SERVICE MANAGERS
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Characteristics of services across care pathway​

The way a service is set up and run can impact implementation of, and women’s access to perinatal mental health care. ​

  • Continuity of carer​.

  • Information provision​.

  • Delivered at home​.

  • Culturally sensitive care​.

  • Delivered in medical setting​.

  • Privacy and confidentiality​.

  • Dedicated perinatal mental health champion​.

  • Technology​.

  • Logistical support.

Continuity of carer​

Care that provides the same health professional along the care pathway is a facilitator to care. Lack of continuity of care is a barrier.​

 

"Every time I went to see the midwife, or…, I always had somebody different, and I don’t want to tell 10 people my story​."​

Evidence level: ​High

​Parts of the care pathway affected: Assessment, Decision to disclose, Access to treatment, Provision of optimal treatment, Women’s experience of treatment​.

Key literature: ​

Megnin-Viggars O, et al. 2015

Delivered at home​

Care that is delivered at home can be a facilitator to care.

"I was more relaxed in my own home."​

Evidence level: ​Moderate

​Parts of the care pathway affected: Decision to consult, Assessment, Decision to disclose, Provision of optimal treatment, Women’s experience of treatment​.

Key literature: ​

Myors et al. 2015

Delivered in medical setting​

Some women and health professionals find that care delivered in a medical setting may be a facilitator to care.  Other women find it to be a barrier​.

"Bangladeshi women living in the UK indicated that they talked freely in the hospital about emotional problems; however, few discussed their difficulties at home apart from practical terms because of censorship by family members"​.

"Thirteen of the women found the baby clinic an inappropriate place to complete the EPDS. The lack of time and privacy, the reluctance to make a fuss and the stress of the clinic were cited as reasons. Most women would have preferred to be screened in their own homes.  ‘That first Edinburgh test, to have it filled in and then talked about in front of everybody else was just terrible.’ ​"

​Evidence level: Low​

​Parts of the care pathway affected: Assessment, Provision of optimal treatment, Women’s experience of treatment​.

​Key literature: ​

Dennis & Chung-Lee, L 2006

​Shakespeare, J et al. 2003 

Dedicated perinatal mental health champion​

Care that has a dedicated person or perinatal mental health champion may be a facilitator to care. ​

"I’ve felt the Liaison Nurse . . . her being a point of contact . . . made a big difference to my follow-up and action planning around the clients​."​

Evidence level: ​Low

​Parts of the care pathway affected: Assessment, Referral, Access to treatment, Provision of optimal treatment​.

Key literature: ​

Willey S, et al. 2018

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Information provision​

Care that provides information about services and perinatal mental health can be a facilitator to care.  A lack of information provision can be a barrier​.

"Some women believed that their physician did not provide sufficient information about pharmacological treatment​".​

​Evidence level: Moderate​

Parts of the care pathway affected: Decision to consult, Referral, Access to treatment, Provision of optimal treatment, Women’s experience of treatment​.

​Key literature: ​

Dennis, CL & Chung-Lee, L. 2006

Culturally sensitive care​

Culturally sensitive care is a facilitator to care. Care that is not sensitive to women’s cultural needs is a barrier​.

"You need someone who’s on the same wavelength as you, who shares the same cultural experiences as you, which sometimes isn’t available."​

​Evidence level: High​

​Parts of the care pathway affected: Decision to consult, Contact with health professionals, Assessment, Decision to disclose, Referral, Access to treatment, Provision of optimal treatment, Women’s experience of treatment​.

​Key literature: ​

Button S, et al. 2017

Privacy and confidentiality​

Care that is private and maintains women's confidentiality may be a facilitator to care. Lack of privacy may be a barrier​​.

"The interruptions took me longer to really get relaxed."​

​Evidence level: Low​

​Parts of the care pathway affected: Decision to disclose, Access to treatment, Provision of optimal treatment.

​Key literature: ​

Jallo N, et al. 2015

Technology​

Technology that is fit for purpose and that works well is a facilitator to care.  Technology that does not work is a barrier​.

"We would be quite good in fact in asking [women to complete the EPDS] and it’s probably because of that little reminder on the screen."​

​Evidence level: High​

​Parts of the care pathway affected: Assessment, Referral, Women’s experience of treatment​.

​Key literature: ​

Noonan M, et al. 2018

Logistical support ​

Services that provide logistical support, such as easily accessible locations, childcare, travel costs can be facilitators to care.  No logistical support can be a barrier​.

"And we were offered a crèche facility; I used to take him there; otherwise it would have been really difficult for me."

​Evidence level: Moderate

​Parts of the care pathway affected: Decision to consult, Access to care, Provision of optimal treatment, Women’s experience of treatment​.

​Key literature: ​

Masood Y, et al. 2015

Recommendations 

It is important services have easy-to-use technology that is compatible with other technology systems used in other services. We recommend service managers encourage co-production or user experience testing of technology to ensure ease of usability and integration into the workflow. ​

 

Where compatibility between IT systems is not possible, we recommend the employment of a liaison person who has access to all systems to bridge the gap between different services. ​

 

Reduction of the changeover of technology when new commissioners join, and encouragement of technology use that is compatible with other systems​.

 

Service managers need to ensure the provision of culturally sensitive care. We recommend service users collaborate with organisations such as The Motherhood Group to ensure care is culturally appropriate The Motherhood Group.

 

Provision of care should ideally be delivered face-to-face, provide logistical support or be carried out in a home setting. If home delivery is not possible, ensure practical support is available such as childcare. We recommend co-production of care. One example of a successful co-produced service is the co-production of perinatal mental health services in Ealing, Hammersmith, Fulham & Hounslow.