Concerns women will 'fall through the cracks' when mother baby unit closes

Concerns women will fall through the cracks when Hobart's mother baby unit replaced In short: There are concerns mothers will fall through the cracks when the mother baby unit at the Royal Hobart Hospital is replaced with a new facility. While the mother baby unit deals with complex mental health challenges, staff have been told mothers must be "psychologically well" to be eligible for the replacement service. What's next? The mother baby unit is to close at the end of the year. Tasmania's health department has dismissed staff concerns about the level of care its new mother baby unit (MBU) will offer, claiming there will be "no reduction in capability". But health workers familiar with the plan have told the ABC they have been informed the Intensive Residential Parenting Unit (IRPU) will only be able to cater to mothers with low-to-moderate postnatal depression and anxiety, as opposed to "complex mental health" issues the current unit deals with. They have told the ABC that, while IRPU will be a "wonderful service", it cannot replace the MBU at the Royal Hobart Hospital. With that unit to close at the end of the year, health workers and advocates are worried some women will "fall through the cracks". The state government opened the MBU at the Royal Hobart Hospital in 2023 after the privately operated St Helen's unit closed. The Royal's MBU looks after mothers with low-to-high mental health issues, including bipolar and a history of postnatal psychosis, provided they are assessed as at low risk of harming themselves or others. It is governed by the Perinatal and Infant Mental Health Service (PIMHS) team, which is made up of psychiatrists and psychologists. Its model of care describes it as "part of a continuum of public mental health care targeted to support consumers with complex mental illness and parent-infant relationship difficulties during the perinatal period, using a family inclusive approach". It only operates two beds and has a constant waitlist. New model requires mothers to be 'psychologically well' Last year, the government revealed it planned to build a six-bed facility at St Johns Park in New Town after feedback that a home-like community environment would be more appropriate than a hospital. With the new location came a new model. Instead of being governed by the Perinatal and Infant Mental Health Service, the Child and Health Parenting Service (CHaPS) will be in charge. CHaPs staff are qualified child and family health clinicians but do not have specialised mental health training. The model of care document for the new unit says it supports mothers with "moderate" or "emerging" postnatal mental health concerns. It has the same exclusion criteria for admittance as the MBU and, like the Royal's unit, if a mother's health issues are so severe they risk her or the baby's safety, she may be sent to the Royal's psychiatric ward and separated from her baby. However, health department workers who have spoken to the ABC say they've been told it will be dealing with lower acuity "clientele" than the current MBU. "The IRPU in as of itself is a great service for what it's proposing, but it is not a replacement for the mother baby unit," a health worker said. "It is a condensed, reduced functionality model. "I'm worried that these mums will have nowhere to go. "They'll fall through the cracks and it's just a huge risk that we can't afford to take." Staff have been informed that mothers must be "psychologically well", showing only low to moderate levels of postpartum depression or anxiety, and the service is largely about settling and feeding babies. A change proposal sent to staff in November 2025 appears to confirm that, writing that the new unit would deal with families facing postnatal challenges, "including assistance with sleep and settling, family attachment, parental anxiety and behavioural concerns". Workers have told the ABC many of the current clients in the MBU are "significantly unwell", with the vast majority struggling with a mental health issue or personality disorder. "Some people need to go [to the psychiatric unit], but a lot of these mums can actually be held by the current model that is the mother baby unit and the previous model that was St Helens," one worker said. "They could hold these mums, which would avoid them being separated from their infants during this stage." In the MBU, mothers have in-house psychiatric and psychological support and one-on-one specialist care. The Intensive Residential Parenting Unit model of care shows there will be one psychologist and no in-house psychiatrist. The Perinatal and Infant Mental Health Service can visit and support "consumers with emerging and/or enduring complex mental illness impacting the parent-infant relationship during the perinatal period". The ABC has also been told that when health staff raised concerns about the designs for the rooms at the new unit not being mental health safe, they were told that was not really the kind of "clientele" that would be staying in the unit. Nurses' union raises concerns The Australian Nurses and Midwifery Federation responded to the change proposal in December and raised concerns that included a significant reduction in perinatal mental health capability and minimal-to-no involvement of the Perinatal and Infant Mental Health Service. Union secretary Emily Shepherd said, while information about the new model of care had not been broadly circulated, her members had been involved in many meetings about what the Intensive Residential Parenting Unit would look like. She said they'd raised concerns with both the union and those in charge of developing the new unit. "My understanding is it's a totally different model of care to what was at St Helens and also what's currently in place at the Royal mother baby unit," she said. "Our view would be that the model of care should replicate what was on offer at St Helens Private Hospital. "There is absolutely a need for women to be able to access dedicated perinatal mental health support in conjunction with their babies and/or in conjunction with challenges around sleep and settling." 'No reduction in capability', health department says In a statement, a Health Department spokesperson said the service would support a "broad range of mothers and babies". "Support will be available for those who need it and is consistent with what occurs today at the Royal Hobart Hospital Mother Baby Unit or at St Helens previously, with no reduction in capability," they said. "The model of care includes a multidisciplinary team to provide residential and day program assistance with issues such as sleep and settling, feeding concerns, behaviour, family attachment, parental anxiety, parental mental ill health, support for multiple births, parental wellbeing and parental exhaustion. "If mental ill health is high acuity (severe) to the extent that the mother and/or the baby's safety is at high risk (for example, the mother develops psychosis), higher acuity mental health support may be required and will remain available at the RHH." The department said it was the same process that occurred in the MBU and at St Helens. When the ABC showed staff the response from the department, they were dismayed, describing it as "misleading", "blatantly untrue" and making them feel "unsafe and unable to trust what is going on". Despite the department's insistence that the service will be much like the current MBU, staff remain worried and sceptical, given what they have been told. "I'm really frightened about women potentially not reaching out for help when they need it," one said. "And maybe maternal suicide, maybe infanticide could be the outcome of this if really unwell women fall through the cracks." While staff think the Intensive Residential Parenting Unit will offer a great service, they are urging the government not to close the Royal's unit. "We want an acute mental health service to remain open for women so those who are acutely unwell with mood disorders get to stay with their babies, like the service that we have currently with the MBU," one said. "We think the IRPU is a wonderful service and it is going to be wonderful for those that need it, but the MBU is also a wonderful service for those who need it and they're not comparable."