The Community Counselling Centre of Nipissing, in partnership with the Thunder Bay Counselling Centre and the B’saanibamaadsiwin Aboriginal Mental Health Program is pleased to present the Northern Ontario Postpartum Mood Disorders Strategy. Through a grant from the Ontario Trillium Foundation and the support of the North East Local Health Integration Network the Northern Ontario PPMD Strategy was developed in 2014/ 2015.
Through the consultation of Project Director Linda Rankin and Community Development Coordinator Jennifer Gordon communities across Northern Ontario came together to create this innovative Strategy. Health and allied care providers, community members and women and families with lived experience have all given voice to a Strategy that presents a greater awareness of PPMD and the needs of families suffering from this mental illness in Ontario’s North.
This Strategy reflects the voices of eight different Steering Committees including members from the Northwest, Algoma region, Timimins and district, Sudbury and District, Timiskaming, Nipissing, Muskoka, Parry Sound, and membership from Northern Ontario First Nations.
Please be advised that this video depicts the true nature of those who have experienced postpartum mood disorder and may not be appropriate for all audiences.
The Postpartum Mood Disorder Project is working to address the lack of comprehensive parental mental health services available in Northern Ontario.
PPMD carries with it the burden of shame, stigma and silence that further complicates the already complex.
More serious than the Baby Blues, postpartum mood disorders (PPMDs) are a mental health issue resulting from physical and emotional adjustment difficulties after the birth or adoption of a child. The arrival of a child can trigger powerful emotions including joy, excitement, sadness, anxiety and depression. PPMDs are often experienced in silence and carry a burden of shame that may prevent families from accessing services where they exist.
In addition, many parents face the stigma that having a PPMD is a character flaw or weakness. PPMDs often involve mood changes, irritability, insomnia, obsessive thoughts, changes in appetite, crying, anger, anxiety, relationship challenges, feelings of worthlessness and loss of interest in pleasure.
"Letting the people that are closest to you know what is happening, is the first step in reaching out. Connections with the right people can greatly impact your journey.” - Michelle
The Northern Ontario PPMD Project estimates that PPMDs effect over 3500 families in Northern Ontario annually. The implications for a lack of awareness, diagnosis and treatment for this disorder can have profound effects on mothers, fathers, infants, partners and the entire family.
At this time, within the province of Ontario, there is no coordinated comprehensive service delivery model for families suffering with PPMD. This mental illness affects the physical and mental health of the parents and the child as well as aspects of child development and infant parent attachment. The complex nature of this illness necessitates a strategic comprehensive response, rather than the postal code lotteries where sporadic services exist and a family’s place of residence determines their access to service. Our project, through the creation of a Northern Ontario Postpartum Mood Disorder Strategy, begins to address this inequality that is resulting in too many families suffering unnecessarily.
What are PPMDs?
Postpartum Mood Disorders can occur during pregnancy and up to the first year post partum. Symptoms of PPMDs can range from mild to severe and include: anxiety, irritability, worry, inability to sleep, concentrate or made decisions, uncontrollable crying, loss of interest or pleasure, change in appetite, exhaustion and may include a fear of harming oneself or child.
Postpartum Mood Disorders are very commonly misunderstood. The shame, stigma and misunderstanding of PPMDs have been consistently reported by the families and professionals working with the Northern Ontario Postpartum Mood Disorder Project. The families with lived experience who have advised the PPMD Project have described the challenges they faced identifying the issue, asking for help and accessing services. Stigma and shame contribute to parents worry, lack of confidence and fear of what may happen if they disclose what they are experiencing, thinking or feeling.
What PPMDs are Not
PPMDs may be confused with postpartum blues which occur after the birth of a child and can affect up to 75% of mothers. Postpartum blues last approximately 10 days. With postpartum blues mothers tend to exhibit symptoms such as crying, fatigue, irritability and anxiety, but unlike PPMD, postpartum blues does not typically require formal intervention. Confusing a PPMD for postpartum blues may lead both professionals and parents to minimize the illness or leave it unidentified.
