2022-12-31-accounts

REGISTERED COMPANY NUMBER: 07466643 (England and Wales) REGISTERED CHARITY NUMBER: 1139925

ACTION ON POSTPARTUM PSYCHOSIS (A COMPANY LIMITED BY GUARANTEE)

TRUSTEES' REPORT AND

UNAUDITED FINANCIAL STATEMENTS FOR THE YEAR ENDED 31 DECEMBER 2022

ACTION ON POSTPARTUM PSYCHOSIS

CONTENTS OF THE FINANCIAL STATEMENTS FOR THE YEAR ENDED 31 DECEMBER 2022

	Page
Reference and Administrative Details	1 to 2
Trustees' Report	3 to 24
Independent Examiner's Report	25
Statement of Financial Activities	26
Statement of Financial Position	27 to 28
Notes to the Financial Statements	29 to 39

ACTION ON POSTPARTUM PSYCHOSIS

REFERENCE AND ADMINISTRATIVE DETAILS FOR THE YEAR ENDED 31 DECEMBER 2022

TRUSTEES A Bauer G S Berrisford C K Cho (appointed 30.3.23) C Dolman S A Hind I R Jones A R Jones A Sampson (resigned 5.10.22) REGISTERED OFFICE International House 12 Constance Street London E16 2DQ REGISTERED COMPANY 07466643 (England and Wales) NUMBER REGISTERED CHARITY 1139925 NUMBER

INDEPENDENT EXAMINER TCA (Shrewsbury) LLP Third Floor 21 St Mary's Street Shrewsbury Shropshire SY1 1ED SOLICITORS (PRO BONO) Howard Kennedy LLP No 1 London Bridge London SE1 9BG

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ACTION ON POSTPARTUM PSYCHOSIS

REFERENCE AND ADMINISTRATIVE DETAILS FOR THE YEAR ENDED 31 DECEMBER 2022

BANKERS

HSBC Bank PLC 18 High Street Burton on Trent Staffordshire DE14 1HU The Cooperative Bank PLC 1 Balloon Street Manchester M60 4EP Bath Building Society 15 Queen Square Bath BA1 2HN

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ACTION ON POSTPARTUM PSYCHOSIS

TRUSTEES' REPORT FOR THE YEAR ENDED 31 DECEMBER 2022

Objectives and Activities

Postpartum Psychosis

Each year, one to two in every thousand new mums will develop hallucinations, delusions, mania, depression and unusual behaviour within days of childbirth, often out of the blue. When a mother experiences mania or psychosis following the birth of their baby it is known as postpartum psychosis (PP). The condition is frightening and can have a devastating impact, not only on the woman affected, but also on their partner and wider family. Ignorance about the illness is widespread and many women experience stigma, isolation, and a lifetime burden of guilt.

Suicide is the leading cause of death among new mothers. Prior to 2011 when our charity began, postpartum psychosis was responsible for the largest percentage of psychiatric deaths. During the last decade, PP-related maternal deaths have become rare, although maternal suicides as a whole have continued to increase. Early evidence suggests that deaths due to PP are again on the increase in the post-pandemic period. For each of these statistics, a baby loses a mother and a family sustains an unimaginable loss, when the fact is, postpartum psychosis is a treatable illness and full recovery is possible. A shortage of Mother and Baby Units (MBUs) means that new mothers can be separated from their newborns when placed in General Adult Psychiatric Wards with the burden of care falling to other members of the family or social services - the separation compounding an already devastating situation.

Charitable Objects, Vision and Long-term Objectives

Under its Articles of Association, the charitable objects for which Action on Postpartum Psychosis (APP) is established are:

• to promote and protect the physical and mental health of women who have experienced postpartum psychosis and their families through the provision of support, education and practical advice;

• to advance the education of the public in general (and particularly amongst health professionals) on the subject of postpartum psychosis and to promote research for the public benefit in all aspects of that subject and to publish the useful results; and

• to advocate for perinatal mental health services for women and their families.

Our vision is for all women and families affected by postpartum psychosis to benefit from best-practice treatment and appropriate support through to full recovery. Our long-term objectives are:

• Improving recovery outcomes by: supporting women and families affected by postpartum psychosis to engage with others who’ve ‘been there’; improving access to evidence-based information; signposting to appropriate support; training and informing health professionals; facilitating research into all aspects of PP; and increasing knowledge of postpartum psychosis in the general public.

• Reducing isolation by building a supportive, peer-led, lived experience community of women and families affected by postpartum psychosis online and in person across the UK.

• Combating stigma and silence by promoting greater awareness of postpartum psychosis in the general public, the media and at conferences and events.

• Improving services and care for women and families by offering specialist information and training on postpartum psychosis and campaigning to increase the number of Mother and Baby Unit beds available across the UK. Facilitating research into all aspects of postpartum psychosis and promoting the useful results of research.

• Reducing the maternal suicide rate by improving understanding of postpartum psychosis among the general public and health professionals; and improving access to specialist care, peer support and information.

APP works nationally in England, Wales, Scotland and Northern Ireland, although we also look for opportunities to influence care and understanding of PP globally.

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Objectives and Activities in 2022

APP is an innovative collaboration between women and families who have experienced postpartum psychosis, leading academic researchers and expert health professionals. Our main objectives and activities in 2022 are described below. Our charitable activities consisted of: providing specialist support and information to affected women and families; raising awareness of postpartum psychosis amongst the public and health professionals; campaigning for improved services; and conducting research to better understand the illness. These activities are undertaken to further our charitable purposes for the public benefit. We measure the success of our work through: surveying service users, volunteers and training participants (using an online survey and feedback forms); monitoring service user data; and asking individuals to write about their experience.

Supporting affected women and families

APP’s Peer Support Service aims to create an active and engaged postpartum psychosis community, improve recovery outcomes for women and families, reduce social isolation, reduce the maternal suicide rate and decrease the long-term impact of the illness on family life.

Our Peer Support Service offers one-to-one support (via email, telephone, video call and face-to-face), café groups (face-to-face and online) and a community forum where those affected can go to ask questions, gain support and signposting. We employ Peer Support Coordinators with personal experience of postpartum psychosis to manage the service and carefully moderate to ensure that the service and forum are safe; the Coordinators are supported in turn by specialist health professionals and academic experts. The Coordinators recruit, train and support Peer Support Volunteers and staff with experience of postpartum psychosis to provide empathy, practical information and hope for recovery. In 2022, we aimed to maintain and grow our national and regional peer support services by:

• Maintaining our NHS projects and ensuring the resilience of each project under a range of scenarios (e.g., staff sickness, pandemic restrictions) by training and supporting employees, sessional workers and new volunteers. Strengthening our NHS peer worker team with ongoing training, opportunities to meet regularly online, sharing resources and participating in co-working days.

• Building links with the newly developing provider collaboratives and strengthening links with all UK MBU peer workers and ward managers with the aim of reaching all MBUs with peer support in the future.

• Growing our national peer support team, to meet demand for forum, email, and social media support, together with online wellbeing, creative and community building activities, and further developing our staff and volunteer ongoing training programme.

• Developing protocols to support our network of café groups, increasing attendance, and ensuring they are safely run and well-advertised.

• Recruiting volunteers in Northern Ireland, Scotland and North Wales and setting up café groups to deliver support and facilitate campaigning. Continuing supporting café groups in Wales and establishing up to two new café groups in Northern Ireland and Scotland.

• Running regular activities to engage partners, grandparents, and Black, Asian and minority ethnic communities to increase engagement. Producing a written plan to reach into Black, Asian and minority ethnic communities with input from our volunteers.

We measure the success of our peer support work through the number of women and family members reached, through surveying service users and volunteers about the benefits and downsides of receiving or delivering support in this way, and by asking individuals to write about their experiences. Survey questions include whether service users feel more supported, less isolated, more informed, less negative about postpartum psychosis, more hopeful, and whether the peer support has aided users’ recovery. We also survey peer support volunteers about the experience of training and volunteering.

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Raising awareness amongst health professionals

In 2022, we aimed to reach more health professionals with training by:

• delivering six one-day workforce training sessions (either as online sessions, in person sessions, or NHS-commissioned sessions for particular NHS teams), promoting, evaluating and seeking accreditation for this training

• Continuing our training collaboration with the Institute of Health Visiting (iHV) and building collaborations with other professional bodies, training, supporting and developing resources for Lived Experience speakers to engage with health professionals. Supporting up to 50 lived experience speaker events throughout the year.

• Surveying professional groups to identify training needs with a view to the future development of e- modules. Identifying a provider to develop APP training modules and creating a timetable for module development and outline of costs.

Our workforce training courses are delivered by our world leading experts in Perinatal Psychiatry, APP staff members, and APP Experts by Experience. By utilising clinical experience, cutting-edge research, and the real experiences of affected women and families, the courses aim to up-skill the workforce, developing expertise and empathetic understanding. APP’s Experts by Experience – trained volunteers and staff members with experience of postpartum psychosis - raise awareness in their local regions, by giving talks to health professionals at conferences and events, disseminating information, and sharing their personal experiences: describing their symptoms, experience of treatment and recovery, what worked well for them and what did not, and the impact on their relationship with their baby, family and friends.

We assess the success of this awareness raising work through the number and range of professionals reached, session feedback and through questionnaire feedback on the one-day training. We ask whether the training: will change their practice; has increased their knowledge of postpartum psychosis and the risks; has increased their confidence and empathy in working with affected women and families; and whether it has made them feel better equipped to help women recover.

Raising awareness amongst the general public

In 2022, we aimed to continue to raise awareness in the general public to reduce stigma and misinformation and help newly affected women and families access our lifesaving information and support. We planned to use media case studies and social media to raise awareness of our lifesaving information and support, using storytelling to help the public understand PP and the importance of our work. In particular, we planned to share stories from women, partners and families:

• about care received in an MBU and the impact of not being able to access an MBU bed; and

• about the impact of not hearing about PP during antenatal classes, and not knowing about the illness before diagnosis.

We also planned to continue supporting support film, theatre, TV or book projects that tell PP stories, linking creatives to our network of women and families with lived experience.

We measure the success of this awareness raising work through the range and reach of media pieces about PP that we are involved in, and the number of followers and level of engagement on our social media channels and website.

Campaigning for improved services

In 2022, we aimed to use our specialist expertise and lived experience voice to create change in systems that are important to women and families affected by postpartum psychosis. Our campaigning work is towards our goal that that all women and families in the UK have access to the services they need to get help and recover from PP.

We planned to continue campaigning for all women affected by postpartum psychosis in the UK to have access to a Mother and Baby Unit (MBU), a specialist perinatal mental health team, well-trained health professionals, information and peer support. We planned to continue our campaign to highlight the gaps in Mother and Baby Unit provision in North Wales, Northern Ireland and Scotland working with the Maternal

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Mental Health Alliance (MMHA) and National Society for the Prevention of Cruelty to Children (NSPCC). We aimed to ensure MBUs are valued by the public and policy makers, by sharing powerful stories from women, partners and families at national events, at key meetings, to influencers, on social media and in the press. We planned to continue connecting with MBU staff and NHS Trusts to support MBU communications and share good news stories. We planned to prepare press releases and expert commentary, analysing and reporting on APP’s MBU data collected in our recent 10-year survey.

We planned to continue developing our campaign for PP to be an essential part of all antenatal class training. We would: promote the findings of our YouGov survey about PP antenatal class education; survey midwives and antenatal educators about PP content in antenatal education, fears and practice, using the results to develop content, suggested phrases, and an online Q&A for midwives/NCT providers in 2023.

