Accessibility and acceptability of perinatal mental health services for women from Ethnic Minority groups (PAAM)

Ethnic minority women face worse maternity outcomes and increased risk of perinatal mental health issues, yet research on the accessibility and acceptability of perinatal mental health services for these groups is limited. (1) To explore access to and utilisation of mental health services during the perinatal period among ethnic minority women; (2) to explore care pathways to community and inpatient perinatal mental health services; (3) to explore the attitudes, experiences and service improvement suggestions of ethnic minority women with perinatal mental health problems, as well as those of their partners, family members and healthcare professionals and (4) to produce recommendations for improving clinical practice. Mixed-methods study was conducted during 2018-23, encompassing four studies aligned with specific aims: (1) a population-based study of 615,092 women who gave birth in National Health Services hospitals in England, using data from the National Commissioning Data Repository; (2) a retrospective evaluation of patients accessing community perinatal mental health services in Birmingham and London (n = 228) and inpatient services in Birmingham, London and Nottingham (n = 198) using an adapted World Health Organization care pathways questionnaire; (3) a qualitative study with four cohorts across England: service users (n = 37), non-users or those who disengaged (n = 23), partners/family (n = 15) and healthcare professionals (n = 24); (4) findings informed recommendations for practice improvements, coproduced with individuals with lived experience of perinatal mental illness and of being in a minoritised ethnic group. Data were analysed using quantitative and qualitative approaches. Access issues to mental health services were evident for Black African, Asian and White other women compared to White British women. Variability in patient journeys to community perinatal mental health services seem to stem from service-level factors rather than patient needs. Asian patients had more emergency admissions to Mother and Baby Units, while Black patients were less likely to experience multiple services before Mother and Baby Unit admission. Barriers to access included limited service awareness, fear of child removal, stigma, remote clinical appointments and unresponsive services. Despite these challenges, many women found services helpful. Family members noted gaps in family-focused care. Recommendations for improvement include raising awareness, monitoring access for different ethnic groups and addressing concerns about child removal, with a focus on consistent care, family involvement and cultural sensitivity. These findings shed light on health inequalities in perinatal mental health care for ethnic minority women. The results can be utilised to address existing barriers and improve outcomes for mothers, infants and families. Diversity within merged ethnic groups; limited sample of non-English-speaking women; reliance on self-reported measures; use of pre-COVID-19 data; under-representation of Black women who did not engage with services, and over-representation of Black and Asian patients in Birmingham and London samples in the study exploring patient pathways to Mother and Baby Units (compared to maternity population). Implementation of good practices in perinatal mental health care, targeted interventions to address the fear of child removal, innovative strategies to recruit Black and non-English-speaking women and exploring the experiences of 'White other' women. This synopsis presents independent research funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme as award number 17/105/14.

Key Informant's Perspective On Barriers and Facilitators in Access to Mental Health Services for Women with Depression in Urban Area of a Low-income Country

BackgroundPerinatal mental illness affects one third of new and expectant mothers. Individuals from ethnic minority groups experience higher rates of mental health problems and higher suicide rates. Despite this, women from ethnic minorities—Black and South Asian women in particular—are less likely to receive support from mental health services in the perinatal period. Healthcare professionals (HCPs) who have contact with women during this period have a unique perspective, and their views may provide insights to understand and remedy this health inequality. This study aimed to identify healthcare professionals’ views on the current accessibility and acceptability of perinatal mental health services, and ways of improving services by addressing the barriers for these women.MethodsSemi-structured interviews were conducted with twenty-four healthcare professionals who work with patients in the perinatal period. Purposive sampling was used to select HCPs from a range of different professions (including mental health staff, midwifery, primary care, social care). The data were analysed using Framework Analysis.ResultsThree main themes were identified from the data: (1) lack of awareness and understanding of perinatal mental illness and service structure in both healthcare professionals and patients; (2) patients’ relationships with family, friends and healthcare professionals can both hinder and facilitate access to services; (3) healthcare professionals encourage raising awareness, flexibility, developing shared understandings and questioning assumptions to improve the accessibility and acceptability of services.ConclusionKey insights into explaining and remedying the health inequalities observed between ethnic groups were proposed by healthcare professionals. Recommendations included sharing information; taking steps to ensure each woman was considered as an individual in her relationship with her culture, ethnicity and childrearing practices; and healthcare professionals addressing their possible unconscious biases through engaging in personal reflexive practices. Reasons these are currently not being implemented deserve further research, and the potential of novel roles such as peer support workers in bridging the space between ideals and practice needs further investigation.

