INDIVIDUAL
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Beliefs about mental illness

Certain beliefs or understanding about mental illness can impact whether women seek help and access services. ​

  • Not knowing what perinatal mental illness is.

  • Not having the language.

  • Spiritual factors.

  • External factors.

  • Physical factors.

  • A normal response to motherhood.

  • Ignoring symptoms

Not knowing what perinatal mental illness is

Not knowing what perinatal mental illness is can act as a barrier to perinatal mental health care​.

"Nobody has ever told me what it is really [postpartum depression] … I just sit here sometimes and I am crying for no reason, but I could have detected it earlier if someone had explained to me what your first symptoms were, but nobody told me​"

Evidence level: Moderate​

​Parts of the care pathway affected: Deciding to consult, Deciding to disclose.

Key literature: ​

Lucas G, et al. 2019

Spiritual factors

Believing that symptoms are caused by spiritual factors and therefore seeking spiritual guidance first may be a barrier to perinatal mental health care. While  spiritual guidance can be helpful for some women, other women find it less helpful.​

 

“They say that she (mother) is being possessed, so instead of medicines they go for talisman (spiritual treatment)”​.

​Evidence level: Moderate​

​Parts of the care pathway affected: Deciding to consult.

​​Key literature: ​

Atif N, et al. 2016

Physical factors

Believing symptoms are caused by physical factors may be a barrier to perinatal mental health care​.

“I thought it was just lack of sleep and this heavy cold. I thought that after a good night’s sleep it would get better, and I would be able to manage​”​.

​Evidence level: Low​

​Parts of the care pathway affected: Deciding to consult.

​​Key literature: ​

Button S, et al. 2017 

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Not having the language

Not having the language to describe perinatal mental illness may act as a barrier to perinatal mental health care​.

"It's hard to explain this anxiety. Because it's like something horrible is wrong, like something horrible happened to you. But nothing horrible happened to me. I don't know how to explain it​".​

​Evidence level: Low​

​Parts of the care pathway affected: Deciding to consult, Provision of optimal treatment​.

​Key literature: ​

Staneva AA, et al. 2015

External factors

Believing that symptoms are caused by external factors such as jobs may be a barrier to perinatal mental health care.

"I think it is about the stress. . . and the (lack of) community​".

​Evidence level: Low​

​Parts of the care pathway affected: Deciding to consult

​Key literature: ​

Schmied V, et al. 2017

A normal response to motherhood

Believing symptoms are a normal response to motherhood can act as a barrier to perinatal mental health care.

"These feelings were considered a part of motherhood and the postpartum period; everyone experiences it​​".

​Evidence level: Low​

​Parts of the care pathway affected: Deciding to consult

​Key literature: ​

Schmied V, et al. 2017

Ignoring symptoms

Responding to symptoms by ignoring or minimising them can act as a barrier to perinatal mental health care.

"And as an African-American woman, we, in order to survive, historically, have learned how to wear the mask. And I was able to, especially the second go around – you know, I could get through the day, you know, smiling. But I had deep circles up under my eyes".

​Evidence level: Moderate​

​Parts of the care pathway affected: Deciding to consult

​Key literature: ​

Jones CCG, et al. 2014

Recommendations

We recommend the development of information aimed at increasing awareness of perinatal mental health illness such as (1) infographics/leaflets disseminated through maternity services, primary care, third sector organisations (e.g. NCT), and antenatal classes (2) short animations & videos disseminated via social media on:​

  • Symptoms of different perinatal mental illnesses​.

  • Prevalence​.

  • Causes​.

  • Best way to cope with symptoms and when to seek help.​

We recommend this information is developed by individual trusts, or third-party organisations (e.g., the NCT) in collaboration with the NIHR Applied Research Collaboration (ARC) Perinatal Mental Health Themes, The Perinatal Mental Health Network Scotland, the National Managed Clinical Network, and the Royal Colleges.

We have provided some guidance for women navigating an imperfect system here.