Research

In 2022, we aimed to continue to facilitate research studies of importance to women and families affected by postpartum psychosis. We aimed to analyse and report on APP’s MBU survey and plan to maximise the impact of the results. We planned to build stronger links with the Institute of Mental Health in Birmingham University and the National Centre for Mental Health at Cardiff University, working with them to raise awareness of APP, develop funding proposals, and share communications. We would survey women and families on research gaps, publishing results on our website, liaising with funders and research groups to make plans to fill these gaps. We would support and engage our Lived Experience research consultation group, developing our processes for supporting lived experience co-production ~~,~~ and begin considering improvements to processes needed to build APP’s research register and engage our community in research participation.

Fundraising and strengthening our capacity

In 2022, we aimed to strengthen our capacity to fulfil our charitable objectives through transforming APP’s data and management systems in order to manage our rapid growth. We planned to build fundraising capacity by appointing an experienced fundraiser to oversee the growth of APP’s fundraising campaigns and grassroots fundraising. We planned to increase core capacity by increasing administrative support to the management team, research, training and NHS projects. We aimed to continue to develop staff training, staff support practices, and report on pay and conditions best practice to support the further development of APP as a model lived experience/working parent employer. We also aimed to refresh the website design and work through web content section by section. We planned to improve internal processes by appointing a staff member with data management and CRM implementation expertise to implement a CRM towards the end of 2022 and oversee a review of data policies and IT security. We also planned to carry out the groundwork considering the organisational capacity and structure required for future growth which would enable us to begin to seek funding for pilot international work in 2023.

Achievements and performance

Peer Support to affected women and families

In 2022, APP continued its national peer support service, making ongoing adaptations to plans and activities as we learned from the pandemic. Overall, in 2022 APP provided peer support to more than 828 people, including those personally affected, partners, grandparents, wider families and friends. An average of 234 people used our online peer support forum every month (2021: 252) with the number of registered users increasing from 3065 to 3,299. Coordinators and volunteers provided support to 241 individuals which included telephone support to 16 people, video call support to 19 women, email support to 145 people, plus one-to-one support for 15 grandparents. In addition, 37 people not included in the above figures attended a regional café group only. A total of 15 partners received one-to-one email, phone or video call support in 2022, with two more opting to receive support through the forum only. In October 2022, we celebrated the tenth anniversary of our online peer support forum, thanking our peer support volunteers and staff, and all those within our APP community who help to offer support via the forum.

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After not conducting our annual peer support service user survey in 2021, due to capacity constraints, we conducted a survey in the third quarter of 2022, promoting it widely and adding new response options to allow us to gather more detail about our different groups as well as our NHS projects. Most respondents had experienced postpartum psychosis (PP), but 12% were responding as a partner or family member of someone who had experienced PP, giving us valuable feedback on our peer support for dads, co-parents and grandparents. We found that 100% of respondents felt more supported and less isolated since finding APP (2020 survey: 95%); 93% of respondents felt more informed about PP (2020: 98%), and 82% felt less negative about PP since finding APP (2020: 88%). In addition, 92% of respondents felt more hopeful about the future since finding APP (2020: 92%). Nearly 1 in 3 people who answered the question (30%) said ‘I might not be alive if I had not found APP's peer support services’ (2020: 32%) demonstrating that APP’s peer support continues to change and save lives. These examples of responses from the survey show the impact of peer support:

“It is hard to put into words how much it's meant to me finding others who've had this horrible illness. APP makes me feel accepted, reassured and supported and proud that I am able to use my experience to help others as a volunteer peer supporter.”

“Speaking with women who truly understand the impact PP has on your whole life has given me hope when I had none. Knowing women do get better with time and support.”

“Amazing community of people. Always have several responses if I post on the forum. Have had amazing peer support from my peer supporter. Just like getting to know a new friend with good advice when feeling not so great.”

Around half of those who answered the question (51%) had used APP’s virtual peer support (including virtual groups and clubs) more than before due to the impact of Covid. Comments show that the availability of this support was clearly very valued during Covid and helped to reduce isolation.

Café groups and wellbeing activities.

Our number of regional café groups increased to nine. They operate in Wales, Sussex & Hampshire, Yorkshire, Lancashire & Cumbria, Morpeth & the North-East, Birmingham, London, Scotland and Northern Ireland. The Scotland and Northern Ireland café groups were established during 2022, with the new North Wales group combining with the South Wales group into one online group. Three grandparent café group meet ups were held in 2022. In total, 106 people attended these support meetings during the course of the year, whilst a further 8 people attended the virtual dads and coparents café group meetings on the third Wednesday of each month. Whilst partner and grandparent support remained online, most other café groups continued to offer both virtual and in-person events to reach more women. Our new Northern Ireland café group held its first meeting with 10 individuals attending in June, with a first face-to-face meeting taking place in October. The Scotland group met a couple of times virtually before meeting in person in Edinburgh in June. One of our new volunteers in Northern Ireland described the impact of meeting other women affected by PP:

"Action on Postpartum Psychosis has helped me in so many ways. It has helped me connect with other mums who experienced PP here in N. Ireland. This has taken away how isolating it was to have gone through PP and even discuss how it felt to have experienced this here in Northern Ireland. I was privileged to be a part of the campaign to help bring about awareness of the necessity of Northern Ireland having its own Mother and Baby Unit. I imagine when I experienced PP after my fourth child was born, recovery would have been so different as I would have not been taken to a general psychiatric ward and separated from my son. I hope for the many generations to come that Northern Ireland has better resources for mums when it comes to mental illness. I am now a peer volunteer with APP and I love that I am a part of this fantastic community of women who all come from various walks in life but are united by one thing and that is to support and uplift each other." Emma, APP Peer Support Volunteer.

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Training and supporting volunteers

We recruited and trained 26 new peer support volunteers in 2022. This included one new partner peer support volunteer and three new grandparent peer support volunteers. The new volunteers included four new peer support volunteers in Scotland, four new peer support volunteers in or from Northern Ireland and one new peer support volunteer in Wales. As at the end of 2022, we had 96 active peer support volunteers who provide support to women and families via our online forum, café group meet-ups, video call, one to one emails and telephone calls.

In 2022 we received good feedback from new volunteers about the online peer support training we provided – 100 per cent would recommend the training to others. Many also found it supported their own wellbeing and recovery: 94 per cent felt more supported, 94 per cent had more understanding about PP and 78 per cent felt less isolated and better connected with others with similar experiences. We received positive feedback in training evaluation forms:

“I felt this day met my needs as I feel I have a much better understanding of what peer support is and the type of things I may be able to do as an APP volunteer. All the speakers/trainers were very knowledgeable and it was great to be able to ask questions and interact with others.”

“There was so much love, care and compassion shown by your team and the way you talked to us all was fantastic.”

Our peer support volunteers were supported during 2022 with both training and social Zoom sessions, including: a self-compassion session; connecting with your baby; meditation techniques; supporting users in crisis and a review of best practice guidance for managing suicidal content online; and three online café group sessions for peer supporters. We received good feedback from our peer supporters on how these sessions met their training needs, for example:

“…when supporting women who are struggling to connect with their baby I feel confident in approaching this a bit differently - reassuring them that it takes time to build that relationship, the importance of watching and observing their baby and what they bring to that relationship, and just being there without the need for constant interaction etc.”

“clearly explained what self-compassion is all about and provided with additional resources to look into the topic in more depth as we wish”

“I felt that it met my training needs by helping me learn and practice relaxation techniques that I may be able to use in volunteer work for APP. It helped me meet other volunteers and listen to shared experiences.”

Peer support volunteers were also invited to additional sessions which were open to our wider volunteer and staff groups or whole APP network including: a writing workshop; a yoga session; a mindful crafting session; APP’s Book Club; and the annual Festive meet up. Finally, a new internal newsletter for peer support volunteers was established during 2022.

Peer support embedded in NHS perinatal mental health services

In 2022, we had five Peer Support Facilitators embedded in NHS perinatal mental health services: in the MBU in Chorley and Lancashire & South Cumbria community; in the Birmingham MBU and in the Birmingham & Solihull Community Perinatal Mental Health Teams; in the Morpeth MBU and supporting the transition home, and in the Community Perinatal Mental Health Teams in the Black Country. In addition, we had sessional peer support workers in the Birmingham, Lancashire & South Cumbria and Morpeth partnership projects able to provide holiday cover and additional support to women and families. The partnerships we had begun with Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust and Black Country Healthcare NHS Foundation Trust in 2021 were both renewed for a second year during 2022.

Our NHS embedded peer supporters helped 274 women (2021: 157) in 2022, in the Chorley, Morpeth and Birmingham MBUs and in the community in Birmingham, Solihull, Lancashire and South Cumbria and the Black Country. Café groups remain an integral part of our NHS partnership projects to enable recovering women to meet; we held 58 café groups in 2022 (2021: 41), 13 of which were held virtually. We found that

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continuing to offer a choice of virtual or in-person groups was beneficial: virtual groups enabled people to attend if they were not comfortable or able to travel, whilst virtual evening groups helped those who had returned to work to participate. We continued to support dads, coparents and other family members of women experiencing PP, supporting 33 individuals in 2022 (2021: 12). We referred women’s partners for further support from our national dads and coparents peer support team and women’s (or their partner’s) parents to our grandparent peer support group.

As Covid restrictions eased we were able to share learning between our NHS projects with peer supporters visiting different MBUs we work in. In March 2022, Jocelyn our Peer Support Facilitator in Lancashire and South Cumbria visited Chamomile Suite in Birmingham to meet Soukaina, our Facilitator there, and share ways of working at the ward. Our Black Country Peer Support Facilitator, Jo, visited Ribblemere MBU in Chorley over the summer and in November 2022 our sessional peer supporters from the Morpeth MBU project also visited. Our NHS peer supporters also shared learning through a series of facilitated reflective sessions where they considered scenarios, self-care for peer supporters and themes such as managing trauma, guilt and suicidality.

Case study

APP supports women and their families through their acute illness and beyond, as they: seek help, recover, rebuild relationships, come to terms with the illness, have concerns about parenting toddlers and teenagers, wish to campaign for change and improve the future for others, plan further pregnancies, navigate menopause, and become grandparents. Many women and family members who initially receive peer support go on to support others on our online forum and may choose to become volunteers themselves. Postpartum psychosis affects women’s extended families and often the baby’s grandparents provide considerable emotional and practical support when their daughter or their child’s partner is diagnosed with PP. This case study demonstrates the impact of APP’s peer support on one family and their journey to recovery:

“When I was in the MBU, my mum would mention APP to me a few times in conversation, but I didn't quite understand what it was at the time and most definitely didn't have the capacity to seek it out or enquire. She mentioned a forum and was able to let me know that she'd read a lot and knew that I would definitely 'get better'. The phrase 'you will get better' felt like it was on loop every day from my family and staff, as I would always ask why I was there and if I'd ever get better. I'm not sure I fully believed I would.

My first point of direct contact with APP was over the telephone with Naomi. My mum had arranged this and I obliged, looking for some comfort. I remember it well as I was sat in the sensory room in the MBU (depressed and without hope) and while speaking to her as a 'well' person who seemed totally normal, I felt a glimmer of hope…[the conversation] allowed me to just imagine that one day that could actually be me-and I could lead a lovely, normal life.

My mum said that she had many calls from Naomi that were reassuring at times of worry. She also received emails from a grandparent volunteer as part of the grandparents peer support- 'to keep in touch and help'.

Later on, upon leaving the MBU and getting treated at home … my mum gave me the APP guide to PP and I was able to semi understand what had actually happened. My partner Malcolm had read both guides and found them extremely helpful.

