My Baby, Psychosis and Me

This programme contains some scenes which some viewers may find upsetting.

The birth of a baby - one of life's happiest moments.

But for some women, about one in 500,

childbirth can trigger a terrifying roller coaster with the sudden

onset of severe mental illness.

Are your thoughts jumping around a bit?

I'm mad as a box of frogs.

There were all these rows of trees and I thought about hanging

myself from one of them, but I don't want to do that.

It's a challenge to you. You're my psychiatrist.

You want to know what's going on in my head

and I want to know what's going on in your head.

What Hannah and Jenny are experiencing is

a condition that is almost unheard of.

Postpartum psychosis.

New mothers are overwhelmed by extreme low or high moods,

strange and dangerous thoughts,

paranoia, delusions.

Good God!

I might be Prime Minister by the end of the day.

Postpartum psychoses are the most severe illnesses that we

see in psychiatry, but it is also an episode of illness that women

recover from and can recover from quite quickly.

But with a severe shortage of specialised psychiatric care,

it's a postcode lottery whether mothers get the expert help

they urgently need.

Over 80% in the UK don't.

-I just want to be better for my daughter.

-Yeah.

We follow Hannah and Jenny as the team at Winchester's

mother and baby unit help them fight this frightening illness

and keep mother and baby together.

OK. I'll be a good girl.

# I love you and you love me

# We love each other cos it's you and me

# I love you and you love me

# And we love each other cos it's you and me. #

12 weeks after she gave birth to baby Esther, Hannah was

admitted to the specialised psychiatric

unit at the Royal Hampshire County Hospital in Winchester.

There was a time when she completely believed that she was God.

And that clearly isn't the case

and it's not something that she normally believes.

There's a good girl. Oh, you're such a good girl.

Hannah is 27 and a trained nurse.

If I could explain just how amazing my husband is,

I don't think there would be a word that could encompass it.

Andy, for me, has been such an amazing support.

He was the beginning of the end for me, really.

She met Andy three years ago.

They soon married and decided to start a family.

It's indescribable. Having a new little baby that we've

brought into the world is something quite special.

But three months on, the joy of Esther's

birth was overshadowed, as Hannah began to have delusions

and suicidal thoughts.

I almost didn't recognise her.

It was like looking at a different person.

You would talk to her, try and engage with her,

try and comfort her,

and no matter what you said, there was no comforting her.

What Hannah was experiencing is a condition far more severe

than postnatal depression.

Things came to a head one day at her parents' home.

She just collapsed into a foetal position and screamed

and screamed and screamed.

I mean, I can only say that it just struck me as complete

and utter madness.

I think, in terms of mental illness,

I don't think I've seen anybody as sick as that.

I literally couldn't explain what had happened to my own daughter.

It was horrific, absolutely horrific.

I'm finding it difficult to talk about even now

because I just didn't want to see her ever like that.

I didn't expect that at all.

I remember when we were at her parents' house.

We were sat down on the sofa and Hannah was really struggling

and very, very anxious and at that time I whispered to her that

"I married you in sickness and in health."

Hannah was brought to Winchester,

where staff took her in under what's known as a section.

When we detain someone under the Mental Health Act,

we do it because there is no other way to ensure they get the care,

the help, the support and the treatment that they need

and in Hannah's situation,

she really doesn't have a very good understanding of how ill she is.

SHE BABBLES

Is your name Esther? Ah, yes.

Two weeks on, the team think Hannah's

showing real signs of improvement.

Esther.

Specialist psychiatric care,

as well as round-the-clock support with her baby, has enabled

Hannah and Esther to stay together, rather than a damaging separation.

I think it's absolutely crucial for Hannah to be together with Esther.

Do you like your bath?

There is lots of evidence now that that makes a difference to the

outcome for mum and for baby.

Do you like your bath time?

The tragedy is that there are lots of parts of the country where

women have no access at all

to the specialist care they need.

I kept thinking I was going to hurt Esther, not deliberately,

but because I felt so weak, because I was so anxious.

I was worried I was going to forget something,

but then when I said to people

I was worried I was going to hurt Esther then I think

they thought actually physically, but I meant through neglecting her.

The team at the unit use a range of treatments,

but the cornerstone is medication.

So Hannah's on olanzapine, an antipsychotic.

That's a regular prescription, so she receives that daily.

She also has another antipsychotic called haloperidol

which she can use as and when she wants.

It helps with intrusive thoughts, racing thoughts, delusions.

Can I have some haloperidol?

-Yeah, sure. Sit down.

-Thank you.

With Hannah responding well to treatment,

she is now allowed to take short trips outside the unit.

I just wondered if I could have maybe a couple of hours leave

with Mum and her friend and my auntie.

-Will you take Esther with you?

-Yes.

-Have you got everything you need for her ready?

-Yes.

-OK.

Any dark thoughts or morbid thoughts?

No, no dark or morbid thoughts, just very grateful to be here.