Early intervention and treatment of PPMD can help to prevent the adverse effects on mothers, children and families, and help to minimize the chances of intergenerational transmission. Recently researchers have demonstrated the importance of a systematic response to perinatal mental health and its impact on child development. Interventions should focus on developing partnerships between adult and pediatric providers and should also focus on the parents, the infant and the parent child dyad while concurrently addressing the bio-psycho-social nature of the issue. Looking toward global trends, in 2011 New Zealand’s Ministry of Health promoted a bio-psycho-social model of care within its’ Health Beginnings guidelines and is advocating for a concurrent model of care for PPMD.
THE PROCESS
From April 2014 to March 2015 the Northern Ontario PPMD Project worked collaboratively with over 60 different organizations and communities.
These Project partners included health and allied care providers and families with lived experience from urban, rural and First Nation communities. Together we built a strategy that presents a greater awareness of PPMD and the needs of families suffering from this mental illness in Northern Ontario
Steering Committees
Eight different Steering Committees participated in the Northern Ontario PPMD Project. Made up of service providers and women with lived experience the Steering Committee members provided in kind donations of time and expertise to inform the Northern Ontario Strategy. In addition, members assisted in the recruitment of women and families with lived experience to participate in the videos and Photovoice project.
Over the course of the project each Steering Committee completed a service map of PPMD for their area, they discussed the challenges and strengths of their district serving families and made recommendations for the challenges they face.
Each Steering Committee operated with two goals in mind:
to inform the Northern Ontario PPMD Strategy.
to expand and enhance community collaboration to create sustainable, culturally safe and innovative ways of working together on the issue of PPMD.
Photovoice is a group method that adopts a grassroots approach to social change. This method was originally developed by Carol Wang and Mary Ann Burris in 1993 and has been used worldwide to reduce stigma, provide a venue for self-representation and self-expression, to empower, to signal hope and for communities to engage in change.
Women who have experienced PPMD are the experts in their recovery and journey. Five participants met electronically, and in person, to complete the PPMD Photovoice. Read more
Over the course of five to six weeks they took pictures, shared their photos with each other, discussed their experiences and made recommendations for change. We have learned so much from these expert participants.
Their photos provide answers to the questions:
When did you know?
How did you know?
What helped you?
What would you like others to learn from your experience?
The photos illustrate the shame, stigma, isolation and fear that exists for families who experience PPMDs. They illustrate how PPMDs can impact relationships, how misunderstood and hidden these feelings and experiences can be.
All families have the right to receive culturally safe services with respect and compassion and to be heard when they reach out for help. This has not been the common experience of our expert participants. By bravely sharing their wisdom we have the opportunity to learn and to make change.
Read less
The first priority of this project is to make Post Martum Mood Disorders a priority. The implications for a lack of awareness, diagnosis and treatment for this mental illness can have profound effects on the entire family.
a. Postpartum mood disorder informed service provision
b. Postpartum mood disorder menu of services for families (considering infant child development in all future services).
Mothers who have had postpartum mood disorders report experiencing:
• Difficulty sleeping and eating
• Feeling lonely
• Irritability and frustration
• Feelings of guilt
• Tearfulness
• Feeling anxious and having panic attacks
• Constant worry
• Confusion
• Exhaustion
• Loss of joy
• Withdrawing from others
• Feeling like they are not bonding with their baby
If you have been experiencing any of these symptoms contact your local health card provider for more information. It is important to remember that you are not to blame for how you are feeling and you are not alone.
Mothers who had experienced postpartum mood disorders tell us there are things they did that were helpful such as:
• asking for help
• talking to their doctor or nurse practitioner
• going to counselling
• getting out and attending Child and Family Centres
• talking to others about their experiences
• exercising
• drinking more water
• eating well
• limiting caffeine
• doing something for themselves each day
• challenging their own thoughts on being a “perfect” mother
Rarely, women may experience a postpartum psychosis. This is a medical emergency.
