be significantly underestimated due to systemic failures in data collection. While current estimations suggest that over 3,500 women experience a perinatal psychological condition each year, Dr Julie Anderson warns that this figure could be much higher. Inadequate data-gathering practices mean the actual demand for services is likely not fully understood, further hampering efforts to secure adequate funding and resources.

This issue is not new. In 2017, the health watchdog, the Regulation and Quality Improvement Authority (RQIA), recommended that government health officials refine its system for cataloging patients to better monitor perinatal psychological conditions. Years later, it was confirmed that action still has not been taken on this recommendation. The Department of Health has stated that a re-evaluation of its coding methods is in the works, but the delay speaks to a lack of urgency in addressing this critical issue. Without accurate data, it is impossible to plan effectively for services that meet the population's requirements.

This data deficit creates a vicious cycle. Without a clear picture of the problem, it becomes easier for funders and policymakers to downplay its significance. The Royal College of Psychiatrists NI has repeatedly highlighted a workforce crisis, with nearly one in four consultant psychiatry posts vacant or filled by locums in 2023, and no increase in training places since 2007. This chronic underinvestment is exacerbated by the lack of robust data to justify urgent action, leaving both clinicians and patients in an untenable situation.

The Ripple Effect on Families

When a mother suffers, the entire family is affected. The experience of Nial Sands, Danielle’s partner, shows that the perinatal period can be a time of immense strain for fathers as well. While Danielle battled postnatal depression after a traumatic birth, Nial focused on being the sole carer for both her and their baby boy, Joe. He felt helpless, shouldering the immense responsibility of holding his family together. Only after Danielle began to recover did Nial recognise the toll it had taken on his own mental health.

He began experiencing anxiety and an inability to concentrate, catastrophising about the future. It was the perinatal team supporting Danielle who encouraged him to seek help. His story is increasingly common, with as many as one in ten new fathers experiencing mental health difficulties. Support groups like Dad's Voice are emerging to provide safe spaces for men to share their struggles, but the issue highlights the necessity for a "think family" approach within perinatal services—an approach that is central to the specialist unit model but difficult to implement in a fragmented system.

The trauma of Orlaith Quinn’s passing continues to devastate her family. Her husband, Ciaran, spoke at the inquest of the daily "hurt and pain" his children endure growing up without a mother. The loss is a constant presence, a reminder of a system that failed them. Siobhan Graham, Orlaith's mother, conveyed the profound sense of injustice, stating that an element of their family was lost along with Orlaith. These testimonies underscore that the fight for a dedicated unit is not an abstract policy debate; it is a fight to prevent other families from being torn apart by a preventable tragedy.

A Campaign for Change

The campaign for a dedicated maternal and infant facility within the region has been driven by a coalition of determined voices. Charities like Action on Postpartum Psychosis (APP) and the Maternal Mental Health Alliance have worked tirelessly to keep the issue on the political agenda. They have been joined by women with direct experience, including Shelley Browne, who now campaigns and fundraises to raise awareness, believing a proper unit would have made her own experience less traumatic. These advocates refuse to let the issue be forgotten, sharing their deeply personal stories to illustrate the urgent human need behind the policy demands.

In October 2022, campaigners presented an open letter signed by 40 organisations and a petition with nearly 7,000 signatures to the then Health Minister, Robin Swann, demanding action. The recent confirmation of a site for the proposed facility at Belfast City Hospital is a direct result of this relentless pressure. While this is a welcome development, campaigners remain cautious. Without a firm timeline and, most importantly, ring-fenced funding, the announcement remains a promise, not a reality. The ongoing lack of a functioning government at Stormont only adds to the uncertainty.

The call to action is clear. The immediate priority must be for government health officials to advance the business proposal for the facility and secure the necessary capital and revenue funding to make it happen. Campaigners argue that interim measures, such as those adopted in Wales where a temporary facility was created, should be considered to bridge the gap until a permanent center is built. The powerful lived experiences of mothers like Shelley Browne, Danielle Sands, and the family of Orlaith Quinn can no longer be ignored. The time for excuses is over. The mothers and babies of Northern Ireland have waited long enough.