Hannah's mum, Pippa, who herself nurses the mentally ill,

has come to be her daughter's chaperone.

We're good to go. We're good to go.

I'm in a patterned dress with beige shoes and a navy cardigan.

I'll write down what Hannah is wearing.

That is in case you were to go AWOL, really.

We would need to notify the police as a missing person so that they

could have an idea of who they were looking for in the community.

The most noticeable thing showing that Hannah still is quite

unwell at the moment is that the range of her emotions is

still very large, laughing and suddenly being terribly,

terribly cheerful and then quite quickly becoming quite upset

and almost tearful.

Hi. I'm just ringing to say I'm sorry I haven't made contact sooner.

Anyway, I love you.

The phone call to her husband Andy is enough to trigger

a change in Hannah.

Just sometimes the way he looks at me.

He might leave me and I know this is a lot for him to deal with

and I don't ever want to put him through more than what he can bear.

Listen, he loves you very much and

he's been a wonderful husband so far.

He has. That's the thing, because I don't think I deserve it.

He's my rock, because ever since I met him, stuff's got better.

Oh, dear.

Jenny is 37. She gave birth to her second child, Libby, six weeks ago.

They can't read me and it terrifies them

because they think I'm going

one way or the other and I know exactly where I'm going.

I'm going from A to B, backwards via Z.

Every option, Ferris wheel.

Jenny has become ill postnatally.

Her mood is elevated. She's high.

She's quite irritable at times.

If you stand there washing your hands,

you cannot actually see that sign.

So there's no point in having it there.

If you're going to have it, have it on the window, have it just there.

It's certainly not right to assume that just

because someone is high, like Jenny is

most of the time at the moment,

that that is a wonderful, pleasant, great experience.

Jenny and her husband Henry, a GP, have been together

since they were 17.

They married at 22.

People don't really know who Jenny is because she's unwell

and she's not her normal self.

But for me, Jenny is a...

She's a really caring person.

She's someone who always is looking out for people.

She's got a really good sense of humour,

which comes across in a different way when she's unwell.

Hello. Hiya. Oh, lovely.

Hello? Hello.

Knock, knock, knock. Hello?

I often think of it as being a state of your brain being in overdrive.

So your thoughts race, you have many more thoughts than you would

normally do all happening at the same time,

but things you are thinking about become less grounded in reality.

Right, let's get this off of you.

Oh, that is a stinky one.

Jenny's first manic episode was quite dramatic.

She was out shopping with me and then suddenly disappeared.

She threw my phone into the river and then took off in the car and I

didn't know where she was going and then she was missing for three days.

And we had the police out looking, police helicopters,

and I really didn't know whether she was going to be found injured

or dead or alive and that was terrifying.

This episode led to Jenny being diagnosed six years ago with

bipolar, a mood disorder which causes extreme highs,

known as mania, and severe depression.

Jenny's bipolar disorder has had a massive

impact on her life.

It's because of that that she had to give up her career

as a patent attorney and recently she's been working as an artist.

We thought for a long time we weren't going to be able to have

children at all, because of Jenny's illness.

SHE SINGS

A range of psychotic illnesses place women at risk.

For Jenny, having bipolar meant she knew

she had about a 50-50 chance of becoming ill after having a baby.

Three weeks after Libby was born,

Jenny began noticing early warning signs and asked to be admitted here.

She is not held under section, but now obsesses about trying to leave.

You know, there's a way out of these buildings.

I think I know most of the door codes by now.

Lots and lots of ways in and out.

I've been in this place for too long.

One of the things Jenny finds very hard is her intensive

programme of medication.

But with her condition deteriorating,

today staff are increasing her dose of an antipsychotic.

I've got your tablets here. Tablet.

Do you want to have it after your breakfast or is it OK...?

What did we agree on the haloperidol?

Well, you had 1.5 milligrams yesterday

and that's gone up to 5 milligrams this morning.

-Five all the time?

-Yeah.

-For how long?

Well, probably until you can achieve a good pattern of sleep.

Do I really, really need to take this?

Yeah, because come tonight, that is going to

help you to get to bed as you want.

-As long as I won't be a zombie all day.

-OK.

And you can watch me take it. It's not gone under the tongue.

OK. I'll be a good girl. Thank you.

I think Jenny's attitude to medication is quite a good

barometer of how well she is.

Because when she's really, really unwell, she won't see the need for

any medication and will go to quite cunning lengths to avoid taking it.

When she's well, she understands that she needs medication.

-How you doing?

-Yeah, getting there.

I just hate the way that the plan gets changed all the time

and then you get more and more confused and haloperidol and we

have run out of this so you've now

got two tablets and it was one tablet.

And you just get handed a whole pile of stuff to stuff inside yourself.

Yeah.

I know you think it's the right thing,

but it just winds the hell out of me.

I know. I know it does, babes. I know.

It's a trade-off, isn't it?

Jenny's also irritated by something that's been

happening on the ward.