If you have:
• had thought of harming your baby or yourself
• hear or see things that are not there
• believe people or things are going to harm you or your baby
• feel confused and out of touch with reality
Get help right away. Go to the Crisis Intervention Program at your local hospital.
It is important to remember that not only mothers are affected by mood changes during and after pregnancy. Fathers and adoptive parents can also experience postpartum depression.
Partners, friends and family can play a key role in helping a mother who is experiencing postpartum depression.
They can,
• ask her what she needs and fulfill those requests
• listen and support her
• help her understand it’s not her fault
• encourage her to access help
• spend time with your baby
• take care of yourself
• be patient
For further information please contact the Community Counselling Centre of Nipissing
at 1-888-814-3327
Support for the Postpartum Mood Disorder Project has been
provided by a grant from the Ontario Trillium Foundation and Wasauksing First Nation Health Services
Family Tree
“I was addicted to substances before, during, and after my pregnancy. Throughout that time, I distanced myself from my family. I felt ashamed of who I became. What I should have done was ask them for help. I needed my family. I needed to know that I was loved and cared about by the ones who were there for me my whole life. I am the trunk of this tree and am surrounded by a loving and caring family, the leaves.”
“What is supposed to be the best days of my life, having this child, became a world of loneliness for me. This waterfall represents the overwhelming feelings and emotions I was experiencing after I had my son.”
"I self medicated throughout my symptoms of postpartum.
The rocks in this picture represent the unstableness of my life. The fog depicts the unrealistic and unclear thoughts I had."
"Like the foggy coffee cup in the picture, I knew that things were not normal when I was just going through life in a fog. After my baby was born I did not feel the immense joy, or the immediate connection, that mothers were supposed to feel. I just felt empty, literally because he was no longer safe inside my womb, and symbolically because I felt no real emotions. I felt as though this new being had completely drained me of energy, emotions, and any real sense of being."
"As Mothers and a Women we have so many expectations imposed upon us. I tell myself that women have been having babies for thousands of years and that my instincts should therefore be enough to get me through motherhood, but I can’t shut out all the voices that are telling me different. I constantly look to others, books, and the internet, to tell me how to take care of my little one. I often get answers that I don’t want to hear and responses that just fuel my anxiety further. Constantly looking outward for approval for my mothering efforts only created more chaos and more stress in my life. If only I could have Shut Out Those Expectations, I know I could be a better mother to my son."
"Relationships can be a battle while suffering with PPMD. PPMD is so hard to identify or explain. I knew that things were not right, but to explain it to someone else is not easy. Instead of explaining myself I would just explode my stress and anxiety on my husband or even my son. It became easier to just be angry and closed off to anything, rather than try and understand what I really needed. All my husband wanted to do was for me to tell him what I wanted him to do to help. He had so much compassion for me but I found it very hard to give that compassion back."
“So many people would tell me that things get better. But as I looked at them, exhausted from a baby who was very colicky and only slept an hour at a time, I could not see this. It is hard to acknowledge the “light” through the clouds when you are suffering with PPMD, but when those moments of light shine through you need to soak them up. It is those moments that keep me going.”
"I found out that I had PPMD when my child was 4 months old. I’ve used my children’s toys to shape the number four. This plays into the postpartum realization that something wasn’t right."
"My husband was the person I leaned on after having both kids, and going through this mood disorder. He was a great help to build my self-esteem back up again."
"Letting the people that are closest to you know what is happening, is the first step in reaching out. Connections with the right people can greatly impact your journey."
"I knew there was something different because I was blanketing my emotions in all directions and feeling guilty about my darkest thoughts. I was afraid of those thoughts falling into action.
