About the author

My name is Veronica, and I am an MSc Occupational Therapy student currently completing an online placement with JBOT. I am also a mother with lived experience of postnatal psychosis following the birth of my child in 2020. Through my placement here, I have begun to understand my recovery in a new way, not only as a mental health experience, but as one that significantly affected my identity, routines, relationships, roles and participation in everyday life. I have written this blog to combine my personal experience with my developing professional understanding and to highlight the valuable role occupational therapy could play in supporting mothers recovering from postnatal psychosis. 

Introduction

Postnatal psychosis is often discussed from a medical and psychiatric perspective, but less often through the lens of occupation. This blog uses my lived experience of postnatal psychosis to reflect on how occupational therapy (OT) could have supported my recovery, identity, routines and participation after childbirth.

I am writing this from the perspective of an OT student, reflecting on my own experience with a developing understanding of occupation, mental health, motherhood and recovery. At the time, I did not have the language of occupational therapy to explain what was happening to me. I now recognise that postnatal psychosis did not only affect my mental health. It affected my daily life, confidence, routines, sense of self and ability to participate in the roles that mattered to me.

The NHS describes postpartum/ postnatal, psychosis as a serious mental health condition that can occur soon after giving birth. It should be treated as a medical emergency (NHS, n.d.). Medical and psychiatric support are essential during the acute stage. However, OT can add an important recovery-focused perspective by considering how the condition affects everyday occupations. These can include self-care, parenting, rest, home management, relationships, work and community participation.

My lived experience: when everyday life no longer felt safe

During my early postnatal period, I experienced hallucinations, intense anxiety and a persistent fear that either I or my baby would die. These experiences were frightening, confusing and overwhelming. At times, I deliberately resisted sleep because I believed that if I slept, I might die and leave my baby. Sleep, which should have been a restorative occupation, became associated with fear and perceived danger.

I also became suspicious of the medical team. I believed they wanted to harm me and take my baby away from me. Looking back, I now understand this mistrust as part of the distressing experience of postnatal psychosis. However, at the time, these beliefs felt very real and significantly affected my ability to accept support, rest or share caregiving responsibilities.

I also found it difficult to trust anyone else with my baby. I felt that only I could keep my baby safe. This meant I carried a heightened sense of responsibility and struggled to allow others to help, even when support was available. This increased my exhaustion and made it difficult to experience rest, reassurance or occupational balance.

Looking back, I can now see that this was not only a mental health crisis; it was also an occupational crisis. I felt trapped because I could not do things in the way I wanted or expected of myself. Before becoming unwell, work, productivity and keeping my home organised were meaningful parts of my identity. I hated feeling idle, but I could not go to work. I also found it difficult to tidy and manage the house in the way I usually valued. This created a sense of loss, frustration and reduced control.

Impact of Lockdown

The wider context of the 2020 COVID-19 lockdown also impacted my mental health and recovery. Lockdown reduced access to normal postnatal routines, informal family support, social contact and community participation. This increased my sense of isolation and limited opportunities for reassurance, rest, shared caregiving and connection with others. For me, the experience of postnatal psychosis was therefore shaped not only by symptoms, but also by environmental restrictions and changes in occupational participation.

Thinking like an occupational therapist

One of the most important things I am learning on placement is that OT is not just about what diagnosis a person has. It is about asking how that diagnosis affects what the person needs, wants or is expected to do. For this project, that shift in thinking is important.

An OT reading my experience might use clinical reasoning to ask:

• What occupations have been disrupted?
• Which routines no longer feel safe or manageable?
• What roles or parts of identity have been affected?
• What environmental factors are supporting or restricting recovery?
• What matters most to this mother?
• What would help her feel safe enough to rest, accept support and participate in daily life again?

This is where clinical reasoning becomes more than a professional phrase. It becomes a way of looking beyond symptoms and into everyday life. In my case, hallucinations, fear and mistrust were not only clinical symptoms. They affected my ability to sleep, trust support, care for my baby, manage the home, accept help and feel like myself. An OT approach would consider these areas as part of recovery.