After a few emails with Ellie, I attended my first cafe meet up alone- and although I felt nervous, I was ready. I wanted to meet someone who would understand. Although my parents and Malcolm have been the best support I could ever have, I still needed to see and talk to someone who knew what it was like having PP (and facing the aftermath.)

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I had been emailing Ellie for cafe details and she was fabulous. I turned up to the group and immediately felt at ease. Jessie was also there, and in her own gentle way, told me about her experience and her work for APP. I was honestly really inspired by each member of the group, and it made me feel stronger and hopeful. I even thought about the future and ways in which I could help others who had PP.

I had been touched by Laura Dockrill's story on the website and I soon read her book…I decided to give writing a bit of a go - and joined a course called Mothership writers, which ended up being a huge, positive contributor to my recovery.

I'll be running 10km for APP in June and with Fliss as my contact- I've received plenty of encouragement and advice.

It goes without saying I admire what you do at APP. I feel truly lucky that you exist and help so many women (and their families) that suffer from this horrendous illness. Your many points of contact- email, telephone, website and Instagram have helped me in various ways. My parents and partner had a trustworthy point of call in APP and for that too, I thank you!”

Raising awareness amongst health professionals

In 2022, we continued to provide training and expert by experience talks to health professionals across the UK. A total of 2,287 health professionals heard one of APP’s lived experience speakers in 2022 (2021: 1,553), including one-day training courses. These were across 21 different online training events (2021: 35) and 30 onsite events. The health professionals attending these events included midwives, health visitors, psychiatrists, mental health staff, perinatal mental health and mother and baby unit teams, psychologists, nursery nurse staff, obstetrics and gynaecology doctors, pharmacists, social workers, occupational therapists, nursing and midwifery students and mental health link workers. Events included NHS workforce training, perinatal mental health study days, University lectures to midwives and mental health nurses, conferences, webinars, and awareness raising events.

We continued our partnership with the Institute of Health Visiting (iHV) and supported their two-day perinatal mental health champions training courses. In 2022, we delivered 10 lived experience talks on their online training courses (2021: 15) and will continue to deliver on these courses in 2023. Our talks continued receive excellent feedback:

“The delegates were visibly moved by what was so honestly shared. They were still talking about the impact it had had on them on the second day, and again at the end of the training - it was obviously a real highlight.”

“I remember you saying you’d carry on telling your story until it wasn’t making a difference - so I think you’ll be doing this for a good while longer.” iHV Training Facilitator

Our relationship with the Royal College of Psychiatry (RCPsych) also continued and we delivered an online training session for psychiatrists in collaboration with them: RCPsych Perinatal Psychiatry Masterclass on Lived Experience and Coproduction. During 2022, in addition to iHV and RCPsych, we collaborated with various other professional bodies in relation to existing training and developing new training opportunities including NSPCC, Royal College of Midwives, NHS Ambulance Education Service and the Royal College of Occupational Therapists. As part of our antenatal campaign, we surveyed midwives and other antenatal educators on their opinions about discussing PP and what training and resources they felt they needed (see Campaigning for improved services below). We also supported the launch of the Maternal Mental Health Alliance’s report[1] about investing in training for midwives and health visitors and recruiting more specialist perinatal mental health midwives. The role of midwives and health visitors is critical in identifying postpartum psychosis and ensuring that women receive the support they need. APP wrote a piece for the

1 http://maternalmentalhealthalliance.org/news/new-economic-research-maternal-mentalhealth/?fbclid=IwAR2aWfa9Z25kSuuKxv6_Mn2SfL-W1dyf6yPRYPTAgMtMlr12mTQiXkW0_uM

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National Health Executive about the importance of training midwives and health visitors in postpartum psychosis.[2]

Our lived experience speakers also gave talks and presentations in support of APP’s campaigns. APP’s National Training Coordinator was a keynote speaker at the Maternity and Midwifery Forum conference in Scotland, which was attended by maternity professionals from across Scotland, presenting about APPs antenatal campaign and the results of our antenatal survey. APP’s National Peer Support Coordinator spoke to health professionals and politicians from Northern Ireland at an event organised by the Maternal Advocacy and Support (MAS) project at the Northern Ireland Assembly in Stormont as part of our campaigning for an MBU in Northern Ireland.

In 2022, we delivered two sessions of APP’s one-day training course (2021: 3) – Managing Postpartum Psychosis, training 33 health professionals (2020:53) from Cheshire and Merseyside NHS and maternal mental health link workers from Cumbria, Sunderland, and Northumberland. 100 percent of the delegates rated the training as excellent (2021: 86.7 percent) and 100 percent would recommend to other health professionals working in the perinatal period. Individual feedback included:

“Listening to the lived experiences was so inspiring. The group discussions and activities were really useful.”

“This training was engaging and captivating – wonderful presenters.”

“The format and delivery kept me engaged for the duration of the training – this is very difficult online.”

“The lived experience input really brings this to life, it also role models speaking about experiences which I think is so valuable, the storytelling approach with questions really worked.”

We also agreed with Lancashire and South Cumbria Foundation NHS Trust to conduct training for their MBU and community perinatal teams in 2023, following up on training first carried out at the start of our NHS partnership project in 2018. Work on developing e-modules (virtual training modules) was put on hold in 2022 due to capacity issues.

Raising awareness amongst the general public

In 2022, our lived experience storytellers helped us to drive engagement with thousands of people, to activate interest in APP’s work, support services, and ensure women and families with PP are heard regionally and nationally. Many of our media case studies, and related social media, during the year were in support of our campaigning work (see Campaigning for Improved Services below). In Northern Ireland in particular, these stories helped raise awareness of PP and the vital need for an MBU, and advertised our new peer support group meaning more women and families were able to access APP’s support. A media consultant from Northern Ireland supported our team with media coverage and recruiting and supporting three new storytellers in the region. We increased the diversity of the stories and imagery on our website, featuring women and their partners from different ethnic, religious and linguistic backgrounds, and women in same sex partnerships.

In July 2022 we welcomed a third APP Ambassador, author and literary agent Catherine Cho. Catherine’s critically-acclaimed book about her experience of postpartum psychosis, Inferno: A Memoir of Motherhood and Madness , was published in 2021 providing readers with a poetic, honest and raw account of the illness and inspiring hope in recovery. Catherine said:

“It is important for me to become an APP ambassador, because it is so important to be open about postpartum psychosis. Maternal mental health, particularly postpartum psychosis, is something that holds so much stigma and shame, which makes it even more of a frightening and isolating experience. I hope that I can help APP in sharing my story and the stories of others. When I was in the midst of recovery, I couldn't imagine becoming well, but it was in finding this community and the kindness of others who were so open in sharing their stories that I could begin to hope that this would, one day, be a story from my past.”

2 https://mag.nationalhealthexecutive.com/articles/the-next-generation-of-midwives-health-visitors

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In 2022, we continued to plan social media and media work around awareness days and in support of our campaigns and regional projects, as well as reacting to events and media requests. We supported pieces in national, regional and health sector media. In May, we ran a campaign for Maternal Mental Health Awareness Week (MMHW), reaching 324,750 people across our social media channels in the month. We also had awareness raising media pieces during the week: Claire, one of our volunteers and Storytellers, shared her story for MMHW week on ITV Tyne Tees[3] ; whilst APP staff member Naomi wrote a piece about her experience of motherhood and PP for the Metro.[4] We worked with international organisations - Cherished Mom and Postpartum Support International - on two events for Pregnancy and Postpartum Psychosis Awareness Day, which fell on the Friday of Maternal Mental Health Awareness Week. These events - an author panel, featuring five published authors with lived experience of postpartum psychosis and a Pregnancy and Postpartum Psychosis Resources and Research Update - aimed to raise awareness of PP globally.

We marked Father’s Day/Father’s Mental Health Day on 20th June 2022 with a live and recorded ‘APP Dads Chat’ about postpartum psychosis and dads' mental health. The event involved with Simon O'Mara (APP Partners coordinator), Hugo White (APP Ambassador, musician and record producer), Professor Ian Jones (world-leading expert on postpartum psychosis), Mark Williams, (organiser of International Fathers Mental Health Day) and guest hosted by Kieran Anders (Dad Matters UK).[5] Other highlights included:

• Significant media coverage in Northern Ireland raising awareness of PP and our MBU campaign including the front cover and full statement from APP in The Irish News, Belfast Telegraph and interviews on BBC Radio Foyle Breakfast Show and BBC Radio Ulster Good Morning Ulster. See “Campaigning for Improved Services” below.

• A double page spread in the Mirror, featuring APP’s storyteller, Nia, about the impact of not receiving care in an MBU and our MBU campaign.[6]

• A radio documentary which celebrated the first year of the South Wales MBU, Uned Gobaith and other MBU campaign related coverage in Lancashire Telegraph[7] , The Big Issue North, Good to Know magazine[8] , Hull Daily Mail[9] and Ramadan Radio.

• APP’s Chief Executive, Dr Jessica Heron took part in CNN’s As Equals maternal mental health roundtable discussion.[10]

• APP Ambassador, Laura Dockrill, shared her story in Hello Magazine’s Mental Health Issue[11]

• APP Storyteller, Lobeh Osagie-Asiah shared her experience of PP with Yahoo Live[12] in September to highlight issues around access to the right type of care among Black women for Black Maternal Mental Health Week which is organised by The Motherhood Group.

APP has always sought to understand the experience of PP in a variety of ways, from clinical and research studies to supporting personal stories and awareness raising pieces in the arts. In early 2022, we promoted the UK tour of “after birth”, a play written by Zena Forster and directed by Grace Duggan. APP had supported the development of this comedy which is deeply rooted in the real-life testimonies of women within the APP network. APP storyteller, Lobeh, wrote a review of “after birth” for Mental Health Today,

3 https://www.itv.com/news/tyne-tees/2022-05-13/i-wouldnt-be-where-i-am-without-specialist-care-andsupport?utm_source=NewsApp&utm_medium=SocialShare

4 https://metro.co.uk/2022/06/28/i-was-sectioned-just-10-days-after-my-daughter-was-born-16560551/

5 https://www.instagram.com/p/Cf6xqNEjVJC/

6 https://www.mirror.co.uk/news/health/new-mums-being-failed-devastating-27383358

7 https://www.lancashiretelegraph.co.uk/news/20108976.lancashire-mums-praise-local-mental-health-service-followingperinatal-struggles/

8 https://www.goodto.com/family/pregnancy/postpartum-psychosis-283244

9 https://www.hulldailymail.co.uk/news/uk-world-news/mums-postpartum-psychosis-made-believe-6616882

10 CNN As Equals maternal mental health roundtable discussion

11 https://www.hellomagazine.com/healthandbeauty/mother-and-baby/20220509138214/laura-dockrill-honest-accountpostpartum-psychosis/

12 https://www.yahoo.com/lifestyle/postpartum-psychosis-mental-illness-mother-forgot-had-baby162330690.html?guccounter=1

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after watching it at London’s Omnibus Theatre.[13] The play was highly commended in the University of Oxford Vice-Chancellor's Innovation and Engagement Awards, being recognised by the awards for its work to engage with maternal mental health research through theatre.[ 14]

In 2022, staff and volunteers continued working with Company Four on the development of a theatre piece based on an historic account of postpartum psychosis, taking part in research and development days in the north of England.[15] Gemma Whiteley, one of the founders of Company Four said:

“Working with real experiences and voices of people from the APP network, we developed performance material and shared this with an invited audience for feedback. We used performance and audio recordings and puppetry, and we’re now looking at how to take the story further, so we are seeking a commitment from a venue to host a production, and funding to produce it as a fulllength piece. It can be a long process putting on a production, but it’s also been an exciting and lifechanging process – I’ve really changed the way I feel about motherhood and speaking to the women and them sharing their stories with me is something I’ll always hold close to my heart.”