We've had two fire alarms. Two hours that fire alarm went off.

Nobody in the building could turn it off.

Two hours? Yeah. 11 o'clock.

-I know. That's really unlucky.

-Yeah. That's one way of putting it.

It was getting to a level of severity where

she was acting on some of her fears and thoughts and concerns,

so for example, she's become very

preoccupied by the idea that there might be a fire

and how would she be able to escape in case of a fire

and she even went as far as putting Libby in her bath in her

bathroom, because she thought that that would be a good

place to keep Libby safe.

There we are.

I don't think there's any chance that she would do anything to harm

the baby, but she might through her distractibility do

things that might make Libby a bit more vulnerable.

We just did it wrong once. OK, let's try...

But evidence shows that mothers are a far greater risk to

themselves than their babies.

There are various things Jenny does only

when she's unwell that are really significant in her mind

and putting the magnet over her face in that family portrait is

obviously one of those really significant things.

I'm just wondering how they'll cope if I'm not here.

I'm actually really missing normal family life at the moment.

I'm finding it much easier to deal with Esther.

I'm actually starting to enjoy it again.

It doesn't scare me any more, going home.

You're making great progress. You're recovering.

You're not quite there, but you're on the road to recovery.

Dr Gregoire decides to lift Hannah's section

and allow her home for a night.

Hannah coming home today is quite a big moment for me.

She hasn't been home for probably nearly a month now.

I think he was absolutely terrified that they would take me

away from him long-term.

I guess the only thing that's slightly daunting for me

is that if she goes downhill while she's at home,

but I'm hoping that's not going to happen.

I'm going to go and make you a feed for when you wake up. Yes, I am.

I'm going to make you a nice big feed.

Her four weeks in the unit has allowed Dr Gregoire to build

a picture of Hannah's moods and behaviours.

There's been a breakthrough.

He's been able to diagnose Hannah with bipolar disorder.

I can't tell you, after 14 years of knowing I wasn't right,

to finally have a diagnosis

and treatment is like the best thing you could possibly imagine.

Like, it's so freeing and it just makes me

feel like I've got a future.

I've really got a future.

I'm sorry.

-Thanks.

-Just through there.

Thank you.

-Hi, baby.

-Hey. How are you?

Fine, thanks. You?

BABY CRIES

Do you want your daddy?

BABY BURPS

-Oh, my gosh!

-Mummy was right.

-Oh, dear!

It's lovely to see you, isn't it? It's nice to see you.

Mummy got a bit mad. A bit sad.

'The time of going home is a high risk time,

'in terms of people becoming ill again, very challenging,

'very demanding,

'going from a situation where we're there 24 hours'

a day for her on the mother and baby unit, to support her, to watch out

for her, to a situation where she's at home, but it has to be done.

She can't stay in hospital for the rest of her life,

nor would anybody wish her to.

So at some point, she's got to take that big, big step for her.

I love my husband so much and I haven't seen him for ages, but

really I'm kind of worried that I just might not be able to

control my emotions. I guess I worry that I'm going

to get overexcited and go into a mania.

But I think I'm becoming more and more aware of my medications

and what I need to do with them.

-I want to give you a hug, is that all right?

-Of course you can.

Right, here goes.

-See you later.

-Take care.

Oh, going home.

You all right, sweetheart?

OK.

-Why through all of this haven't you left me, like I asked you to?

-Um...

Cos I love you, but also because I knew that you would get better,

ultimately.

Do you understand now why I always used to say to you I thought

I was better off on my own?

Yeah, but that was because you were ill, wasn't it, and you weren't...

-I just knew that I was hard work.

-You needed some help.

Your sister was right. I was high maintenance.

You are high maintenance, but in a different way.

We're on the home stretch. I always remember this corner.

Oh, I'm really excited.

I love our house. It's almost a little bit Lords of the Ring.

I have no idea what you're on about.

Lord of the Rings! That is a film, isn't it?

Lord of the Rings is fictional,

much before 1860 when that house was built.

That's what I mean! It's like a little Hobbit house!

-Oh, OK.

-I'm not mad!

Is... Oh!

It looks amazing!

Oh, dear.

Oh, my gosh! Look at the garden!

Oh, I love it!

I want to stay here for ever!

I'm sorry, it's only cos I'm happy.

It's OK. I'm glad you're happy to be home.

I love you.

-We're going to be OK, aren't we?

-Yeah.

-Have you come across those drugs before?

-Yeah.

So quetiapine and haloperidol are both mood stabilisers?

-Antipsychotics?

-Yeah, that sort of thing, yeah.

-But I haven't got psychosis, have I?

-Well...

I think last week they would have said that you were quite unwell.

-You don't like me saying that, do you?

-No, not really.

-Well, they described you as being manic last week, didn't they?

-Mm-hm.

The only problem is that I'm not really manic.

My brain's going really fast, and no-one else can keep up.

They don't like that.

The problem is with other people's brains, rather than your own?

Is there a possibility that's true?