I was embarrassed by these thoughts because as Anishnabekwe we are life givers and protectors of life. Why would I feel this way or have these thoughts?"
"More of a network would have improved my experience. I needed more of a safety net, more services, more transparent plans, overall more support.
The professional and medical service providers need to be more clear on safety plans, support services and referrals. They need to be more open to other options for care and support and provide appropriate follow up with the patient and their whole family."
Recently, researchers have argued the importance of recognizing the unique aspects of PPMD for fathers as these issues are linked to adverse implications for children, families and parental relationships. Fathers experiences of PPMD also result in a higher economic cost for this illness. Overall the issue of PPMD for fathers has received limited attention, and there are currently no programs in Ontario for routine screening or treatment of fathers for depression or anxiety during the postnatal or post adoption period.
During the transition to parenthood both mothers and fathers are transforming their relationship(s) within in the family and community. For fathers’ this transformation can bring unique stressors connected to expectations of self and perception of what society may expect of them. Stress in fathers has been shown to relate to dissatisfaction with the couple’s relationship and negative perceptions of parenthood. Recently researchers have shown that stressors for men most often include: (1) societies expectations; (2) low social support, (3) low self –esteem, (4) problem fatigue, (5) increasing family responsibility, including concern about the future; (6) a focus on financial provision, (7) demands of workplace and, (8) a reduced confidence in the relationship with co parent.
Postpartum Mood Disorder in the Indigenous Population
The colonization of Indigenous Peoples is widely accepted as an underlying determinant to mental and physical health. As a direct result of colonization, and the associated economic, political and social disadvantages resulting from systemic racism, Aboriginal People in Northern Ontario experience a higher rate of unemployment and poverty, more physical and mental illness, and lower levels of education than the general population.
Although exact rates of PPMD for Indigenous populations in Northern Ontario are unclear, it is reasonable to estimate that the prevalence rates may be significantly higher than estimates in other populations. A review of the literature revealed best practice guidelines including the concept of Cultural Safety in maternal, child and family care, for the development of interventions for Indigenous Peoples suffering from PPMD.
June Bond coined the term Post Adoption Depression in 1995 where she defined the issue as a mood disorder that includes depressive symptoms. Bond’s description of PAD emphasized the experiences of: (1) infertility, (2) a completion of a life goal and subsequent let down, (3) the unique stressors of the process of adoption, (4) loss of the birth experience, (5) loss of the ideal of the "dream child" and (6) the legal uncertainty that can accompany the post adoption period. Recently researchers have illustrated that adoptive parents experienced similar stressors to birth parents such as loss of sleep, less marital satisfaction, impact of colic, reflux and crying babies. Together these factors create a unique set of stressors for adoptive parents. Common risk factors may include: sleep or rest, self-esteem, relationship satisfaction, social support, history of depression and parental expectations.
When left untreated parental mental health concerns have implications for both parents and children. Postpartum Mood Disorders can impact children’s physical, social and psychological well being, this is called intergenerational transmission.
The economic and social burden of PPMD is immense. Canada currently spends less on mental health services than other developed countries. The bulk of these funds are invested in acute care. The MOHLTC Advisory Group for the 2010 Mental Health and Addiction Strategy has advised that in order to provide the needed supports and services, more investments need to be made in community-based services (Respect, Recovery and Resilience, 2010).
It is vital to understand the economic and social costs of PPMD and the ways it contributes to the overburdening of the social and health care systems in Ontario. Conservative estimates, which only measured the direct health care costs of untreated mood disorders in pregnancy alone, identify the figure to be about $20.5 million. As only half of all PPMDs are identified by health care providers, this estimated cost is no way reflective of the true cost of this illness.