APP also supported Lauren-Nicole Mayes, a writer and actress from Blackpool, with research for her screen play BABYNUN X0, which explores postpartum psychosis. With support from Arts Council England and The Lowry in Salford Quays, Lauren began a five-day research and development period. In April, APP was invited to attend a “scratch” performance of a short theatre piece at The Lowry. We were able to provide feedback on the piece and look forward to further work towards a completed performance in the future. In October we collaborated with Sampad, South Asian Arts to host a screening of No Bond So Strong - a film that addresses perinatal mental health encompassing pre and postnatal depression and postpartum psychosis – followed by a Q&A. We also continued to support the development of the Good Enough Mums Club, a musical produced, written, directed and performed by mums. Finally, APP volunteer, Danielle shared her PP story with BBC investigative journalist Stacey Dooley for her latest book, Are You Really OK? published by BBC books.[16] Danielle’s story forms part of a wider collection of firstperson stories about mental health. It includes positive stories of recovery to inspire and offer hope.

We continued to use social media to provide peer support in a variety of ways, running live events and activities online for volunteers and beneficiaries - for example our regular book club – and ensuring that there was always a trained peer supporter monitoring our social media to provide support and signposting to anyone needing help who commented or messaged us. We used social media to promote our online café groups, online volunteer meetups and community activities. In July, APP’s book club read Alison Cobb’ ~~s~~ “A Secret Never to be Told” and we interviewed her about her story for our website discovering how the stigma surrounding mental illness almost prevented her from meeting her own mother who developed postpartum psychosis after Alison’s birth in the 1930s.

Our social media followers increased by 10 percent across all platforms, from 22,375 to 24,683. Our total social media reach was 1,052,295 (2021: 2,469,054). Our reach is lower than previous years. This however seems consistent with the findings of other charities who use organic reach rather than paid-for advertising and seems to be driven by platforms trying to increase paid advertising. We have set aside a new budget for social media advertising for 2023. Newsletter engagement increased with an open rate increase from 30% in December 2021 to 38% in December 2022. The number of emails delivered peaked at 1,923 in July 2022 with 320 click throughs in October 2022. We had 116,647 website hits (2021: 132,833), including 6,398 views of our Insider Guides web page (2021: 6,448); we believe the decline in hits is due to increased search competition. We supported 34 national and regional media stories in 2022 and shared these across our four main social media channels.

13 https://www.mentalhealthtoday.co.uk/blog/parental-mental-health/an-exploration-of-motherhood-and-postpartumpsychosis-reviewing-afterbirth

14 https://www.npeu.ox.ac.uk/news/2292-after-birth-play-highly-commended-in-vice-chancellor-s-innovation-andengagement-awards

15 https://www.companyfourmcr.co.uk/untitled-rd-who-is-your-mummy-and-where-did-she-go.html

16 https://www.app-network.org/uncategorized/apps-danielle-thomas-shares-her-story-with-stacey-dooley/

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Campaigning for improved services

In 2022, we used our specialist expertise and lived experience voice to work towards change in systems that are important to women and families affected by postpartum psychosis, with a particular focus on campaigning for women throughout the UK to have access to a Mother and Baby Unit (MBU), and developing our campaign for PP to be an essential part of all antenatal class training. PP must be managed as a medical emergency for the safety of both mother and baby. APP continues to raise awareness of PP and campaign for improved services because each year, babies lose a mother and families are bereaved, when the fact is, PP is a treatable illness and full recovery is possible. In 2022, an inquest into the tragic death of Orlaith Quinn, due to postpartum psychosis stated that her death was “both foreseeable and preventable”. Coroner Maria Dougan recommended that a specialist mental health Mother and Baby Unit (MBU) should be established in Northern Ireland as a matter of urgency. The findings of the Confidential Enquiry into maternal deaths 2018-20 noted that that deaths of women with psychosis continued to be lower than in the early part of the century:

“ In keeping with the general trend in recent Enquiry reports, there is a relative absence of women suffering from psychosis amongst those who died … which had been a feature in the reports in the first decade of this century ”1(Knight et al, 2022: 31). Whilst this is encouraging evidence of APP’s UK impact, early evidence suggests that deaths due to PP are again on the increase in the post-pandemic period. Unusually in late 2022, we were supporting three separate families who had been recently bereaved. In 2023 we will have discussions and examine national datasets to determine the cause of this increase and actions needed.

Mother & Baby Unit campaign

The first stage of APP’s Northern Ireland MBU campaign was launched in May 2022. Staff and volunteer storytellers spoke to journalists throughout Northern Ireland, on TV, radio and in the press to demonstrate the need for a Mother and Baby Unit (MBU) in Northern Ireland:

• APP’s Policy and Campaigns Coordinator, Naomi, was interviewed on BBC Radio Foyle’s Breakfast show and BBC Radio Ulster’s Good Morning Ulster.

• APP Chief Executive, Dr Jess Heron, discussed the need for an MBU in Northern Ireland in the Irish News.[17]

• One of our Storytellers shared her experience of PP with UTV, also calling for a Northern Ireland MBU.[18]

• APP-led article in The Mirror[19] and 2-page spread in-paper in the Sunday People, featuring a number of diverse experiences, including Joanne, our first Northern Irish story.

• APP’s National Peer Support Coordinator, Ellie Ware, and psychiatrist Dr Keira Walsh were interviewed on The Lynette Fay Show on BBC Radio Ulster.

We partnered with Northern Ireland charity the Maternal Advocacy and Support Unit (MAS) and built a coalition of nearly 40 charities and organisations calling for a MBU in Northern Ireland. On World Mental Health Day in October 2022, we presented an open letter to the NI Health Minister Robin Swann signed by all 40 organisations to ask him to urgently prioritise setting up a Mother and Baby unit. A short film was created to show the presentation of the letter.[20]

We worked with our Northern Ireland regional rep volunteer, Oorlagh Quinn, to develop and promote a public petition calling for a MBU for NI, which received nearly 6,000 signatures. The petition was presented

17 https://www.irishnews.com/news/northernirelandnews/2022/05/27/news/orlaith-quinn-death-specialist-mental-healthmother-and-baby-unit-badly-needed-2724720/

https://www.irishnews.com/news/northernirelandnews/2022/06/16/news/postpartum-psychosis-support-group-to-have-firstmeeting-2744177/

18 https://www.itv.com/news/utv/2022-06-14/new-mum-suffering-psychosis-heard-voices-saying-youre-going-to-kill-your-baby

19 https://www.mirror.co.uk/news/health/new-mums-being-failed-devastating-27383358

20 https://www.youtube.com/watch?v=oZ6Kq0AaB2c

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alongside the letter to ministers. It was supported by a large group of mums, showing the strength of public support for an MBU. Oorlagh can be seen talking about the petition in this extract from the above film.[21]

We continued campaigning work in Wales and Scotland, including:

• APP’s storytellers Danielle and Barbara took part in 'Unit of Hope' a programme about postpartum psychosis, the campaign that led to the opening of the Uned Gobaith MBU in South Wales and how they participated in the design of the unit on BBC Radio Wales.[22]

• APP’s storyteller Nia wrote in The i Paper about her experience of travelling from North Wales to Manchester to access the MBU care she needed.[23]

• APP’s Chief Executive, Dr Jessica Heron and National Training Coordinator, Dr Sally Wilson, joined the speaker panel in a filmed one-year anniversary celebration of the opening of Uned Gobaith, the South Wales MBU. Welsh Assembly Members joined the event and reconfirmed their commitment to supporting a North Wales unit.

• Continuing involvement in Wales perinatal networks, the All Wales PMH Steering group, All Wales PMH Board and Communities of Practice.

• Participating in the Scottish government’s consultation on options to increase Mother and Baby Unit (MBU) capacity, providing evidence and quotes from our Scottish volunteers about the importance of a unit in the north of Scotland.

• APP’s media consultant, Lucy Nichol wrote a piece for The i Paper about MBUs: A lack of NHS beds will force mothers away from their babies.[24]

• Submitting evidence to the Senedd Cymru / Welsh Parliament Health & Social Care Committee consultation on Mental Health Inequalities.[25]

We continued to work in collaboration with the Betsi Cadwaladr University Health Board to develop services for women in North Wales. APP will be involved in the development process for the new Cheshire MBU in 2023[26] which will significantly reduce travel times for patients and families from across North Wales and will have Welsh language provisions. We will seek to continue amplifying the voices of women and families from North Wales to ensure their voices are heard.

Finally, we presented the initial findings of our 10-year survey on experiences of care for PP in the UK at the International Marce Society Conference in September 2022 (see Research below for more information). Further analysis of the data will be used to support our ongoing MBU campaigning.

Antenatal Campaign

In May 2022 we launched our campaign for information about postpartum psychosis to be shared at every antenatal class in the UK. We promoted our YouGov survey findings showing that only 6% of women report having received information about PP at their antenatal classes. We invited midwives and antenatal class providers to complete a survey into how providers feel about discussing PP with expectant parents. We also asked antenatal class providers to share what resources they need from APP to feel confident in giving this information to expectant parents. The results of our survey were presented at the International Marce Society Conference and a variety of midwifery and other conferences. In 2023 we will work with women, families, midwives and educators on a web resource and media campaign aimed at antenatal class providers to support them to give the correct information.

21 https://www.facebook.com/watch/?v=108551882223367

22 https://www.bbc.co.uk/programmes/m00159hr

23 https://inews.co.uk/opinion/post-partum-psychosis-mother-baby-postcode-lottery-1621961

24 https://inews.co.uk/opinion/lack-nhs-beds-force-mothers-babies-christmas-2038862

25 https://business.senedd.wales/documents/s123797/MHI%2045%20-%20Action%20on%20Postpartum%20Psychosis.pdf

26 https://bcuhb.nhs.wales/news/health-board-news/new-unit-set-to-transform-mental-health-experience-for-new-andexpectant-mums/

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Research

APP facilitates research, supports lived experience consultancy, and helps disseminate findings, ensuring evidence-based information is accessible to women, families, and health professionals. We continue to work closely with researchers at the National Centre for Mental Health (NCMH) at Cardiff University. In 2022 we supported the following large-scale studies from the NCMH:

• Cross Cultural study of Motherhood and Mental health (MAM-CC)

• Mums and Mental Health (MaM) study: postpartum psychosis cohort

In 2022, APP supported 42 research projects into postpartum psychosis across a variety of UK universities, including:

• University of East Anglia: New psychological intervention to support women and families who have experienced postpartum psychosis

• Institute of Mental Health, University of Birmingham: An investigating of the role of sleep in triggering postpartum psychosis

• Royal Holloway, University of London: Understanding beliefs and emotional experiences following postnatal mental health difficulties.

• University of Sheffield: Research to improve care for women with severe mental illness

• Coventry University: Hallucinations in early motherhood study.