Well, I think you're probably the only person

thinking that it is true.

Despite questioning the medication, Jenny's been persevering with it.

But she's not finding the side-effects easy.

You know, the most noticeable thing for me at the moment is that

I can't see myself.

Because my vision is so blurred by the side-effect of haloperidol

that I actually can't see my face in the mirror.

-So, how are things going with you?

-Well, I slept more last night.

-I'm sure that's been handed over.

-Yeah.

I think eight-and-a-half hours in a go...

-And your sleep is really important, so...

-Yeah.

Anything that interrupts your sleep, we need to try and do something.

Because then I have to resettle.

It's actually quite helpful to have to live in one room.

Really and truly, the night staff want us

in our rooms after medication time, so 11 o'clock,

-potter around in your room, lights out at midnight.

-Yeah.

-Which is sensible. Promotes sleep.

-Get into the bed and sleep...

-Yeah.

So, by 11, I know I can't tinker around out there.

What would your plans for leave be now?

-My main priority is to get some time with Reuben, my two-year-old.

-Mm.

And for him to just feel connected.

Dr Gregoire has allowed Jenny home for one night.

# Oh, you're so happy...

# Boo-boo boom-boom. #

Reuby cube!

# Doo-doo

# Doo dum. #

That's Reuben smiling. What are you doing there?

-Sleeping.

-Sleeping.

It's so lovely to have Jenny home. I think it's lovely for all of us.

I certainly have worried that being with Reuben at home might be

a bit too stressful, but it's just been lovely so far.

She's been relaxed and has seemed to find it really therapeutic.

I miss just holding him. Picking him up and cuddling him.

Smelling his hair and being close to him.

Look at that!

When Reuben was born, Jenny showed signs of becoming unwell,

but with increased medication and psychiatric support at home,

she quickly got better.

-Are you better?

-Pardon?

Is Mummy better?

-Yeah.

-Yeah, Mummy is better, isn't she?

You're not going to Winchester?

Well, I have to go back to Winchester in a little bit.

But I'll be here in the morning. We'll go to preschool together.

OK, see you later.

Bye. Can we go this way?

Next morning, things haven't gone quite to plan.

I think she only slept about three hours last night.

Ready, steady, go.

And we know that if she has several

nights like that, it can be really detrimental to her mental state.

I'm just going to fling some things together.

The unit wants me at half 12 at the latest, do they?

For Jenny, as for most people with bipolar disorder,

lack of sleep is a major risk factor.

The risks are that she could be up all night

and that would not be good news, actually.

Well, in my head, I've got three nights.

If I have a bad night and it's a signature bad night, which is

absolutely no sleep all night, that's not good.

I've got two days to rectify it and if I haven't rectified it,

then I'm on my way to mania.

And that's like skateboarding down a hill

when you don't know how to stop.

It's kind of fun, but it's terrifying.

I did notice that the bathroom cupboard had been reorganised

this morning when I went to shave.

When her brain's doing what it is now, she feels that it's all

a process she needs to go through in order to feel calm.

But sometimes, it can just spiral and get worse and worse.

It's just so disheartening when she's made quite

a bit of progress in the last few days to then have a bad night.

It does make me scared that things are going in the wrong

direction again.

Take care. Look after Libby for me.

Likewise, Libby.

Yeah.

I'm sorry, I know it's embarrassing. I'm sorry, I'm sorry.

I'm trying.

Over the past week, Hannah has been granted three further

overnight visits out of the unit.

But her behaviour is alarming her mum, Pippa,

who has decided to bring her to see Dr Gregoire.

-Come with me, Hannah.

-Yeah.

-Shall we go and find Dr Gregoire?

-You are having a difficult time?

-Yeah.

I don't want to be back here, I want to be at home.

-Is that what is making you feel a bit rotten?

-Yeah.

So, have you been feeling like this just today, then?

No, yesterday it was just as bad if not worse,

-but I was able to control it with an hour-long walk.

-Mmm.

It's the olanzapine, it's too high.

Mm-hmm, and what is telling you that, that it is too much?

My body. I keep getting a headache here.

It wasn't the headaches that were the first thing, was it?

-It was the lows.

-The lows, yeah.

When you were in hospital you were taking all of these

-medications fairly regularly.

-Yeah.

Things were going reasonably well, then, and then you went home...

And I tried to get better too fast.

And you started cutting down on some of the medications

and things got a bit worse.

Is it possible that actually the olanzapine

and lorazepam are helping?

Maybe you're right. I don't trust my thinking, so I needed...

-That is why I needed to see you today, to know what to do.

-Mmm.

I'm so sorry, I thought I was doing the right thing.

I'm so stupid.

I thought I was clever.

What you have learned is actually really useful, which is

-that you have a bit of a more difficult time.

-Yeah.

-Yeah?

-I'm sorry, I wasn't trying to be naughty...

-No!

..I was genuinely trying to get better and I...

This is your illness, it's your mind, your body and your medication.