Understanding the experience through an OT lens

Occupational therapy is concerned with how people engage in meaningful activities, roles and routines. RCOT explains that OTss help people overcome challenges in completing everyday occupations. OT’s also consider the relationship between what people do, the barriers they experience and the environments around them (RCOT, n.d.). In perinatal mental health, OT may support self-care, productivity, leisure, parenting occupations and mother-infant co-occupations, such as feeding, changing and playing with the baby (RCOT, n.d.; NHS England e-Learning for Healthcare, n.d.).

This is significant because recovery from postnatal psychosis is not only about the reduction of symptoms. For a mother, recovery may also involve rebuilding confidence in mothering occupations, re-establishing routines, reconnecting with identity, accepting support from others and feeling safe within everyday life again. An OT approach could have helped me understand that my difficulties with work, home management, trust, rest and parenting confidence were not personal failures. They were part of the wider occupational disruption caused by severe perinatal mental illness.

From an OT perspective, my refusal to sleep was not simply a symptom to be observed; it had a direct impact on occupational functioning, recovery and safety. Sleep is an essential occupation that supports physical, emotional and cognitive wellbeing. When sleep became associated with fear, my ability to recover, regulate emotions, trust others and participate in daily routines was further disrupted. This highlights why OT intervention in perinatal mental health should consider not only visible daily activities, but also rest, sleep, environment, trust, family support and the mother’s sense of safety.

Applying the Model of Human Occupation

The Model of Human Occupation, also known as MOHO, is useful for understanding my experience. MOHO considers how occupation is influenced by volition, habituation, performance capacity and environment (Taylor, 2017). Volition relates to motivation, values and belief in one’s ability. Habituation relates to habits, routines and roles. Performance capacity relates to the physical and mental abilities needed for skilled action. Environment includes the physical, social and cultural contexts that support or restrict occupation.

From a MOHO perspective, my volition was affected because fear, anxiety and hallucinations reduced my confidence and sense of control. Habituation was disrupted because my usual routines of work, home management, rest and self-care changed suddenly after birth. My performance capacity was affected by emotional distress, disturbed thinking, exhaustion and reduced ability to feel safe. My environment was also restricted by COVID-19 lockdown, which reduced access to social support, community spaces and normal postnatal routines.

Using MOHO, I can now understand that postnatal psychosis disrupted my occupational identity. I was not only trying to recover clinically; I was trying to become myself again. OT could have supported me to rebuild manageable routines, regain confidence in meaningful roles and gradually participate in daily occupations at a safe and realistic pace.

Applying the Person-Environment-Occupation model

The Person-Environment-Occupation model, also known as PEO, also helps explain my experience. Law et al. (1996) describe occupational performance as the result of the interaction between the person, environment and occupation. This model is relevant because postnatal psychosis does not affect the mother in isolation. It affects how the mother interacts with her home, family, baby, work, routines and support systems.

In my experience, the person factors included anxiety, hallucinations, fear, reduced trust in others and loss of confidence. The environmental factors included the home environment, family support, healthcare services, cultural expectations of motherhood and the restrictions caused by the COVID-19 lockdown. The occupational factors included self-care, baby care, sleep, rest, household tasks, work, social connection and meaningful daily routines.

From a PEO perspective, occupational therapy could have supported recovery by improving the fit between me, my environment and the occupations I needed or wanted to do. For example, an OT could have helped me develop a manageable routine, identify which tasks felt overwhelming, grade my return to household activities, support shared caregiving with trusted family members and explore safe ways to rebuild confidence in leaving the house or engaging with others.

Doing, being, becoming and belonging

The occupational concepts of doing, being, becoming and belonging also help me make sense of my experience. These concepts highlight that occupation is not only about completing tasks. It is also about identity, meaning, development and connection (Hitch et al., 2014a, 2014b).