In February 2022, we announced the news that APP is joining and being hosted by Birmingham University’s new Institute for Mental Health (IMH) – an inter-disciplinary research hub. Towards the end of 2022, we started to streamline the research process to support studies that align with APPs strategies and focus. Moving into 2023, APP will be supporting studies in the following areas, from larger research groups, that have potential for funding opportunities;

• Genetic and clinical studies related to bipolar and postpartum psychosis

• Evidence based psychological therapies for recovery from postpartum psychosis

• The role of sleep in postpartum psychosis

• Care and services for those affected by postpartum psychosis

• Drug discovery studies

• Experiences of postpartum psychosis in those from Black, Asian and ethnic minority backgrounds

During Maternal Mental Health Awareness Week in May, NCMH and APP hosted a webinar entitled ‘Understanding Postpartum Psychosis’ with leading researchers in the field and women with lived experienced of PP. Over 200 people attended the webinar live, with thousands more subsequently viewing it on You Tube.[27]

We had launched our survey on experiences of care in autumn 2021 and 350 women with experience of postpartum psychosis in the last 10 years completed the survey. The survey results will help us to understand: the impact of APP’s work and campaigns over the last decade; and how differences in the types of care women receive for postpartum psychosis impacts on their experiences and recovery outcomes. The survey data was analysed in 2022 to assess and compare recovery and care outcomes in women cared for in MBUs and on General Units, and to inform APP’s future work and objectives. The results showed that, as with our 2010 survey, women cared for in MBUs report much better outcomes than those admitted to general psychiatric units. We found that care in both groups had considerably improved since 2010, with more women admitted to MBUs and fewer to mixed sex general wards; women reported that staff in both groups are better informed than they were prior to 2010, and that women feel safer during care for PP than those admitted prior to 2010. We presented the initial findings of our survey on experiences of care at the International Marce Society Conference in September 2022. Further analysis and reporting will be undertaken in 2023.

A team from APP attended the International Marce Society for Perinatal Mental Health conference in London, which brings together researchers, clinicians and those with lived experience of perinatal mental illness from around the world to share research and learning. APP aimed to raise the profile of postpartum

27 https://www.youtube.com/watch?v=Oy_FWgcSTj0

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psychosis in the perinatal research community and promote the voices of lived experience, influencing research of importance to women and families. APP participated in two symposiums:

• What do women and families need from perinatal mental health services? This session was chaired by Dr Clare Dolman (APP trustee) and featured our brilliant ambassador Laura Dockrill, who powerfully and beautifully shared her personal experience of PP, as well as our National NHS Contracts Coordinator, Hannah Bissett, speaking about the value of peer support in perinatal services. They were joined by Dr Henry Fay on video– a former GP with experience of PP as a partner, and trustee of the Maternal Mental Health Alliance.

• Postpartum psychosis: strategies and collaborations to increase knowledge, address stigma and improve care globally. This session was chaired by our CEO, Dr Jess Heron, and featured discussion from Hannah Bissett as well as Dr Sally Wilson, APP’s National Training and Research Coordinator. We shared APP evaluations showing: that care for PP has improved considerably in 10 years; that women admitted to MBUs have better outcomes than those separated from their baby in General Psychiatric Units; that peer support is essential and life-saving during recovery; and the impact of our co-produced and co-delivered health professional training on clinical practice, empathy and knowledge. We discussed the impact of each project, exploring the ingredients for lasting impact, lessons learned, and how this learning might be used to influence care for women and families affected by PP globally .

Dr Heron said: “It was great to be at conferences again, raising the profile of postpartum psychosis in the perinatal research community. The weeklong academic conference is a valuable opportunity for us to hear from world leading experts about their cutting-edge work. The voices and values of the Third Sector and lived experience play an important role in scientific conferences, helping translate the evidence base into practice, reducing stigma, and influencing research of importance to women and families."

In 2022, we developed our website content on the menopause[28] highlighting what is known about the risks of mental ill health during perimenopause for women with experience of PP. Capacity constraints meant that we didn’t launch our survey on research gaps and work on guidelines for researchers. Ongoing discussions with NCMH about engaging our community in research participation led to a project for 2023 to improve the processes needed to build APP’s research register and promote engagement with research.

Fundraising and strengthening our capacity

The aftermath of the coronavirus pandemic, together with the cost-of-living crisis and challenges faced by the NHS, continued to have an impact on APP in 2022. The pandemic has impacted the nation’s mental health, and this is especially true of women with a history of postpartum psychosis or bipolar disorder. Existing mental health problems are being exacerbated, and more women in our community are experiencing relapses. For APP’s staff and volunteers, all of whom are parents themselves and many of whom have a history of psychosis or bipolar disorder, 2022 continued to be challenging. APP supported them by offering flexible working and focusing more management time on overseeing wellbeing, pastoral care and training. Unlike 2020 and 2021, we didn’t need to change our plan for the year in 2022 but certain activities were delayed as staff capacity was reassigned to cover staff sickness, towards the most urgent and important tasks. A new mobile friendly website template was developed ready to be launched in 2023, however the review of website content was ongoing. Groundwork for future international growth was also delayed, but we attended the International Marce Society conference, enabling us to meet international researchers (see research above) and we began working with groups in Italy, Spain, Thailand and Malta on translations and cultural adaptations of APP Insider Guides.

We continued to improve our staff and volunteer training and development, particularly the sessions offered to peer support staff and volunteers, and to seek opportunities for staff to participate in training and events relevant to their roles and new areas of work we are developing. We were part of the Media Trust Headlining Mental Health training programme. On 25 May, APP's Jessie (APP Marketing and Digital Communications Coordinator), Lucy (APP Media Consultant) and Naomi (APP Policy and Campaigns Coordinator) were given the opportunity to take part in the Media Trust 'Headlining Mental Health Charity Challenge Day 2022'. For one full day, they had the support of a dedicated group of PR and media industry

28 https://www.app-network.org/what-is-pp/getting-help/postpartum-psychosis-and-the-menopause/

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experts from the creative agency HAVAS to work on APP's antenatal education campaign, identifying ways to increase its reach and impact.

A fundraiser was recruited in the early part of 2022 and started in post in mid-March. They completed an audit of current income streams and worked to revamp our existing fundraising strategy to ensure income streams can be maximised. We also recruited an administrator with data management skills who has streamlined systems and processes in fundraising and many other areas of the organisation. Improved processes have been put in place to support and steward individual donors. We plan to build on this further in 2023.

We developed our strategies for supporting and retaining individual fundraisers and had some fantastic amounts of money raised. We were successful in our applications to the Big Give Women and Girls Fund and the Christmas Challenge, which enabled us to run match funding campaigns in July and December. July’s month-long campaign raised more than £11,000 and a week-long December campaign raised nearly £5,000. We also made a successful application to Charity Job’s annual giving fund - more than 700 charities applied and only seven were chosen to receive funds – receiving a £15,000 unrestricted grant. We developed our Big Bake fundraising campaign – a way to raise awareness and funds through cake based social events, with healthcare settings and individuals getting involved. This raised £2,000, with one of our peer supporters on our Birmingham NHS project, Jenni, raising around half of this amount at a coffee morning she organised in Birmingham.

We continued to grow our Miles for Mums and Babies fundraising campaign. Each mile reflects the journey mums, babies and families travel to be together, whilst mums receive care in Mother and Baby Units (MBUs). Many fundraisers told their own stories to help raise awareness, whilst three Mother and Baby Unit staff teams also took part this year. Fundraisers and their chosen challenges included:

• To mark 10 years since she was admitted to an MBU with PP, APP’s National Peer Support Coordinator, Jenny, and her family raised more than £2,500 in July. Her initial target was to jog and walk 37 miles during the month, the distance from her home to the MBU. But then she got some family members involved and between them they covered 375 miles through running, walking and swimming. The 375-mile distance reflects five return journeys from Jenny’s home to the MBU in Stafford, a journey travelled by her husband every day during her stay.

• Trichana had PP after the birth of her son in 2014, having never heard of the illness before. She chose to run 300km over a period of six months to help other mums affected by PP and raised more than £500.

• APP volunteer Tara had PP after the birth of her daughter and chose to cycle 10 kilometres every day in May 2022.

• A team of 17 staff members from Uned Gobaith MBU in Swansea Bay covered 1,000 miles between them during the month of May raising more than £1,200. In their first week they covered more than 300 miles, initially doing the most miles separately but they went on to organise a series of group walks - with a team even making it to the top of Pen Y Fan - the highest peak in South Wales.

• A team of 30 staff from Chamomile MBU in Birmingham climbed Yr Wyddfa (Snowdon) in June, raising nearly £3,000. They said “ APP (Action on Postpartum Psychosis) has provided irreplaceable support to our ward during a time of staffing crisis offering peer support to instil hope into our recovering families and providing recovery-based activities. Postpartum psychosis is a lifethreatening condition that can have detrimental impacts on mothers, babies and families and we would like to support APP in their mission to increase awareness to enable families to get support early and save lives ”[29]

• A team from Clover MBU in Winchester covered 428 miles during November, representing the distance that one of their mothers and her family had to make to receive care.

We are very grateful to all our individual fundraisers who have found creative ways to fundraise and increase awareness. We’d particularly like to thank our Royal Parks Half Marathon and London Marathon runners, Jamie, Sarah, Steve, Debbie, Vanessa and Sara who raised almost £10,000 between them, and

29 https://www.justgiving.com/fundraising/chamomile-mbu

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finally Alice Stroud who completed her triathlon challenge in 2022 having never done a triathlon before starting fundraising for APP. Alice said:

“Last year I completed five triathlons in support of APP finishing with an Olympic distance at the London Tri. The experience of the support and hugging my daughter at the end and being reminded how far I’ve come in recovery was incredible.”

Financial Review

The Statement of Financial Activities on page 26 shows APP’s income and expenditure for the year. During the year ended 31 December 2022, expenditure exceeded income by £72,413. These net outgoing resources are primarily the result of the planned spending down of funds in several areas: £24,078 had been designated by the Trustees to complete organisational transformation work to respond to APP’s growth; whilst £8,631 and £25,821 had been designated by the Trustees to complete planned work in Morpeth and the Black Country respectively. In our Unrestricted Funds, expenditure exceeded income by £70,975. Income from charitable activities decreased, reflecting contract income received in 2022 for work in Morpeth and the Black Country, decreased grant income with the Comic Relief Peer Support Project coming to an end, but offset by increased income from training health professionals. Income from donations increased, particularly corporate and major donor donations and as a result of our two Big Give match funding campaigns. In our restricted funds expenditure exceeded income by £1,438, reflecting the expenditure of funds carried forward from the prior year for peer support which was offset by a £4,000 grant received at the end of 2022 for peer support for Dads and Coparents in 2023.

The Balance Sheet on page 27 shows that at 31st December 2022, APP was holding £ 118,049; of which £4,000 was restricted funds. APP’s reserves policy is to hold three months core operating costs in reserve to guard against fluctuations in income. At the end of the 2021 financial year, the Board deemed three months core operating costs to be in the range of £110,000 to £120,000. On 1st January 2022, APP was holding £126,494 in free reserves, which was slightly above the range then recommended by our reserves policy. On 31st December 2022, APP was holding £114,049 in free reserves, which was within the range then recommended by our reserves policy. (£110,000 - £120,000). The Board continues to review the appropriate reserves level and take steps to keep the funds held in line with that.

Structure, Governance and Management

Action on Postpartum Psychosis was incorporated as a Company Limited by Guarantee on 10th December 2010. It is governed by its Articles of Association, amended by special resolution in 2012 and 2018. The charity arose from a research network within the University of Birmingham Medical School and is still hosted by the University of Birmingham today. The University provides office space, expert time, infrastructure and resources to the charity. We are co-hosted by the Birmingham and Solihull Mental Health Foundation NHS Trust and the University of Cardiff National Centre for Mental Health, who provide expert time and resource support for the charity.

