‘Mums are dying and it’s so preventable’

Family handout Image of a woman cuddling a sleeping baby. She has her hair tied back, is wearing a roll neck jumper and is smiling. She has her faced pressed against the baby's, which has its eyes closed. The baby is wearing a dark coloured jumper and has very chubby cheeks.Family handout
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Lucy took her own life after suffering from postnatal depression

Lucy will never again dance with her three-year-old daughter or hold her 12-month-old baby boy. She died by suicide in September this year after suffering from postnatal depression and psychosis.

Her family say she was failed by mental health services. It was the second time Lucy suffered with the condition, but she had no extra support in her second pregnancy.

They are calling on the government to end what they say is a postcode lottery of perinatal mental health care.

‘It’s like a living nightmare’

Lucy died on 23 September after going missing from a psychiatric unit in Scarborough where she had been staying as a voluntary inpatient.

After hours of searching with mountain rescue, her sister Faye was told that the “bubbly, caring and brilliant mum” had taken her own life.

“I just howled. It was unbelievable. It’s like a living nightmare for the whole family,” Faye said. “Her three-year-old is still asking when mummy is coming home and pointing to mummy’s side of the bed.”

But Lucy’s death was not out of the blue.

Family handout A woman holding a toddler in a garden. She has brown hair tied back and is wearing sunglasses and a grey vest top, and is smiling at the camera. The child has blonde curly hair and their face has been blurred out. There is grass and a green hedge behind them.Family handout

Lucy’s family noticed a big change in her behaviour after her daughter’s birth

Lucy started suffering from postnatal depression when her first baby turned three months old.

“She changed massively. A dark cloud came over her and took all of the life out of her,” Faye said.

“Any joy that she took from life was just gone. Her anxiety went through the roof. Her depression was horrendous. The insomnia and fatigue – it took over her life.”

A woman sitting on a sofa looking at the camera. She has straight blonde hair and is wearing pearl earrings and a dark blue cable knit jumper. The sofa is cream coloured with a dark blue throw over the back and there is a door in the background.

Faye says postnatal depression robbed her sister of her any joy

Her parents moved Lucy and the baby into their home, she was prescribed antidepressants and at around the time her daughter turned one she began to recover.

“We had Lucy back and she was marvellous”, said her mum Ann.

Lucy told her family she did not recognise the person she was while she was suffering with the depression.

Family handout A woman sitting on a bench with her arms around two small children. She has brown hair and is wearing a pink t-shire, grey cardigan and blue jeans, and is smiling at the camera. The children both have blonde hair and their faces have been blurred out. One is holding a takeaway coffee cup.Family handout

Lucy was an “amazing mum” to her two children, her family said

When Lucy fell pregnant with her second baby in 2023, her family were shocked to discover no extra support was provided.

“I assumed there would be more wraparound care, knowing she had depression with her first. But no extra support or care was offered”, Faye said.

After the birth of her son, the first three months were brilliant, her family say.

“She was an amazing mum. So creative. She did everything for her kids”, Faye added.

But again, the depression hit when her baby was three months old, and despite the best efforts of her family they said this time round it was even worse.

“We were floundering. We needed help as well. We gave her the medication and it was constantly being changed. It wasn’t working,” Ann said.

A man and a woman sit looking into the camera. The woman has short grey hair and is wearing a gold necklace and a black top with purple, yellow and red flowers on it. The man is balding with short white hair at the sides and a white goatee beard. He is wearing a blue striped polo shirt. Behind them is a plant, and a wooden cabinet with crockery on display.

Lucy’s parents Ann and David moved her and the children in while she was suffering from postnatal depression

Lucy started talking seriously about taking her own life, and her husband contacted the crisis mental health team.

She received some counselling and home visits, and she was then referred to the perinatal team which provided weekly counselling sessions

But staff sickness meant face-to-face sessions were replaced with phone calls and her condition deteriorated.

In August she made an attempt on her life. She also started hearing voices, a sign of psychosis that can result from severe postnatal depression.

Family handout A man and a woman sitting on a sofa with two children. The man has dark hair with a receding hairline and a dark beard. He is smiling at the camera and has his arms around a toddler who has their face blurred. The woman is looking down at a sleeping baby in her arms.Family handout

The family feel warning signs were missed, despite the involvement of mental health services

“We were all absolutely terrified at this point. We were so lost and scared about how we could support her knowing what she had done”, Faye said.