IntroductionWomen from ethnic minorities who experience mental health problems during the perinatal period are disproportionately represented in involuntary care. They have poorer access to community care but have higher engagement with services once accessed. Their pathways to accessing perinatal mental health care remain underexplored.ObjectivesTo investigate the pathways to perinatal mental health services for women across different ethnic groups, including number of caregivers encountered and time elapsed between referrals.MethodsAnalysis of patient records and routine service data from community and inpatient perinatal mental health services in the United Kingdom. Use of an adaptation of the WHO’s pathway encounter form.ResultsWomen from ethnic minority groups experience increased levels of complexity on their journey to accessing perinatal mental health care. We will present a detailed analysis of patient and service characteristics.ConclusionsReferral pathways to perinatal mental health services need to be optimised for women from underrepresented groups.

The consequences of untreated perinatal mental health conditions are well-established, yet fewer than one in five women experiencing perinatal mental health distress receive treatment. Although recommendations for evidence-based treatment are increasingly widespread, patients and providers still face substantial hurdles to accessing needed services. This study sought to update the literature with a report on providers' perceptions of the demand for and accessibility of mental health services for women in the perinatal period with the goal of pinpointing areas where quality improvement should be implemented. An eight-item, mixed-methods (i.e., open choice, multiple choice, and open response) questionnaire assessing perceptions of patients' access and barriers to care was sent in a department-wide email at a large academic medical center. Forty-six providers completed the survey (n = 18 physicians, n = 14 nurse midwives, n = 13 advanced practitioner nurses, n = 2 other providers). Providers reported pervasive barriers to perinatal mental healthcare and that only occasionally are their perinatal patients able to access appropriate mental healthcare. The findings contribute to the growing body of knowledge regarding access to mental healthcare, ultimately aiming to improve the overall well-being of women during the perinatal period. The study emphasizes the ongoing critical need for researchers and the healthcare system to recognize and address the persistent challenges faced by obstetric providers, highlighting the pervasive nature of issues in accessing quality perinatal healthcare and underscoring the importance of acknowledging these challenges for justifying increased clinical access, rigorous intervention studies, and policy change.

Common perinatal mental disorders are prevalent in low- and middle-income countries. The gap between the need for and availability of mental health services, also known as the mental health treatment gap, is particularly acute for women during the perinatal period in rural Mali. This qualitative study aimed to identify a feasible and acceptable integrated care approach for the provision of maternal mental health care in rural Mali to help narrow the treatment gap and increase access to care. From April to June 2016, qualitative data were collected in the Sélingué health district and Bamako, Mali. In-depth interviews were conducted among women, community health workers, midwives, and mental health specialists. Focus group participants included community health workers, midwives, and an obstetric nurse. All data were inductively coded and analyzed using a thematic analysis approach. Women described several coping strategies to manage their distress, including visiting their parents; confiding in a friend, relative, or community health worker; and participating in women's association groups. Mental health-related stigma was described as being widespread in the community and among health providers. In response to the lack of mental health services, midwives and community health workers supported the feasibility and acceptability of the integration of mental health services into maternal health services. Midwives were discussed as being key providers to conduct mental health screenings and provide initial psychosocial care for women. Integrated maternal and mental health interventions are needed to narrow the gap between the need for and availability of mental health services in rural Mali. Findings from this study underscore the great need for mental health services for women in the perinatal period who reside in rural Mali and that it is both feasible and acceptable to integrate mental health screening and low-level psychosocial care into antenatal care, delivered by midwives.

ObjectivesApproximately 70% of people in British Columbia’s provincial prisons have mental health and/or substance use disorders. Many serve short sentences, and cycle frequently between corrections and community. This study examines mental health (MH) services access and reincarceration among people with a mental illness released from British Columbia’s provincial prisons.
 ApproachA 20% random sample of the general population of British Columbia (BC) (N=1,089,682) contained within BC’s Provincial Overdose Cohort was used. People who had a record of release from a provincial correctional centre between January 1 2015- December 31st 2018, and a mental illness diagnosis in the year prior to release were eligible for inclusion (N=3,907). MH services access was determined using primary care, hospitalization and emergency department records, and reincarceration and additional covariates were retrieved from linked provincial health and corrections records. Hazards of MH services access and reincarceration were calculated using state arrival extended cox proportional hazards models.
 ResultsOf the 3907 releases, 45.9% (N=1795) had MH services access following release, while 40.5% (N=1584) ended in reincarceration without MH services access. The remaining releases were censored prior to observing either outcome. Of those with MH services access, 59.4% (N=1067) ended in subsequent reincarceration. The hazard of reincarceration was elevated for people with concurrent substance use disorder, among both people who did (HR: 1.33 (95%CI: 1.13-1.57) and did not (HR: 1.55(95%CI: 1.22-1.81)) access MH services prior to reincarceration. MH services access had a protective effect on reincarceration (HR: 0.64 (95%CI:0.42-0.99)). Timeliness of MH services access was protective, such that each additional month that passed between release and subsequent MH services access was associated with a 5% increase in the hazard of reincarceration (HR: 1.05(95%CI: 1.02-1.08)).
 ConclusionMental health services access upon release from prison reduces risk of reincarceration. The timeliness of services access plays a critical role in reducing return to reincarceration. Efforts targeted at increasing accessibility of timely mental health services for this population can support increase individual well-being an reduce reincarceration.