It sounds like you need that little bit of extra support and help.

There is also one other consideration that I'm quite keen

-on checking out, and that is that you are going to be safe.

-Yeah.

-Because I can't get you better if you're not alive.

-No.

Are you at the moment wanting to be dead?

No, I just want to sleep a lot.

Right, so you want to just not be feeling how you are feeling,

-get away from that.

-Yeah.

Are there times when you want to be dead?

Yeah, but I talk to Jesus and it stops.

Mm-hmm.

I just say, "Please stop it, Jesus, please stop it."

When Hannah talks about ending her life, I would say it is

probably one of the most distressing things a mum can hear

because you as a mum do everything from the time they are born

to preserve life and to enhance their life,

and for her to feel that her life is not worth continuing

is really difficult.

Physical illnesses can cause suffering in some cases,

so terrible cancers can cause people to be distressed and in pain,

but mental illnesses are suffering.

They are at the very root of where suffering lies,

which is of course in our heads, in our brains,

and that is gruesome to watch in somebody else.

Have you got to the point where you have decided right now,

"I am going to do it?"

No, because I look at my baby and I say that she needs a mum

-and I can't do that her.

-Right, OK.

That's why I like waking for her,

-because it keeps my perspective on her.

-OK.

-We are here to help you.

-I know.

-OK?

You are all being really nice. I just want to get better.

But we want you to get better and if we can work together to get

you better, that is going to be the most efficient way of doing it.

After six weeks in the unit, most women would be well into recovery.

But Jenny's condition has suddenly worsened.

Towards the end of last week things were generally OK,

but since Saturday night, really,

has become increasingly chaotic in her presentation.

Calm at times, frustrated at other times, argumentative,

tearful and laughing loudly.

Sleep hasn't been good at all, so this morning we are kind of seeing

a continuation of this behaviour, really.

And her mood, is that predominantly high, low?

-It's more high than low.

-Right.

But she set off the fire alarms,

then she was holding Libby in a sling.

She phoned the fire brigade to tell them it was a false alarm.

She was in the blaring noise right by the alarms,

not aware of Libby's needs or concerns.

I haven't seen it before.

I don't know she is actually aware that she has become unwell.

While Libby is being cared for in the nursery,

Dr Gregoire wants to assess Jenny for himself.

So, how are things with you?

Absolutely tiptop.

-20/20, Tinker Tailor Soldier Spy.

-Right.

I scream in the night.

Have you heard that before?

I have not heard you say that before, no.

I scream...

-Ice cream.

-Mm.

-You're playing on words quite a lot, aren't you?

-Yes.

Are you enjoying that?

It's very tiring. You have to have a lot of water to do that.

Is your mind just doing that even

-when you are not particularly trying to?

-No.

Are your thoughts jumping around a bit?

-I am mad as a box of frogs.

-Right.

-Do you think you are not so well at the moment?

-I think...

-Seriously.

-Tout le monde est un peu fou.

-Tout le monde est quoi?

-Un peu fou.

-Un peu fou, oui.

-Oui. C'est ca. C'est vrai?

Yeah, I think there's some truth in that. Everybody is a bit mad.

-Je peux parler le francais un peu.

-Tres bien.

-Merci.

You want to know what is going on in my head

-and I want to know what is going on in your head.

-Yeah. Do you?

That's actually what it is, yes.

And I want to rip off that disguise because it doesn't fool any of us.

HE LAUGHS

-You are Hercule Poirot.

-No, but I will continue to hide behind it.

I suspect that you think you're not that well at the moment.

-Would that be right?

-Tiptop.

Which kind of means, "I'm very well,"

but I suspect you're not completely convinced by that.

Would that be fair to say?

-Tick tock.

-Mm-hmm.

Tick tock.

-I would like to lie down and go to sleep right now.

-OK.

-Everybody out.

I will leave you in peace, but can I just say,

what I would like to do is just increase the quetiapine dose.

-Above 800?

-Which is above the 800.

That is a challenge. How high can we go?

Well, that's always difficult, but we can certainly go to 900.

-Up to 1,000 probably won't kill me.

-But it may be that it works for you.

-Yeah.

-No, I'm sure it won't. We can keep an eye on you.

We will do, say, an ECG just to check

that your heart is OK and so on.

-So I become...

-A little bit of extra checking.

..a rat.

No, you don't, or the guinea pig, but you are an individual

-and some people...

-Or a chimpanzee.

-It is not an experiment.

-It is an experiment.

I think it is too risky to leave it.

I think you need to have some more mood stabiliser.

-I think I need to have a lot more sleep.

-OK.

Well, shall we go for both?

-Yes.

-OK. And let's see what happens over the next few days.

So it is kind of a compromise.

I'm not saying a huge increase, a small increase...

I'll only do it if it's a game,

because I am fed up of being in this place.

You play your bit, I'll play my bit

-and we might both win.

-Yes.

-Good to talk to you.

