What is a postpartum psychiatric emergency? There are three types of emergent situations:
- Risk of harm to self (suicidality)
- Risk of harm to others (homicidality)
- Inability to provide basic care for self (usually due to psychosis). Psychosis is associated with both suicidality and homicidal ideation toward the infant or others.
If you suspect that a mother is suicidal or homicidal:
- Do not leave the patient by herself or alone with baby until you can complete an assessment and plan for her safety!
- Explore suicidality with the Edinburgh Postnatal Depression Scale
- If the mother answers anything other than "never" to question 10 of the EPDS, use the format suggested in the Cox questionnaire (see page 27 and 28 of linked source) for further assessment
- Implement agency or practice guidelines for self-harm, suicidal or homicidal ideation; or access the Mental Health Services Locator for specific services in your area
- Discuss with the mother her willingness to engage in treatment planning that includes a safety plan
- Refer the mother for immediate mental health assessment
- Engage support system (discuss importance of involving partner, family)
- Document evidence in medical record
Suicide Prevention Hotlines:
If you believe a mother has postpartum psychosis: