Informing Perinatal Mental Health Services
SERVICE MANAGERS
Characteristics of treatment
Certain aspects of treatment can impact implementation, as well as whether women find the treatment acceptable and therefore engage with it.
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Opportunity to talk.
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Flexibility.
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Individualised care.
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Group support.
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Appropriateness of treatment.
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Face to face.
Opportunity to talk
Interventions that provide women with an opportunity to talk about how they are feeling may be a facilitator.
"…the opportunity to talk and have someone ‘really listen’ was considered therapeutic, giving the women the opportunity to ‘get things off [my] chest.’”
Evidence level: Low
Parts of the care pathway affected: Provision of optimal treatment, Women’s experience of treatment.
Key literature:
Individualised care
Individualised and person-centred care can be a facilitator. A lack of individualised care can be a barrier.
[Discussing therapy ending before she was ready] One woman stated, “Just me thinking about it [ending the visits] now makes me feel quite panicky. . . . What would have been the point of ripping off the plaster and starting to abrade the wound only to just then say, oh well.”
Evidence level: Moderate
Parts of the care pathway affected: Access to treatment, Provision of optimal treatment, Women’s experience of treatment.
Key literature:
Appropriateness of treatment
Treatment that is appropriate to women’s needs can be a facilitator. Treatment that does not suit women’s needs can be a barrier.
"CBT [Cognitive behavioural therapy] is often indicated as first line treatment but really it’s not an option for a lot of women. They don’t have the means to access it, they don’t have the motivation to access."
“I don’t even have time to go to the bathroom by myself so why would I sit down and do nasal breathing?”
Evidence level: Moderate
Parts of the care pathway affected: Access to treatment, Provision of optimal treatment, Women’s experience of treatment.
Key literature:
Flexibility
Flexible treatment can be a facilitator. Inflexible treatment can be a barrier.
"I loved that I could access the program anytime. It fit into my schedule in a way that traditional therapy could not have, as my baby is demanding and my husband works out of town."
Evidence level: Moderate
Parts of the care pathway affected: Provision of optimal treatment, Women’s experience of treatment.
Key literature:
Group support
For some women, group support was a facilitator. Other women did not want group support and therefore found it to be a barrier.
"I was a bit intimidated – intimidated’s [sic] the wrong word I was a bit hesitant at first because I thought oh my God I’ve gotta sit in front of a bunch of other people and talk about the problems I was having, you know what are they gonna think of me, but it actually ended up being better for me being in a group".
Evidence level: Moderate
Parts of the care pathway affected: Provision of optimal treatment, Women’s experience of treatment.
Key literature:
Face-to-face
For some women, face to face support may be facilitator.
"...an in-person therapist would be able to personalize the learning process a little more, and spend more time on things I needed to spend more time on".
Evidence level: Low
Parts of the care pathway affected: Provision of optimal treatment, Women’s experience of treatment.
Key literature:
Recommendations
We recommend service managers ensure the provision of culturally sensitive care, that is individualised, flexible, and appropriate to women’s needs.
Ideally care should be be delivered face-to-face.
Peer support is valued by some women too and should be considered.
We recommend that care is co-produced with women. One example of a successful co-produced service is the co-production of perinatal mental health services in Ealing, Hammersmith, Fulham & Hounslow.