-Great to talk to you. We have made a deal.

-We have made a deal.

-Gentlemen's agreement.

Well, poor Jenny is having a really tough time at the moment.

Her thinking is all over the place, I think is the most striking thing.

She is manic, I think she probably is psychotic.

-I will bow down to you, because...

-Don't do that!

It's in my culture.

I will bow down to you, because you are giving me a way out.

-That's the point.

-OK.

-You are my brother.

-Let's get it sorted out.

-Kindred spirits.

-Yeah.

I am surprised that she has become ill again, returned into a state

of illness so quickly after getting better so substantially.

She wasn't fully better but she was well on the road to recovery.

She seems to me more unwell than she was in the first episode.

-She is more unwell.

-I find that... I don't understand.

And yet she definitely improved on this medication regime.

He just said that she is very subtle,

the way she takes her medication.

-You might think that she swallows but she doesn't.

-Henry said?

He says it is just something we have got to be mindful of

when we give it to her.

I am a little bit quizzical about why it has happened and there are

a number of avenues we need to check, and a kind of obvious one is

whether the individual, whether Jenny,

has actually been taking her medication exactly as she was

meant to because if she were, that makes this...

..this relapse even more surprising.

Good God. Whoo! I might be Prime Minister by the end of the day.

Dr Gregoire and his team are also concerned that Hannah's condition

is continuing to deteriorate.

So, this is Hannah's words for her weekly review with you.

"Things have stayed the same the past week -

"anxiety and dark thoughts.

"Things that have got worse and have started to trouble me

"in the first week - the intensity of the dark thoughts

"when they do come." I've got a quote here saying,

"Just wanted to go to sleep and never wake up.

"Struggling, hopeless.

"Hopelessness."

She had to be sedated last night to sleep because she was very,

very anxious and really had dark thoughts,

which were really tormenting her.

She was high risk yesterday and again today

and so they very discreetly place a chair outside of her room.

She has a nurse one on one just sitting, observing,

waiting for her to move and if she moves, they move with her,

so she is not actually left to her own devices

and she is never vulnerable and on her own.

Just everything seemed bleak

and we would be better off without her, and she would be better off

not here and Esther would be better off without her.

It is extremely rare that we come across women who might pose

a risk of physically harming their infants.

It is extraordinary that even though Hannah is very, very ill,

suffering gruesomely,

her ability to squeeze the last bit of determination

out of herself in order to give some care to Esther is still there,

that she is still able to do that.

To be aware of when she can't so that she is asking for help

from members of staff -

and that's what we are here for, to help her with that.

A few weeks later, Hannah's condition becomes critical.

I received a call from a member of staff called Sam at the unit,

picked up the phone and heard Sam's voice

and I just thought the worst.

She had obviously got so desperate she realised that she needed

something that was actually going to do the job properly,

and that was when she broke a jar of Esther's food

and used the glass to cut her neck and her arm.

And was really lucky she didn't end her life because she was

so close to hitting major vessels,

which would have been the end.

Most counsellors... People want to live.

Even though they are suffering, they want to keep living.

It is really not until the suffering is unimaginably gruesome

and hopeless that they want to die.

People with these severe mental illnesses, even though

we, the doctors, are telling them that they will get better,

they are in such depth of suffering that the idea of living

is impossible for them.

I was just desperate to see her better.

When someone is not responding to treatment

and there doesn't seem to be any way out and you just see them

struggling day after day after day, you think something has got to give.

There has got to be something which is going to have an effect.

We were increasing her medications,

adding new medications,

changing medications.

We had been doing all the psychotherapies

and psychological approaches to treatment that we

have at our disposal, but despite all of that, she had reached

a point where this was dangerous.

I knew that the most effective treatment

to get her better quickly and actually,

if we are honest about it, save her life, was ECT.

This is a treatment that has a lot of stigma attached to it.

It is actually extremely safe, not in the least bit barbaric.

The reality of this treatment is that we know it is the most

effective treatment and the fastest treatment for severe depression.

I was very much against ECT.

I couldn't accept ECT has a...

..accepted treatment, really,

because there was no explanation as to how it actually works.

-How are you feeling today?

-All right, thank you.

-Have you noticed any improvement?

-Yes.

I didn't want her to have it and I expressed it in verbal form

as well as written form to Dr Gregoire.

But Hannah said to us,

"I can't go on like this and if it means that there is a chance

"that ECT will help, then I have given consent already."

All right, a little bit of fresh air to breathe.

Just take some nice, deep breaths.

Hannah is having a series of sessions of ECT.

She is anaesthetised first

and feels no pain as the treatment is given.

REGULAR BEEPS

OK, testing.

It's good. And treat.

PROLONGED BEEP

23.

-DR GREGOIRE:

-Just as with an electric shock

that we use for shocking the heart when that is not working properly,

this electric shock is delivered in a very controlled way.

But the electricity causes a seizure.

It is very like an epileptic seizure

and it is this element of the treatment that seems to be

the bit that is effective in treating the depression.

