Melinda McLennan was “on verge of a psychosis” in 2021 when she went to the emergency room. She hadn’t slept at all for three days.
She sought help from her GP as well as a maternal and infant health nurse, her child psychologist, Tresillian’s early parenting program, and several maternal health hotlines, since she had her baby just four months earlier. However, she felt unsafe.
Melinda from Casino, in the northern rivers region of NSW, says, “I didn’t cope, I didn’t feel me, and I felt more and more disconnected with reality.”
She desperately wanted to be admitted to a perinatal mental health unit with her baby — but was told no such facility existed in her area.
She said, “I never felt more alone and helpless.”
Melinda, who had presented five times at local hospitals within a single week, was finally connected to a mental healthcare team. The team helped her recover at home from postnatal depression, anxiety, and psychosis.
Two years after that critical low point, Melinda is calling for more perinatal mental health units — sometimes known as Mother and Baby Units (MBUs) or Parent and Baby Units — in Australia’s regional areas.
Bed numbers do not meet recommendations
Professor Megan Galbally of Monash Health, Melbourne’s Centre of Women’s and Children’s Mental Health, believes that Australia should strive to have one eight-bed Mother and Baby Unit per 15,000 births.
This benchmark was set by the Royal College of Psychiatrists in the UK and is used by The Royal Australian and New Zealand College of Psychiatrists as a point of reference.
Based on these figures, Australia could have up to 168 MBUs, which would be spread over 21 eight-bed units.
Instead, the nation falls well short of that, with just 83 beds in total, split across 13 units.
Those states and territories with the lowest birth numbers — the Northern Territory (which recorded 3,736 births in 2021), Tasmania (6,027 births), and the Australian Capital Territory (6,410 births) — currently have no dedicated public Mother and Baby Units at all.
In Tasmania, some public patients may be admitted to the private unit.
New South Wales had no public Mother and Baby Unit beds until 2022, but now has two, eight-bed units in Sydney.
South Australia has a six-bed unit at Adelaide’s Women’s and Children’s Hospital, and plans to increase the number of beds there.
Western Australia has two units with 16 beds each in Perth. Victoria has six MBUs, which are spread across metro and regional areas.
Families in the regional area relying on apartments located in cities
Dr Galbally is the National Chair of the Section for Perinatal and Infant Psychiatry of the Royal Australian and New Zealand College of Psychiatrists. He says that there are “huge issues of access” for parents in rural and regional areas who wish to be admitted into an MBU.
She points out that Victoria is the only state with Mother and Baby Units in regional areas.
She said that some new mothers are admitted into general adult psychiatric facilities, but they cannot bring their babies with them. This is not recommended by the RANZCG.
Other people are allowed to stay in apartments located in cities that may be several hours away by car or plane.
Distance can be a problem for patients who require family involvement in severe illnesses.
“We would definitely want the husband or a family member present if we had a really sick and psychotic mother,” says Dr Michael Block. He is perinatal psychiatrist at Bright in north-east Victoria.
Families with several children can also be affected by the fact that one parent may need to travel long distances for medical treatment.
“What are they going to do about the kids that already exist who may be young?” And what do dads do, because they need to be in two places at once — what do they do if they’re farmers and can’t leave the farm?”
It can be difficult to staff specialized units in rural areas, as they are required to have knowledge in mental health care and infant care.
Dr Blocksays believes he is the only perinatal psychiatrist specialist in rural Victoria.
He says the regions simply don’t pay psychiatrists as much as the city, despite high demand — which contributes to the shortage of specialist mental health care providers available to work in regional and rural MBUs.
Get governments to buy in
Dr Galbally claims that some states have made recent investments in new MBUs. This is a positive step.
Queensland has opened an MBU at Mater’s South Brisbane Campus this year.
According to a NT Health spokesperson a mental unit will be built at the Royal Darwin Hospital in the Northern Territory, which will include beds for both parents and their babies. The ACT also has plans to open a MBU dedicated to this purpose within the next few years.
But Dr Galbally would like to see consistent funding at the state and federal level for new units throughout the country. “So that we can use modelling based upon the number of deliveries and the anticipated population demand so that we have the right number beds.”
Dr Block says that the shortage is worsened by the absence of a funding model which integrates federal, state and local resources.
There’s always the federal/state “let’s try to get them to fund it” approach.
The bottom line is that they are not profitable. [and for] “You need to justify the existence of expensive services much more than you do profitable services,” says he.
What are the two groups that have no voice in our society? “Women, babies.”
As for Melinda, the fight for her health drove her to lodge a petition — with more than 8,100 signatures — with the NSW parliament for a new perinatal mental health facility in the northern NSW local health district.
She’s since continued to advocate for more MBU beds across Australia’s regional and rural areas — emailing local Members and meeting with CEOs of several perinatal mental health organisations to push for change.
“I do not want anyone else to experience this, as it is a very harrowing situation,” she said.
Melinda shared her experiences with ABC in a segment called The Birth Project.
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