APP’s Board of Directors/Trustees is made up of women with personal experience of postpartum psychosis; world-leading clinical and academic experts in postpartum psychosis; and individuals with specific skills relevant to the management of a charity. Dr Jessica Heron is APP’s Chief Executive and manages the running of the charity. Her time for this is bought by the charity from the University of Birmingham. Operational plans and all major strategic decisions are discussed and agreed by the Board of Trustees.

Directors/Trustees are recruited through advertising and networking and appointed in a general meeting or by the other directors at a Board meeting. New Directors/Trustees are inducted and trained through meetings with the Chair, Chief Executive and members of staff, as appropriate to their particular area of expertise, and provided with a pack of background information about the charity. A skills audit has been undertaken and efforts are made to recruit Trustees who meet the skills requirement. In 2016, the Board agreed to aim towards a leaner Board, with all the skills necessary to the functioning of the charity. During 2022, one Board member resigned, and a new Board member was appointed in early 2023.

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ACTION ON POSTPARTUM PSYCHOSIS

TRUSTEES' REPORT FOR THE YEAR ENDED 31 DECEMBER 2022

APP is part of the Maternal Mental Health Alliance and seeks to support and collaborate with the Alliance in campaigning for better perinatal mental health services; this does not impact on the charity’s operating policies.

Risk management

The Trustees consider the principal risks to which the charity is exposed, and the systems in place to mitigate those risks. The Chief Executive reports the most substantial inherent risks, together with any significant emerging risks, and the control measures in place to Trustees at each Board meeting.

Financial risk: The Trustees have identified that financial sustainability is the major financial risk to the charity. The political climate for small charities is tough, demand for services is high, and capacity pressures impact on income generation. Since 2017, a new fundraising strategy has been implemented to improve sustainability and diversify our funding base, whilst in 2021 we began recruiting for a dedicated fundraising role. Internal financial management risks are reduced by the implementation of procedures for authorisation of all transactions. Budgets are set for all major areas of expenditure, and adjustments are reviewed by the Board.

Non-financial risks: The Trustees have focussed attention on mitigating non-financial risks such as safeguarding, health and safety, lone working, operational and legal risks, with different risks assigned to members of senior staff or Board of Trustees. For each new area of operation (for example peer support contracts), the financial, legal, health and safety, operational and reputational risks are reviewed by senior staff and the Board of Trustees, to determine new policies and procedures needed, training and information needed by Managers, Coordinators and Volunteers, and additional external advice and support needed.

Key risks facing the organisation in 2022 were financial sustainability, management capacity and operational risks, in particular high rates of mental health relapse in staff and volunteers (80 percent of APP’s staff, and all volunteers have personal experience of PP and/or ongoing bipolar disorder. In the post pandemic period, we have seen increased rates of mental illness throughout the UK – and this is particularly the case for those with previous diagnoses). Financial sustainability was addressed by: frequent reviews of forecast income and expenditure by the Board; developing plans for increasing income and cutting costs; reviewing our fundraising strategy and stewardship of supporters; and carefully planning and budgeting for 2023. Management capacity risks were addressed though utilising the skills of new staff members to improve systems and processes, and contracting administrative support to fill a vacant post until recruiting a new administrator with project management skills. We continued to actively network to seek Board members to fill the identified skills gaps, with new board members joining in 2023. Operational risks arising from mental health relapse were addressed through: continuing to agree new flexible working patterns, prioritise and reassign work; holding regular meet-ups with staff, contractors and volunteers to provide pastoral care and support; reviewing staff Wellbeing Plans and increasing staff capacity, in particular casual peer support workers who can work additional hours at short notice.

Plans for Next Year

Action on Postpartum Psychosis plans for 2023 were grouped under the following objectives:

1. Supporting women and families. We plan to maintain and grow our national and regional peer support service by:

• Maintaining our strong peer support presence, offering online, in person, video call and café group support to all who need it nationally and via our NHS projects, and maintaining long term contact with those we support.

• Continuing to: train new peer supporters, prioritising volunteers from diverse communities and project regions; and develop the ongoing training programme and activities for volunteers, holding six evening training sessions and offering online social and wellbeing activities.

• Seeking funding to maintain and grow our peer support offer for dads, co-parents and grandparents through one-to-one support and online meet ups.

• Seeking funding to maintain and grow our peer support for women and families from diverse communities.

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ACTION ON POSTPARTUM PSYCHOSIS

TRUSTEES' REPORT FOR THE YEAR ENDED 31 DECEMBER 2022

• Maintaining high-quality service delivery and good functioning of existing NHS partnership contracts and seeking to add new NHS contracts to the APP portfolio, particularly those with APP staff embedded in MBUs.

• Finalising the translation of APP’s guides into the first five languages and obtaining funding for further translation and international partnerships.

• Continuing work to review our journey for beneficiaries, volunteers and fundraisers.

• Raising awareness amongst health professionals. We plan reach more health professionals with training by:

• Continuing to offer online bookable one-day training and NHS commissioned in-person training days.

• Developing training in specialist areas, for example supporting dads and co-parents, and working with women from diverse backgrounds.

• Continuing collaborations with the Institute of Health Visiting (iHV) and other professional bodies, training, supporting and developing resources for Lived Experience speakers.

• Raising awareness amongst the general public . We plan to raise awareness in the general public to reduce stigma and misinformation by:

• Developing media and communications for the main ‘moments’ across the year (for example Maternal Mental Health Awareness Week, Black Maternal Mental Health Week, World Mental Health Day, and Suicide Awareness Week); placing case studies in the media and social media to support APP campaigns, new projects, and to raise awareness of APP peer support, training and information resources.

• Continuing our diverse communities outreach work: promoting understanding of PP in all cultures and raising awareness of APP’s peer support; supporting sessional staff and volunteers to take part in social media activities and tell their stories in the media; linking with MBU professionals from diverse communities for communications pieces, and seeking funding for a staff member who could lead this area of our work.

• Continuing the development of our new website.

• Campaigning. Our goal is that all women and families in the UK have access to the services they need to get help and recover from PP. We plan to use our specialist expertise and lived experience voice to create change in systems, by:

• Continuing APP’s MBU campaign, with a particular focus on an MBU for Northern Ireland: calling for urgent action for MBUs for NI, North Wales & the north of Scotland; developing communications to showcase the value of MBUs and positive MBU stories; and continuing analysis of our MBU survey data.

• Continuing APP’s antenatal education class campaign: developing web content from the antenatal provider survey outlining why talking about PP is important, sharing what women and families need to know; building on previous social media and media work to raise awareness of the campaign.

• Research. We will continue to facilitate research studies of importance to women and families affected by postpartum psychosis, as capacity and funding allows, by

• Finalising APP’s Impact Report and MBU survey reports.

• Completing a research gaps survey and promote findings to universities/funders.

• Developing a plan and costings to support APP’s involvement in research and seeking funding to support APP as research resource.

• Publishing the drafted ‘Being A Parent’ Guide in electronic format and in hard copy once funds secured.

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ACTION ON POSTPARTUM PSYCHOSIS

TRUSTEES' REPORT FOR THE YEAR ENDED 31 DECEMBER 2022

1. Strengthening our capacity to fulfil our charitable objectives. We plan to strengthen our internal systems to support sustainable growth by:

2. Developing the data manager role and implementing a data project to simplify data collection and develop simpler cloud-based data recording system.

3. Continuing to develop and improve user journey and functionality of the updated APP website.

4. Continuing work supporting coordinators’ development as project managers, with work on business planning, reporting & budget responsibilities.

5. Continuing development as gold standard lived experience, family friendly employer.

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ACTION ON POSTPARTUM PSYCHOSIS

TRUSTEES' REPORT FOR THE YEAR ENDED 31 DECEMBER 2022

APP’s Board

APP is governed by its Board of Directors/Trustees, which remains a mix of women with lived experience of postpartum psychosis, academic researchers, clinicians and trustees with specific skills (e.g. grant fundraising and health economics). Directors/Trustees during 2022 were as follows:

Dr Giles Berrisford Chair Annette Bauer Treasurer Catherine Cho (appointed 30[th] March 2023) Dr Clare Dolman Sarah Hind Anna Jones Vice Chair Professor Ian Jones Abbie Sampson (resigned 5[th] October 2022)

There have been no other changes to the Board of Directors/Trustees.

Public Benefit Statement

Under its Articles of Association, the objects for which Action on Postpartum Psychosis is established are: to promote and protect the physical and mental health of women who have experienced postpartum psychosis and their families through the provision of support, education and practical advice; to advance the education of the public in general (and particularly amongst health professionals) on the subject of postpartum psychosis and to promote research for the public benefit in all aspects of that subject and to publish the useful results; and to advocate for perinatal mental health services for women and their families. The Trustees confirm that they have referred to the guidance contained in the Charity Commission’s general guidance on public benefit when reviewing the organisation’s aims and objectives and in planning future activities.

The identifiable benefits of APP’s work are that women and family members affected by postpartum psychosis are able to access support and information to improve their recovery, and that healthcare professionals and the general public are better informed about, and have more understanding of, this illness. A number of examples of benefit appear earlier in the report. These benefits are achieved through peer support, patient information development, health professional training, public awareness raising, research and campaigning. The only restriction is that individuals receiving peer support have suffered from postpartum psychosis or are a partner or family member of someone who has had the illness. There are no fees for the peer support service; a fee may be charged for health professional training and lived experience speakers.

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ACTION ON POSTPARTUM PSYCHOSIS

TRUSTEES' REPORT FOR THE YEAR ENDED 31 DECEMBER 2022

Trustees’ Responsibility Statement

The trustees (who are also the directors of Action on Postpartum Psychosis for the purposes of company law) are responsible for preparing the Trustees' Report and the financial statements in accordance with applicable law and United Kingdom Accounting Standards (United Kingdom Generally Accepted Accounting Practice) including Financial Reporting Standard 102 "The Financial Reporting Standard applicable in the UK and Republic of Ireland". Company law requires the trustees to prepare financial statements for each financial year which give a true and fair view of the state of affairs of the charitable company and of the incoming resources and application of resources, including the income and expenditure, of the charitable company for that period. In preparing those financial statements, the trustees are required to:

• select suitable accounting policies and then apply them consistently;

• observe the methods and principles in the Charity SORP;

• make judgements and estimates that are reasonable and prudent;

• prepare the financial statements on the going concern basis unless it is inappropriate to presume that the charitable company will continue in business.

The trustees are responsible for keeping proper accounting records which disclose with reasonable accuracy at any time the financial position of the charitable company and to enable them to ensure that the financial statements comply with the Companies Act 2006. They are also responsible for safeguarding the assets of the charitable company and hence for taking reasonable steps for the prevention and detection of fraud and other irregularities.

Approved by order of the board of trustees on ............................................. and signed on its behalf by:

.................................................................

A Bauer - Trustee

Page 24

INDEPENDENT EXAMINER'S REPORT TO THE TRUSTEES OF ACTION ON POSTPARTUM PSYCHOSIS

Independent examiner's report to the trustees of Action on Postpartum Psychosis ('the Company')

I report to the charity trustees on my examination of the accounts of the Company for the year ended 31 December 2022.

Responsibilities and basis of report

As the charity's trustees of the Company (and also its directors for the purposes of company law) you are responsible for the preparation of the accounts in accordance with the requirements of the Companies Act 2006 ('the 2006 Act').

Having satisfied myself that the accounts of the Company are not required to be audited under Part 16 of the 2006 Act and are eligible for independent examination, I report in respect of my examination of your charity's accounts as carried out under Section 145 of the Charities Act 2011 ('the 2011 Act'). In carrying out my examination I have followed the Directions given by the Charity Commission under Section 145(5) (b) of the 2011 Act.