Now there is some hope.

Only 20 minutes later, Hannah is waking up.

-Can you balance?

-Yeah.

I sometimes have a headache

-and if I now have a headache I have a jaw ache.

-Yeah.

-Is that after each treatment?

-Mm-hmm.

It's difficult, really, because it often feels quite surreal.

Erm...

-I just want to be better for my daughter.

-Yeah.

She is precious.

I am really nervous right now about going in to see Jenny,

which is a horrible feeling because, you know,

in any other circumstance I just wouldn't be able to imagine

being nervous going to see my own wife.

Staff have called Henry to the unit as Jenny's condition is much worse.

ALARM WAILS

That sounds like the fire alarm going off again.

I wonder if that isn't Jenny setting off the fire alarm again?

She did that yesterday and she has a pattern of doing that

because when she is ill she has a tendency to think about any

means of getting out of the building.

Jenny was really, really unwell.

It was really horrible to see.

Very disordered and sort of chaotic.

It was quite hard to spend any more than a few seconds with her

and obviously not able to settle with her mind on one

particular thing, and getting increasingly bizarre.

Half the time I really didn't have any idea what she was talking about.

So it was pretty hard, and then just now she started running up

and down the corridor and was very loud

and I just couldn't get away quick enough, really.

It was really hard to be there.

Staff have begun to notice that Jenny is not taking her medication.

I think it was first noticed when Jenny was taking her liquid

medication with water and was spitting it back out into the water.

She had suspected she didn't need it because she wasn't ill,

but also that it might potentially harm her.

So if that is what you believe,

I can well understand that you wouldn't take it.

I know for sure that she really needs this medication in order

to get better and get back to her normal self.

If our mums become sort of quite acutely unwell,

if they are posing any kind of danger to other babies on the unit

or other mums on the unit, sometimes it is not appropriate for us

to keep them here just in terms of safety.

So we have had instances where we have had to unfortunately

have some of our ladies transferred to more of an acute adult unit.

Babies can't go there,

so that would mean they would have to be separated,

which in terms of their recovery

is quite a setback in terms of bonding with baby.

They are really throwing everything they can at it...

at the situation, and doing everything they can for Jenny.

I just hope that that is enough to keep her here, really.

BABY GURGLES

Over the next ten days, Jenny's behaviour becomes too

difficult for the staff on the mother and baby unit to manage.

She is now sectioned in a high-security psychiatric

intensive care unit 100 miles away.

Having Libby at home has been the most amazing silver lining

in this horrible dark cloud.

It is really weird that simultaneously you can have

such joy at getting to know your daughter

and also such misery at seeing your wife in such a horrible place.

Jenny at the moment is so ill that the unit she's in

has advised Henry not to visit her.

It feels like we are really as... probably as separated

as we have ever been in 15 years of being married.

And I don't know how long that is going to last.

I think what I really miss about Jenny is being able to have

conversations with her about stuff that crops up -

news from friends, decisions that I have had to make about her care

or about Libby's care,

where I have intuitively thought, "Well, when I talk to Jenny

"about it, we'll decide," and then I remember that I won't be

able to talk to Jenny about it for probably quite some time.

So I think that is the hardest,

apart from just the day to day, you know, not having

her around the house and not having my closest companion around.

Just give me a moment.

Hannah is back on the unit after another ECT session.

-How was the ECT this morning?

-Yeah, it was all right.

Even compared to yesterday, you seem much better to me.

I anticipate with Hannah that she will get substantially better

from this episode of illness.

She is now dealing with the realisation

of quite how ill she was, of how suicidal she was.

The dark periods are so dark that you just don't get a choice.

Every time I wake up I kind of hope that it is just a nightmare,

but that is my constant physical reminder.

I don't want it to be a reminder of a nightmare,

I want to turn it into something beautiful,

so I am hoping in time to maybe have a tattoo

with a verse, a biblical verse.

And it is Jeremiah 29:11, and it talks about having a purpose

and a plan for your life and that that will bring hope.

I guess I was lucky that I do have a future

and I have a baby who has been my focus throughout this,

I'm so glad that I am beating the illness now

and it is not beating me.

"How could I be like that?"

And of course the answer is that it isn't her.

Just like if you can't walk properly when your leg is broken

you don't say, "Well, I'm a person who can't walk properly,"

you say, "At the moment I can't walk properly because my leg is broken

"and it is the broken leg that's causing that, not me as a person."

And of course, that applies to everybody around her

and indeed the whole of society.

You know, we need to have compassion and understanding

and blame these nasty illnesses,

not the poor unfortunate people who bravely have to live through them.

You had another one this morning. How are things today?

I am feeling better. I have not had any dark thoughts today.

And I'm feeling more in control.

I think that is the bit that it has given me, is control back.

I feel like my memories have actually improved,

which I wasn't expecting.