Postnatal psychosis disrupted my doing because everyday activities such as resting, tidying, working, caring for my baby and engaging with others became difficult. It affected my being because I struggled to feel like myself. Becoming, because my transition into motherhood was shaped by crisis, fear and uncertainty. It affected my belonging because lockdown and mistrust limited my connection with others and reduced my sense of safety within ordinary family and community life.

Through this lens, OT could have supported me to move from survival towards participation. It could have helped me reconnect with meaningful doing, rebuild my sense of being myself, support my becoming as a mother after crisis and strengthen my belonging within my family and wider support network.

How occupational therapy could have helped me

Occupational therapy could have supported my recovery in several ways. Firstly, OT could have helped me rebuild daily structure. This may have included developing gentle routines around sleep, meals, washing, dressing, rest, baby care and household tasks. A structured but flexible routine may have reduced the sense of being trapped and helped me regain some control over my day.

Secondly, OT could have supported my relationship with sleep and rest. Because I feared that sleeping would lead to death or separation from my baby, rest became emotionally unsafe. An OT could have worked alongside the wider multidisciplinary team to explore practical and environmental strategies to support safer rest. Such as involving trusted family members, creating predictable routines, reducing overstimulation and gradually rebuilding confidence in shared caregiving. This would not have replaced urgent medical or psychiatric care, but it could have supported recovery by addressing how fear affected everyday occupations and participation.

Thirdly, OT could have supported graded re-engagement in meaningful occupations. Rather than expecting myself to immediately return to how I functioned before birth, an OT could have helped me break activities into manageable steps. For example, tidying the whole house may have felt overwhelming. But, starting with one small area or one meaningful task could have supported confidence and reduced pressure.

Fourthly, OT could have supported mothering occupations. This might have included helping me build confidence with feeding, changing, soothing, playing and spending calm time with my baby. It could also have included supporting safe shared caregiving, so that I could gradually trust others to help without feeling that I was failing as a mother.

Fifthly, OT could have supported my occupational identity. Work and productivity were important to me, and not being able to work contributed to my sense of being idle and trapped. An occupational therapist could have helped me explore other meaningful occupations during recovery, such as gentle home-based routines, rest, spiritual practices, journaling, short walks, creative activities or structured time with family. This could have helped me experience value and purpose even before I was ready to return to work.

Sixthly, OT could have supported my environment. During lockdown, the home became almost the whole world. An OT could have helped me consider how the home environment affected my wellbeing, including noise, rest, stimulation, space, routine and support. This may have helped create a calmer environment that supported recovery rather than increasing pressure.

Finally, OT could have supported relapse prevention and future planning. This may have included identifying early warning signs, understanding the impact of sleep disruption, planning support after birth, involving family members and developing strategies to maintain occupational balance. This is particularly important because women with a history of postnatal psychosis may require proactive planning and specialist support in future pregnancies or postnatal periods.

Relevance to my online placement with JB Occupational Therapy

This project is relevant to my online placement here because it shows how OT reasoning can be applied to real-life experiences of mental health, identity and participation. During placement, I have observed how OTs use conversation, activity analysis, clinical reasoning and person-centred practice to understand how health conditions affect everyday life. This has helped me reflect on my own experience more critically and recognise the potential value of OT in perinatal mental health.

Although my placement has not been specifically within a perinatal mental health service, the principles I am learning are transferable. OT is concerned with what matters to the person, what they need or want to do, what barriers affect participation and how environments can be adapted to support wellbeing. My lived experience has helped me understand that these principles are highly relevant to mothers recovering from postnatal psychosis.

A blog project on this topic can raise awareness that postnatal psychosis recovery is not only a medical process. It is also an occupational process. Mothers may need support to rebuild routines, confidence, identity, parenting occupations, relationships, rest and participation in meaningful life roles.

Where to get help and support

If you or someone you know is experiencing symptoms of postnatal psychosis, it is important to seek urgent professional help. Postnatal psychosis is a mental health emergency and should not be managed alone.

If there is immediate danger to the mother, baby or anyone else, call 999 or go to A&E immediately.