Independent examiner's statement

Since your charity's gross income exceeded £250,000 your examiner must be a member of a listed body. I can confirm that I am qualified to undertake the examination because I am a member of the Institute of Chartered Accountants in England and Wales, which is one of the listed bodies.

I have completed my examination. I confirm that no matters have come to my attention in connection with the examination giving me cause to believe:

1. accounting records were not kept in respect of the Company as required by Section 386 of the 2006 Act; or

2. the accounts do not accord with those records; or

3. the accounts do not comply with the accounting requirements of Section 396 of the 2006 Act other than any requirement that the accounts give a true and fair view which is not a matter considered as part of an independent examination; or

4. the accounts have not been prepared in accordance with the methods and principles of the Statement of Recommended Practice for accounting and reporting by charities (applicable to charities preparing their accounts in accordance with the Financial Reporting Standard applicable in the UK and Republic of Ireland (FRS 102)).

I have no concerns and have come across no other matters in connection with the examination to which attention should be drawn in this report in order to enable a proper understanding of the accounts to be reached.

C L Moelwyn-Williams BSc FCA

TCA (Shrewsbury) LLP Third Floor 21 St Mary's Street Shrewsbury Shropshire SY1 1ED

Date: .............................................

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ACTION ON POSTPARTUM PSYCHOSIS

STATEMENT OF FINANCIAL ACTIVITIES (INCORPORATING AN INCOME AND EXPENDITURE ACCOUNT) FOR THE YEAR ENDED 31 DECEMBER 2022

Unrestricted funds Notes £ INCOME AND ENDOWMENTS FROM Donations and legacies 2 242,978 Charitable activities 5 General 228,621 Other trading activities 3 1,212 Investment income 4 86 Other income 25 Total 472,922 EXPENDITURE ON Raising funds 19,394 Charitable activities 6 General 524,503 Total 543,897 NET INCOME/(EXPENDITURE) (70,975) RECONCILIATION OF FUNDS Total funds brought forward 185,024 TOTAL FUNDS CARRIED FORWARD 114,049	Restricted funds £ 22,485 4,375 - - - 26,860 100 28,198 28,298 (1,438) 5,438 4,000	2022 Total funds £ 265,463 232,996 1,212 86 25 499,782 19,494 552,701 572,195 (72,413) 190,462 118,049	2021 Total funds £ 137,683 301,407 - 8 - 439,098 6,019 424,246 430,265 8,833 181,629 190,462

CONTINUING OPERATIONS

All income and expenditure has arisen from continuing activities.

The notes form part of these financial statements

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ACTION ON POSTPARTUM PSYCHOSIS (REGISTERED NUMBER: 07466643)

STATEMENT OF FINANCIAL POSITION 31 DECEMBER 2022

Notes FIXED ASSETS Tangible assets 12 CURRENT ASSETS Debtors 13 Cash at bank CREDITORS Amounts falling due within one year 14 NET CURRENT ASSETS TOTAL ASSETS LESS CURRENT LIABILITIES NET ASSETS FUNDS 16 Unrestricted funds: General Fund Designated Fund Restricted funds TOTAL FUNDS	2022 £ - 35,324 172,065 207,389 (89,340) 118,049 118,049 118,049 114,049 - 114,049 4,000 118,049	2021 £ 280 89,084 142,030 231,114 (40,932) 190,182 190,462 190,462 126,494 58,530 185,024 5,438 190,462

The charitable company is entitled to exemption from audit under Section 477 of the Companies Act 2006 for the year ended 31 December 2022.

The members have not required the company to obtain an audit of its financial statements for the year ended 31 December 2022 in accordance with Section 476 of the Companies Act 2006.

The trustees acknowledge their responsibilities for

• (a) ensuring that the charitable company keeps accounting records that comply with Sections 386 and 387 of the Companies Act 2006 and

• (b) preparing financial statements which give a true and fair view of the state of affairs of the charitable company as at the end of each financial year and of its surplus or deficit for each financial year in accordance with the requirements of Sections 394 and 395 and which otherwise comply with the requirements of the Companies Act 2006 relating to financial statements, so far as applicable to the charitable company.

The notes form part of these financial statements

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ACTION ON POSTPARTUM PSYCHOSIS (REGISTERED NUMBER: 07466643)

STATEMENT OF FINANCIAL POSITION - continued 31 DECEMBER 2022

These financial statements have been prepared in accordance with the provisions applicable to charitable companies subject to the small companies regime.

The financial statements were approved by the Board of Trustees and authorised for issue on ............................................. and were signed on its behalf by:

.............................................

A Bauer - Trustee

The notes form part of these financial statements

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ACTION ON POSTPARTUM PSYCHOSIS

NOTES TO THE FINANCIAL STATEMENTS FOR THE YEAR ENDED 31 DECEMBER 2022

1. ACCOUNTING POLICIES

Basis of preparing the financial statements

The financial statements of the charitable company, which is a public benefit entity under FRS 102, have been prepared in accordance with the Charities SORP (FRS 102) 'Accounting and Reporting by Charities: Statement of Recommended Practice applicable to charities preparing their accounts in accordance with the Financial Reporting Standard applicable in the UK and Republic of Ireland (FRS 102) (effective 1 January 2019)', Financial Reporting Standard 102 'The Financial Reporting Standard applicable in the UK and Republic of Ireland' and the Companies Act 2006. The financial statements have been prepared under the historical cost convention.

The accounts have been prepared in pound sterling, which is the functional currency of the charity, rounded to the nearest pound.

The charitable company has taken advantage of the relevant disclosure exemptions in preparing the financial statements, as permitted by FRS 102.

Income

All income is recognised in the Statement of Financial Activities once the charity has entitlement to the funds, it is probable that the income will be received and the amount can be measured reliably.

Expenditure

Liabilities are recognised as expenditure as soon as there is a legal or constructive obligation committing the charity to that expenditure, it is probable that a transfer of economic benefits will be required in settlement and the amount of the obligation can be measured reliably. Expenditure is accounted for on an accruals basis and has been classified under headings that aggregate all cost related to the category. Where costs cannot be directly attributed to particular headings they have been allocated to activities on a basis consistent with the use of resources.

Taxation

The charity is exempt from corporation tax on its charitable activities.

Fund accounting

Unrestricted funds can be used in accordance with the charitable objectives at the discretion of the trustees.

Restricted funds can only be used for particular restricted purposes within the objects of the charity. Restrictions arise when specified by the donor or when funds are raised for particular restricted purposes.

Further explanation of the nature and purpose of each fund is included in the notes to the financial statements.

Pension costs and other post-retirement benefits

The charitable company operates a defined contribution pension scheme. Contributions payable to the charitable company's pension scheme are charged to the Statement of Financial Activities in the period to which they relate.

Debtors

Prepayments are valued at the amount prepaid.

Cash and cash equivalents

Cash and cash equivalents include cash in hand and deposits held at call with banks.

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ACTION ON POSTPARTUM PSYCHOSIS

NOTES TO THE FINANCIAL STATEMENTS - continued FOR THE YEAR ENDED 31 DECEMBER 2022

1. ACCOUNTING POLICIES - continued

Creditors and provisions

Creditors and provisions are recognised where the charity has a present obligation resulting from a past event that will probably result in the transfer of funds to a third party and the amount due to settle the obligation can be measured or estimated reliably. Creditors and provisions are normally recognised at their settlement amount.

Financial instruments

The charity only has financial assets and liabilities of a kind that qualify as basic financial instruments. Basic financial instruments are initially recognised at transaction value and subsequently measured at their settlement value.

Derecognition of financial liabilities

Financial liabilities are derecognised when the company's contractual obligations expire or are discharged or cancelled.

Pensions

Payments to defined contribution retirement benefit schemes are charged as an expense as they fall due.

Going concern

At the time of approving the accounts, the directors have a reasonable expectation that the charity has adequate resources to continue in operational existence for the foreseeable future. Thus, they continue to adopt the going concern basis of accounting in preparing the accounts.

2. DONATIONS AND LEGACIES

Unrestricted funds £ Donations 242,978	Restricted funds £ 22,485	2022 Total funds £ 265,463	2021 Total funds £ 137,683

In the prior year, £137,683 of the income related to unrestricted funds and £nil to restricted funds.

3. OTHER TRADING ACTIVITIES

OTHER TRADING ACTIVITIES
			2022	2021
	Unrestricted	Restricted	Total	Total
	funds	funds	funds	funds
	£	£	£	£
Sale of literature	91	-	91	-
Income from Other Trading activities	1,121	-	1,121	-
	1,212	-	1,212	-

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ACTION ON POSTPARTUM PSYCHOSIS

NOTES TO THE FINANCIAL STATEMENTS - continued FOR THE YEAR ENDED 31 DECEMBER 2022

4. INVESTMENT INCOME

INVESTMENT INCOME
			2022	2021
	Unrestricted	Restricted	Total	Total
	funds	funds	funds	funds
	£	£	£	£
Bank interest	86	-	86	8

In the prior year, £8 of the income related to unrestricted funds and £nil to restricted funds.

5. INCOME FROM CHARITABLE ACTIVITIES

2022 £ Comic Relief – APP Peer Support Community Project - Other Trusts and Foundations 4,375 Government Grants – Coronavirus Statutory Sick Pay Rebate Scheme - Contract Income - Lancashire and South Cumbria NHS Foundation Trust 67,530 Contract Income - Birmingham and Solihull Mental Health NHS Foundation Trust 96,489 Contract Income - Black Country Healthcare NHS Foundation Trust 11,775 Contract Income - Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust 34,429 Workforce Training and Experts by Experience 18,398 Research contracts - 232,996 Total activities

2021 Total activities £ 32,452 2,500 128 67,530 96,614 48,050 29,998 8,925 15,210 301,407

In the prior year, £266,455 of the income related to unrestricted funds and £34,952 to restricted funds.

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ACTION ON POSTPARTUM PSYCHOSIS

NOTES TO THE FINANCIAL STATEMENTS - continued

FOR THE YEAR ENDED 31 DECEMBER 2022

6. CHARITABLE ACTIVITIES COSTS

General

Direct Costs (see note 7) £ 545,376	Support costs (see note 8) £ 7,325	Totals £ 552,701

In the prior year, £357,765 of the expenditure related to unrestricted funds and £66,481 to restricted funds.

7. DIRECT COSTS OF CHARITABLE ACTIVITIES

Staff and freelance costs Consultancy Project costs Travel Information materials and awareness raising Volunteer training & expenses Office and running costs Workforce training and experts by experience costs Bad debts Depreciation	2022 £ 397,032 68,993 914 18,555 30,160 1,330 27,885 32 195 280 545,376	2021 £ 304,339 62,887 320 9,704 11,806 1,167 26,070 127 - 400 416,820

8. SUPPORT COSTS

SUPPORT COSTS
		Governance
		costs
		£
General
Support costs, included in the above, are as follows:		7,325
	2022	2021
		Total
	General	activities
	£	£
Independent examiners fee	2,310	2,200
Accountancy fees	4,768	5,140
Other fees	247	86
	7,325	7,426

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ACTION ON POSTPARTUM PSYCHOSIS

NOTES TO THE FINANCIAL STATEMENTS - continued FOR THE YEAR ENDED 31 DECEMBER 2022

9. NET INCOME/(EXPENDITURE)

Net income/(expenditure) is stated after charging/(crediting):

	2022	2021
	£	£
Depreciation - owned assets	280	400
Surplus on disposal of fixed assets	(25)	-
Independent Examination Fee	2,310	2,200

10. TRUSTEES' REMUNERATION AND BENEFITS

There were no trustees' remuneration or other benefits for the year ended 31 December 2022 nor for the year ended 31 December 2021.