BackgroundWomen from ethnic minority groups are at greater risk of developing mental health problems. Poor perinatal mental health impacts on maternal morbidity and mortality and can have a devastating impact on child and family wellbeing. It is important to ensure that services are designed to meet the unique needs of women from diverse backgrounds.AimThe aim of the review was to explore ethnic minority women's experiences of perinatal mental ill health, help-seeking and perinatal mental health services in Europe.Data sourcesSearches included CINAHL, Maternity and Infant Care, MEDLINE and PsycINFO with no language or date restrictions. Additional literature was identified by searching reference lists of relevant studies.DesignThis was a mixed method systematic review. Study selection, appraisal and data extraction were conducted by two researchers independently. A convergent approach was adopted for the analysis and the data were synthesised thematically.ResultsThe 15 eligible studies included women from a range of minority ethnic backgrounds and were all undertaken in the United Kingdom (UK). Seven overarching themes were identified; awareness and beliefs about mental health, isolation and seeking support, influence of culture, symptoms and coping strategies, accessing mental health services, experiences of mental health services and what women want.ConclusionLack of awareness about mental ill health, cultural expectations, ongoing stigma, culturally insensitive and fragmented health services and interactions with culturally incompetent and dismissive health providers all impact on ethnic minority women's ability to receive adequate perinatal mental health support in the UK. Future research should focus on in-depth exploration of the experiences of these women across multiple European settings and interventions to reduce health inequalities among vulnerable mothers and families affected by perinatal mental ill health.

Initiation and Use of Public Mental Health Services by Persons With Severe Mental Illness and Limited English Proficiency

Women's experience of mild to moderate mental health problems during pregnancy, and barriers to receiving support

Provision of Mental Health Services in U.S. Nursing Homes, 1995–2004

Perinatal mental health services for women from minority ethnic groups: why patient-centred approach matter

ObjectiveLack of access to mental health services during the perinatal period is a significant public health concern in the UK. Barriers to accessing services may occur at multiple points in...

Current research has identified how ethnic minority women experience poorer health outcomes during the perinatal period. In the United Kingdom, specialist perinatal mental health services provide mental health treatment for women throughout the perinatal period. Service users have previously highlighted that perinatal services are hard to access and lack cultural sensitivity, whereas healthcare professionals have described limited opportunities and resources for developing cultural competency. We explored the experiences of ethnic minority women with National Health Service (NHS) specialist perinatal teams and identified what culturally sensitive perinatal mental health care means to this group. Individual semi-structured interviews were conducted, and an interpretative phenomenological analysis framework was used to analyse the interview transcripts. Participants were recruited from NHS specialist perinatal teams and online via social media. Six women were interviewed. Four group experiential themes central to the experiences of participants emerged: (1) strengthening community networks and peer support; (2) valuing cultural curiosity; (3) making sense of how culture, ethnicity, race and racism impact mental health; and (4) tailoring interventions to ethnic minority women and their families. The findings capture how ethnic minority women experience specialist perinatal teams and offer insights into practising culturally sensitive care. Perinatal mental health professionals can support ethnic minority women by strengthening their access to community resources and peer support; being curious about their culture; helping them to make sense of how culture, ethnicity, race and mental health interact; and applying cultural and practical adaptations to interventions. A Lived Experience Advisory Group (LEAG) of women from ethnic minority groups contributed to the design and conduct of this study. The LEAG had lived experience of perinatal mental health conditions and accessing specialist perinatal teams. The LEAG chose to co-produce specific aspects of the research they felt fit with their skills and available time throughout five group sessions. These aspects included developing the interview topic guide, a structure for debriefing participants and advising on the social media recruitment strategy.

Even though the policy of deinstitutionalization of mental health services purports to improve access to community-based services, there is a paucity of research that evaluates the impact of this policy on the general community. The research in this study builds on an empirical analysis of 40 years of the process of deinstitutionalization of mental health services in Canada (Sealy & Whitehead, 2004). An experimental design is simulated through the use of a derived construct—earlier vs. later deinstitutionalization—in order to test whether the policy of deinstitutionalization has achieved the goal of improving the accessing of mental health services by people with increased levels of psychological distress, while taking into consideration various social correlates. Data about the accessing of mental health services were obtained in the National Population Health Survey (Statistics Canada, 1996, 2001). Results identify that provinces that implemented deinstitutionalization earlier show improved access of community mental health services and fewer social inequalities of access. Nevertheless, the majority of people who have higher levels of psychological distress have not accessed mental health services.