If symptoms of postnatal psychosis are suspected but there is no immediate danger, contact a GP, midwife, health visitor, maternity unit or mental health crisis team urgently and request same-day support. In the event you are unsure what to do, call NHS 111 or use NHS 111 online for urgent advice.

Useful UK support and information:

NHS: Postpartum psychosis
Information about symptoms, treatment, recovery and urgent help.

NHS urgent mental health support
Information on how to access urgent mental health help.

Action on Postpartum Psychosis — APP
A UK charity providing specialist information, signposting and peer support for mothers and families affected by postpartum/postnatal psychosis.

APP Peer Support
Peer support for people newly recovering, parenting after postpartum psychosis, considering another baby, supporting a loved one, or reflecting on an experience from years ago.

PANDAS Foundation UK
Support for parents, carers and families affected by perinatal mental illness.

PANDAS WhatsApp support
Message 07903 508334 to be connected with a trained PANDAS volunteer.

Samaritans
Free emotional listening support, available day or night. Call 116 123.

Shout
Free 24/7 text support in the UK. Text SHOUT to 85258.

This blog is not a replacement for medical advice. If someone is experiencing hallucinations, delusions, extreme confusion, severe anxiety, thoughts that feel unsafe, or fears that they or their baby may come to harm, urgent professional support should be sought immediately.

Professional and ethical considerations

Because this project is based on lived experience, it must be written carefully and ethically. My experience is personal and meaningful, but it does not represent every mother’s experience of postnatal psychosis. Mothers may experience postnatal psychosis differently depending on their symptoms, support systems, culture, family circumstances, access to services and previous mental health history.

It is also important to state clearly that OT does not replace urgent medical or psychiatric care. Postnatal psychosis is a mental health emergency and requires urgent professional support. OT should be understood as part of a wider multidisciplinary approach, supporting recovery, occupational participation and everyday functioning alongside medical, psychological, nursing, midwifery and family support.

As an occupational therapy student, this project also links with professional expectations around evidence-informed practice, reflection, communication, confidentiality and working within scope. The Health and Care Professions Council standards highlight the importance of communicating responsibly and ensuring that information shared publicly is accurate, true and not misleading (HCPC, 2024). Including clear signposting to urgent and specialist support is therefore an important part of writing about postnatal psychosis safely.

This project has helped me use my lived experience not only as a personal story, but as a foundation for professional learning, critical reflection and advocacy.

Conclusion

Reflecting on my experience of postnatal psychosis through an OT lens has helped me understand that recovery involves more than becoming clinically stable. It also involves rebuilding everyday life. For me, postnatal psychosis affected my confidence, routines, mothering role, home management, work identity, trust, autonomy, sleep, rest and sense of belonging. The 2020 COVID-19 lockdown further intensified this disruption by limiting support, social contact and normal postnatal routines.

Using MOHO, PEO and the concepts of doing, being, becoming and belonging, I can now see how occupational therapy could have supported my recovery. OT could have helped me rebuild manageable routines, grade my return to meaningful occupations, support mothering confidence, adapt my environment, involve family support and reconnect with my occupational identity.

This project has strengthened my understanding of the unique value of occupational therapy in perinatal mental health. It has also helped me recognise that lived experience, when used safely and critically, can support professional development, empathy and advocacy. Most importantly, it has shown me that after postnatal psychosis, mothers do not only need to survive; they need support to live, participate, belong and become themselves again.

References

Health and Care Professions Council. (2023). Standards of proficiency: Occupational therapists. https://www.hcpc-uk.org/standards/standards-of-proficiency/occupational-therapists/

National Health Service. (n.d.). Mental health services. https://www.nhs.uk/nhs-services/mental-health-services/

National Institute for Health and Care Excellence. (2014). Antenatal and postnatal mental health: Clinical management and service guidance. NICE Clinical Guideline CG192. https://www.nice.org.uk/guidance/cg192

Taylor, R. R. (Ed.). (2017). Kielhofner’s Model of Human Occupation: Theory and application (5th ed.). Wolters Kluwer.