Trustees' expenses

There were no trustees' expenses paid for the year ended 31 December 2022 nor for the year ended 31 December 2021.

11. STAFF COSTS

The average monthly number of employees during the year was as follows:

Core charitable activity	2022 17	2021 14

No employees received emoluments in excess of £60,000.

The total remuneration and benefits paid to the key management personnel, to whom the Trustees delegate the day-to-day running of the charity was £42,824 (2021: £42,412).

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ACTION ON POSTPARTUM PSYCHOSIS

NOTES TO THE FINANCIAL STATEMENTS - continued FOR THE YEAR ENDED 31 DECEMBER 2022

12. TANGIBLE FIXED ASSETS

COST At 1 January 2022 and 31 December 2022 DEPRECIATION At 1 January 2022 Charge for year At 31 December 2022 NET BOOK VALUE At 31 December 2022 At 31 December 2021 13. DEBTORS: AMOUNTS FALLING DUE WITHIN ONE YEAR Trade debtors Other debtors Prepayments and accrued income 14. CREDITORS: AMOUNTS FALLING DUE WITHIN ONE YEAR Trade creditors Social security and other taxes Other creditors Accruals and deferred income

Office equipment £ 1,200 920 280 1,200 - 280 2022 2021 £ £ 23,686 79,492 - 96 11,638 9,496 35,324 89,084 2022 2021 £ £ 4,548 2,637 7,228 6,069 543 339 77,021 31,887 89,340 40,932

Deferred income includes income received during the period of £54,100 (2021: £16,883) which relates to services to be provided during the financial year ended 31 December 2023.

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ACTION ON POSTPARTUM PSYCHOSIS

NOTES TO THE FINANCIAL STATEMENTS - continued FOR THE YEAR ENDED 31 DECEMBER 2022

15. ANALYSIS OF NET ASSETS BETWEEN FUNDS

Unrestricted funds £ Fixed assets - Current assets 203,389 Current liabilities (89,340) 114,049 16. MOVEMENT IN FUNDS Unrestricted funds General Fund Designated Fund Restricted funds Other Peer Support Dad's & Co-parents Peer Support TOTAL FUNDS Net movement in funds, included in the above are as follows: Unrestricted funds General Fund Designated Fund Restricted funds Other Peer Support Dad's & Co-parents Peer Support Big Give Peer Support Digital Capacity Building Marce 2022 TOTAL FUNDS	Restricted funds £ - 4,000 - 4,000 At 1.1.22 £ 126,494 58,530 185,024 5,438 - 5,438 190,462 Incoming resources £ 426,718 46,204 472,922 - 4,000 16,235 375 6,250 26,860 499,782	2022 2021 Total Total funds funds £ £ - 280 207,389 231,114 (89,340) (40,932) 118,049 190,462 Net movement At in funds 31.12.22 £ £ (12,445) 114,049 (58,530) - (70,975) 114,049 (5,438) - 4,000 4,000 (1,438) 4,000 (72,413) 118,049 Resources Movement expended in funds £ £ (439,163) (12,445) (104,734) (58,530) (543,897) (70,975) (5,438) (5,438) - 4,000 (16,235) - (375) - (6,250) - (28,298) (1,438) (572,195) (72,413)

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ACTION ON POSTPARTUM PSYCHOSIS

NOTES TO THE FINANCIAL STATEMENTS - continued FOR THE YEAR ENDED 31 DECEMBER 2022

16. MOVEMENT IN FUNDS - continued

Comparatives for movement in funds

Unrestricted funds General Fund Designated Fund Restricted funds Comic Relief Covid Response Comic Relief Peer Support National Lottery - Leaders With Lived Experience Other Peer Support TOTAL FUNDS	At 1.1.21 £ 86,300 58,362 144,662 4,502 16,291 9,955 6,219 36,967 181,629	Net movement in funds £ 118,242 (77,880) 40,362 (4,502) (16,291) (9,955) (781) (31,529) 8,833	Transfers between funds £ (78,048) 78,048 - - - - - - -	At 31.12.21 £ 126,494 58,530 185,024 - - - 5,438 5,438 190,462

Comparative net movement in funds, included in the above are as follows:

Unrestricted funds General Fund Designated Fund Restricted funds Comic Relief Covid Response Comic Relief Peer Support National Lottery - Leaders With Lived Experience Other Peer Support Wales Peer Support TOTAL FUNDS	Incoming resources £ 404,146 - 404,146 - 32,452 - 500 2,000 34,952 439,098	Resources Movement expended in funds £ £ (285,904) 118,242 (77,880) (77,880) (363,784) 40,362 (4,502) (4,502) (48,743) (16,291) (9,955) (9,955) (1,281) (781) (2,000) - (66,481) (31,529) (430,265) 8,833

Unrestricted funds

The general reserve represents the funds of the charity which are not designated for a particular purpose.

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ACTION ON POSTPARTUM PSYCHOSIS

NOTES TO THE FINANCIAL STATEMENTS - continued FOR THE YEAR ENDED 31 DECEMBER 2022

16. MOVEMENT IN FUNDS - continued

Designated funds

In 2021, funds were designated for the Black Country and Morpeth peer support projects and the Organisational Transformation Fund, which have all been fully expensed during this financial year.

Organisational Transformation Fund

In 2019, Trustees designated £60,000 for organisational transformation work in 2020. Whilst significant progress was made, the impact of the pandemic meant some planned organisational transformation work was set aside. In planning for 2021, Trustees considered the constraints under which the Charity was operating in 2020 as the organisation expanded and the pandemic impacted upon capacity and priorities. Organisational transformation priorities were included in the 2021 plan and budget including: data management and financial forecasting systems; conducting a data security review; a ten-year impact project; website structure and content review; recruiting a fundraiser; and further developing APP's project management structure. The Trustees designated a further £25,000 to complete the work initially planned in 2020 and the new priorities added for 2021.

In 2021, the coronavirus pandemic continued to have a significant impact on APP: plans for the year were adapted; staff and resources were directed to peer support, signposting and disseminating information about PP and the support available. This reprioritisation meant that some organisational transformation work was delayed, in particular the website, CRM and impact report projects were running behind their original schedules at year end.

In 2022, the remaining designated organisational transformation funds allocated to complete these projects were spent in full.

Morpeth and Black Country Peer Support Fund

In December 2021, Trustees decided to designate the funds required for APP to meet its existing commitments to peer support projects in the Black Country and Morpeth. The funding for these projects to October 2022 and April 2022 had already been paid to APP, so Trustees felt it was important to set aside the funds to complete the agreed work. In 2022, the funds allocated were spent in full.

Restricted funds

Dads & Co-parents Peer Support

In December 2022, The D'Oyly Carte Charitable Trust made a grant of £4000 to support APP's Dads and Co-parents peer support project. This project connects dads and co-parents whose partner has PP with trained volunteers who have 'been there', via telephone, video call or email support. A monthly group video call for dads and co-parents provides a supportive and informal group for partners to meet others, share what has helped them and their family through the experience and provide a friendly listening ear. Our peer support staff and trained dad and co-parent volunteers also provide support on our online forum. The grant will be spent on this project in 2023.

Big Give Peer Support

APP successfully applied to the Big Give's Women and Girls Fund and their Christmas Challenge, which enabled us to run match funding campaigns in July and December. July's month-long campaign raised more than £11,000 and a week-long December campaign raised nearly £5,000 in donations and match funding. Both fundraising campaigns focused on APP's national peer support and the funds were used to support that work in 2022.

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ACTION ON POSTPARTUM PSYCHOSIS

NOTES TO THE FINANCIAL STATEMENTS - continued FOR THE YEAR ENDED 31 DECEMBER 2022

16. MOVEMENT IN FUNDS - continued

Digital Capacity Building

APP received a grant for digital capacity building of £375 from The Big Give. The grant was in addition to the match funding we received from their Women & Girls Match Fund for our July fundraising campaign. The grant was used to explore new ways using our social media to reach existing and potential new supporters.

Marce 2022

APP received a donation to support research into postpartum psychosis, particularly through APP participating in the biennial International Marcé Society for Perinatal Mental Health Conference, which was held in London in 2022. This would promote lived experience involvement in research and develop APP's global profile and networks. APP staff and volunteers with lived experience presented in two symposiums including presenting the impact of APP's work over the last decade, exploring the ingredients for lasting impact, lessons learned, and how this learning might be used to influence care for women and families affected by PP globally. The funds were used for conference and staff travel costs.

Comic Relief - Covid Response

In 2020, APP received a grant from Comic Relief co-funded from the Comic Relief 'The Big Night In' Match Fund - COVID Response through a partnership between Comic Relief and the Department for Digital, Culture, Media and Sport (the DCMS). The grant helped APP adapt our services to meet the needs of women and families suffering from postpartum psychosis during the pandemic: increasing our use of social media; developing our support for partners of women with PP; and working to understand and better meet the needs of diverse communities. The project ended in February 2021.

Comic Relief Peer Support and Other Peer Support

Our Comic Relief funded peer support project had ended during 2019. The Comic Relief grant for the APP Peer Support Community Project enabled our Peer Support Coordinators to support and manage APP's existing Peer Support Volunteers and train new volunteers to provide peer support to women and families affected by Postpartum Psychosis across the UK. In 2020, Comic Relief made an additional grant to APP to extend this project in 2020 and 2021. The grant was for the continued operation of APP's peer support services and the development of APP's digital information and support to adequately meet the need of pregnant women at risk of PP, families in crisis developing PP, and families recovering from PP during the Covid-19 crisis. The additional Comic Relief grant ended in November 2021. The Other Peer Support fund consisted of donations restricted to peer support activities.

tnlcf - Leaders with Lived Experience

APP was awarded a project grant from the Leaders with Lived Experience Programme of the National Lottery Community Fund (tnlcf). The project started in July 2019 and enabled APP to provide additional training and support to our three national programme leaders. Project activities would enable our staff to develop as vocal lived experience leaders and enable APP to pilot gold standard ways of supporting and sustaining lived experience leadership, informing APP's future work, and championing lived experience at all levels within our charity. The project was due to end in 2020, however some activities were delayed due to the coronavirus pandemic and the Fund agreed to extend the project into 2021. The National Lottery Community Fund also provided some additional COVID-19 funding under this grant in 2020 which enabled APP to employ and develop a fourth lived experience leader, to co-ordinate APP's marketing and digital communications work. The project ended in 2021.

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ACTION ON POSTPARTUM PSYCHOSIS

NOTES TO THE FINANCIAL STATEMENTS - continued FOR THE YEAR ENDED 31 DECEMBER 2022

16. MOVEMENT IN FUNDS - continued

Wales Peer Support

APP received a grant from the Gwendoline & Margaret Davies Charity in February 2021 to develop our peer support community and café groups in Wales. The grant enabled us to run our café groups in North Wales and South Wales, which met a total of 11 times throughout the year, both virtually and in person. mixture of virtual (video call) and in-person meet-ups. We now have 10 Welsh volunteers who support our PP awareness-raising work through lived experience talks and sharing their experiences in the media. The project ended in 2021.

17.

RELATED PARTY DISCLOSURES

Action on Postpartum Psychosis is hosted by the University of Birmingham. During 2022 Action of Postpartum Psychosis paid a hosting fee to the University of £40,660 (2021: £39,167.) The charity receives benefits from this relationship including meeting and office space.

The charity has included an accrual of £10,555 (2021: £9,896) representing the amount outstanding to the University of Birmingham at 31 December 2022.

During the year, Trustees made donations to the charity totalling £7,503 (2021: £1,350).

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