Lucy was admitted to a psychiatric unit on a voluntary basis, which meant she could come and go freely.

She was offered the option of finding a bed in a mother and baby unit but turned it down, which Faye feels was a warning sign.

“She should have been sectioned and sent to a mother and baby unit automatically,” she said.

“If the mother doesn’t feel like they want to be with their baby, there should be alarm bells ringing.”

Eight days before she died, in her hospital journal, Lucy wrote “help me”.

Family handout A page of a lined notebook. At the top it says 'Journal prompt: What specific situations or thoughts trigger your anxiety, and why?'. Underneath are scrawled the words 'Help Me' and 'Lucy' in black biroFamily handout

Lucy had been keeping a journal while in hospital

On the day Lucy died her mum visited her in hospital and took her out for lunch. It was the last time she saw her daughter alive – Lucy never returned to to the hospital, or home to her babies.

“No child should ever have to ask why their mummy isn’t coming home. No husband should be without their wife. And no parents should have to bury their daughter for something that is so treatable,” Faye said.

Family handout A woman sitting in a chair outside feeding a baby from a bottle. She had dark hair tied back and is wearing sunglasses, a blue coat with a light purple fleece underneath, and dark blue trousers. The baby is wearing a bright blue padded romper suit and bright blue woolly hat. There is a brick wall behind them.Family handout

Pictures drawn by Lucy’s daughter were placed on her coffin

Lucy’s death is part of a bigger picture.

The postcode lottery of perinatal services is stark. Yet one in 10 women suffer from postnatal depression according to the NHS.

Research from the Maternal Mental Health Alliance (MMHA) reveals North Yorkshire, where Lucy lived, did not meet the care quality standards for perinatal care set by the Royal College of Psychiatrists 2023.

The orange sections of the map highlight the areas where staffing and services fall short.

Maternal Mental Health Alliance A map of England showing some counties coloured in green and others coloured in orange, depending on what level of perinatal mental health care is providedMaternal Mental Health Alliance

Maternal Mental Health Alliance map of perinatal mental health provision

Karen Middleton, head of policy at MMHA, says mums are being failed by the lack of consistent maternal mental health care.

“Maternal mental health isn’t fully understood and has been historically under-invested,” she said.

“We need to raise awareness so commissioners and managers at the local level provide sustainable funding that is based on the levels of need in their area.”

Maternal suicide is the leading cause of direct death for mums when babies are between six weeks and one year old, according to the latest Saving Lives, Improving Mothers’ Care (SLIMC) report.

This remains unchanged since 2009.

Care under review

A spokesperson for Tees, Esk and Wear Valleys NHS Foundation Trust said: “We are looking closely at the care Lucy received from us and, in keeping with national guidance, we will establish if there is anything different we could have done to prevent Lucy’s death.

“We will support Lucy’s family through this process as their involvement is incredibly important.”

A spokesperson for NHS Humber and North Yorkshire Integrated Care Board (ICB) expressed their condolences to Lucy’s family and friends, and said it would “not be appropriate” to comment further while a review is under way.

The Department for Health and social care said it was “unacceptable” that anyone should feel let down by maternity support services.

“Specialist perinatal mental health services are established in all parts of England, but we know more is needed,” a spokesperson said.

“Too many people with mental health issues, including mothers who have recently given birth, are not getting the support or care they need.

“That’s why we’re reforming the Mental Health Act to fix the broken system and give more people greater say over their care.”

Family handout A woman in a park with two children. She has dark hair and is wearing sunglasses, a blue and white striped top, and blue trousers. The woman is standing in front of a buggy - there is a child standing on the back of the buggy who has blonde hair and is wearing a blue and white striped top and a pink skirt. Her face is blurred out. Sitting in the buggy is a toddler whose face is also blurred. Behind them is trees and grass.Family handout

Lucy’s family are now campaigning for better support for other women

Lucy’s family say she was a victim of the system. But they are determined to fight for change.

“Mummies are dying and it’s something so preventable. We’ve got a baby and three-year-old growing up without their mummy,” Faye said.

“We need to save the mummies.”

If you have been affected by any of the issues raised in this story, you can visit the BBC Action Line.

You can also email yorkslincsinvestigations@bbc.co.uk to share your experiences.

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