You can get a bit of memory loss with ECT,

but the memory loss from severe depression is dramatic,

and because we are treating the severe depression effectively now,

what you describe doesn't surprise me that much.

I would predict the improvement will continue.

We'll keep at it and you will get better.

I actually believe that now.

-Well, that's a big change.

-I didn't believe that.

That's a big change!

-Right, you can see yourself getting fully recovered.

-Yeah.

-That has changed even from yesterday.

-Wow, that's fantastic.

And I can see that I am actually doing a good job with Esther

-and that is new...

-Fantastic!

..because I constantly worried that I wasn't doing enough.

I want to start to take some more pride in my appearance again,

so, like, have my eyebrows done, have my hair cut.

That's really good as well. That is nice.

And cuddle the baby.

After a month being treated away from the mother and baby unit,

Jenny is well enough to come back and be reunited with baby Libby.

There she is. There she is!

When she arrived back it took quite a while for us

to see any improvement.

Erm...

But she is getting there now.

And I guess over the last probably ten days or so,

she has got a lot better.

Hello. Hello.

Hello.

After four months of treatment,

three times longer than average, Jenny is finally turning a corner.

There have been lots of times over the last 18, 19 weeks

when I have really not looked forward to coming in at all

because it has been too upsetting.

So it is nice to be able to be a bit more positive about it.

I just remember the times when I wasn't with her

and feeling really empty at not having either child with me.

And I was on a unit which wasn't a specialist unit, so I wasn't

with other mothers and it was an experience that was quite isolating.

It was a relief to get back here

and this more like normal life for me,

to have a baby to look after.

Within a couple of days I had her back in a cot in my room

and that was really good.

That was really positive, to have worked towards that again

because it's so nice to wake up in the morning to her little noises

and to be able to give her that first feed.

Hello. Hello!

You are doing really well with this meal.

Yeah, are you enjoying that?

Hey, babes.

Nice to see you.

Jenny's improvement came with the help of an intensified

programme of medication which she is now agreeing to take.

But also key to her recovery is rebuilding her bond with Libby.

We videoed you and Libby together

and now we are going to look back at it together.

So, what do you think you are going to see?

-Probably less eye contact than I'm expecting.

-Right, OK.

I think I tended to focus on giving her what

she needs in terms of her, sort of, physical requirements

and maybe less in terms of emotional stuff and bonding.

Well, that's really interesting you have said that

because I have had a look at the video

-and I have picked a moment that I would like to show you.

-OK.

LIBBY SQUEALS

JENNY SQUEALS

You do a fantastic job, though, of copying her.

Yeah.

THEY SQUEAL

What is happening right now between the two of you?

-We are having a little conversation again.

-You are!

-She is doing more noises and I am trying to copy all her noises.

-Yeah.

So, what did she do it just then? Did you notice?

Yes, she turned to look at me because I moved down to her

-and she could see me.

-Yeah.

So, is that a surprise for you, given what you said a minute ago?

-Yeah, it is, actually. I didn't realise that I was doing that.

-Mm.

It has given me a bit more confidence to keep trying

the things that I would naturally do and also shows me that instinctively

there are things that I am doing that are, you know, positive things.

And normal parent things as well.

Libby! Hello, hello.

Hello!

# Five little ducks went swimming one day

# Over the hill and far away

# Mummy duck said... #

HE IMITATES A DUCK

THEY LAUGH

I am hoping for Jenny to return to herself

and I think today is the best I have seen her

since she first came in around three or four months ago.

# Only three little ducks came back. #

Things are improving, but I am still very aware of it

every time I talk to her. There is still quite a way to go.

It is like the very first bit of spring,

when you start seeing bulbs coming up.

There is a bit of hope that things are going to get better

and there's lots of stuff to look forward to.

Good girl.

Good little girl. You had a busy day today, had some time with Daddy.

And now it's time to go to sleep.

Good girl.

-BABY CRIES

-It's coming.

Dr Gregoire is confident that Hannah is now recovered from her episode

of illness, so she has been fully discharged from the unit.

It is her first day back at home.

It does feel amazing, just to be at home.

Because there was times when I was ill when I wondered

if I would ever be able to get home.

Mummy loves you.

It was lovely yesterday, when you said, "Mum, Mum, Mum, Mum, Mum."

I don't know whether she did actually say Mum.

Are you sure it wasn't a figment of your imagination?

You had just had ECT.

-SHE LAUGHS

-No, she definitely did.

Dr Gregoire had said that he felt 11 ECTs would be enough for me,

so the rest will be medication

and just rebuilding my confidence at home.

They are going to support me over the next six months to a year

and they're just making sure that obviously I have no slips back.

Right now it feels really different.

It feels like I am actually going to be able to enjoy

watching my daughter grow up.

I really thought I would lose friends.

I was so embarrassed, I was scared, I was shocked, and I thought

life was quite fulfilling before, so, yeah, I'm excited.

And there's a little lady in the mix as well.

It just feels...

I don't know, it feels like a fresh start for me.