In 2009-2010, there were 11721 babies born in the three LHIN areas that make up Northern Ontario. The Northern Ontario PPMD Project, using prevalence rates for both mothers and fathers, estimates over 3500 biological families in Northern Ontario impacted by this illness annually. Additionally, in the province of Ontario there are approximately 1600 adoptions annually. With prevalence rate of one in four adoptive families experiencing PAD we can add to the 3500 estimate the Northern Ontario families who have adopted children. Action needs to be taken now to address this significant community health issue.
It is vital to understand the economic and social costs of PPMD and the ways it contributes to the overburdening of the social and health care systems in Ontario. Conservative estimates, which only measured the direct health care costs of untreated mood disorders in pregnancy alone, identify the figure to be about $20.5 million. As only half of all PPMDs are identified by health care providers, this estimated cost is no way reflective of the true cost of this illness.
The first priority of this project is to make PPMD a priority. The implications for a lack of awareness, diagnosis and treatment for this mental illness can have profound effects on the entire family. We know that the economic and social impacts of this illness are substantial. These impacts contribute to the overburdening of the social and health care systems in Ontario.
Expected Results:
Reduce the social and economic impacts of this illness,
Reduce the stigma and shame that leads many families to suffer in silence.
PPMD informed communities require ongoing education and training to ensure the community is informed on the prevalence, risk factors, and identification and referral process to available resources for PPMD. Informed communities engage all members of the community including formal supports and social networks.
3. Funding Northern Ontario communities to provide culturally safe
a. Postpartum mood disorder informed service provision
b. Postpartum mood disorder menu of services for families (considering infant child development in all future services).
Funding dedicated to PPMD is necessary to the provision of a timely, comprehensive continuum of care in Northern Ontario. Consistent with the Ontario’s Ministry of Children and Youth Services direction to partner with the Ministry of Health and Long Term Care this Strategy recommends a partnership between ministries to provide funding for service provision.
Expected Results:
Infusion of funding for PPMD continuum of care
Increased awareness
Available screening for infant child development
Available menu of services to include children and families
Universal PPMD screening protocols for parents and children across Northern Ontario
Creation of Service Maps/ pathways for communities from across Northern Ontario
Design a treatment model based in best practice for Northern Ontario
Partnerships and collaboration to increase the access to services and decrease the barriers for families
Menu of services would include Screening, Admission, Assessment, Treatment, Supporting Recovery
The first priority of this project is to make PPMD a priority. The implications for a lack of awareness, diagnosis and treatment for this mental illness can have profound effects on the entire family. We know that the economic and social impacts of this illness are substantial. These impacts contribute to the overburdening of the social and health care systems in Ontario.
Expected Results:
Reduce the social and economic impacts of this illness,
Reduce the stigma and shame that leads many families to suffer in silence.
PPMD informed communities require ongoing education and training to ensure the community is informed on the prevalence, risk factors, and identification and referral process to available resources for PPMD. Informed communities engage all members of the community including formal supports and social networks.
Expected Results:
Reduce the stigma and the shame
Getting communities talking
Utilize best practice related to PPMD
Encouraging families to seek help
Encouraging professionals to identify & screen
3. Funding Northern Ontario communities to provide culturally safe
a. Postpartum mood disorder informed service provision
b. Postpartum mood disorder menu of services for families (considering infant child development in all future services).
Funding dedicated to PPMD is necessary to the provision of a timely, comprehensive continuum of care in Northern Ontario. Consistent with the Ontario’s Ministry of Children and Youth Services direction to partner with the Ministry of Health and Long Term Care this Strategy recommends a partnership between ministries to provide funding for service provision.
Expected Results:
Infusion of funding for PPMD continuum of care
Increased awareness
Available screening for infant child development
Available menu of services to include children and families
Universal PPMD screening protocols for parents and children across Northern Ontario
Creation of Service Maps/ pathways for communities from across Northern Ontario
Design a treatment model based in best practice for Northern Ontario
Partnerships and collaboration to increase the access to services and decrease the barriers for families
Menu of services would include Screening, Admission, Assessment, Treatment, Supporting Recovery
