Search Results

References Atif N, Lovell K, Husain N, Sikander S, Patel V, Rahman A. Barefoot therapists: barriers and facilitators to delivering maternal mental health care through peer volunteers in Pakistan: a qualitative study. Int J Ment Health Syst. 2016;10:24. Mar 15. doi:10.1186/s13033-016-0055-9 Atif N, Nazir H, Zafar S, Chaudhri R, Atiq M, Mullany LC, Rowther AA, Malik A, Surkan PJ and Rahman A (2020) Development of a Psychological Intervention to Address Anxiety During Pregnancy in a Low-Income Country. Front. Psychiatry 10:927. doi: 10.3389/fpsyt.2019.00927 Bina R, Barak A, Posmontier B, Glasser S, Cinamon T. Social workers' perceptions of barriers to interpersonal therapy implementation for treating postpartum depression in a primary care setting in Israel. Health Soc Care Community. 2018;26(1):e75-e84. doi:10.1111/hsc.12479 Bina R. Predictors of postpartum depression service use: A theory-informed, integrative systematic review. Women Birth. 2020;33(1):e24-e32. doi:10.1016/j.wombi.2019.01.006 Boyd RC, Mogul M, Newman D, & Coyne JC. Screening and referral for postpartum depression among low-income women: a qualitative perspective from community health workers. Depression Research and Treatment. 2011. Button S, Thornton A, Lee S, Shakespeare J, Ayers S. Seeking help for perinatal psychological distress: a meta-synthesis of women's experiences. Br J Gen Pract. 2017;67(663):e692-e699. doi:10.3399/bjgp17X692549 Byatt N, Biebel K, Debordes-Jackson G, et al. Community mental health provider reluctance to provide pharmacotherapy may be a barrier to addressing perinatal depression: a preliminary study. Psychiatr Q. 2013;84(2):169-174. doi:10.1007/s11126-012-9236-0 Chartier MJ, Attawar D, Volk JS, Cooper M, Quddus F, McCarthy JA. Postpartum Mental Health Promotion: Perspectives from Mothers and Home Visitors. Public Health Nurs. 2015;32(6):671-679. doi:10.1111/phn.12205 Dennis CL, Chung-Lee L. Postpartum depression help-seeking barriers and maternal treatment preferences: a qualitative systematic review. Birth. 2006;33(4):323-331. doi:10.1111/j.1523-536X.2006.00130.x Doering JJ, Maletta K, Laszewski A, Wichman CL, Hammel J. Needs and challenges of home visitors conducting perinatal depression screening. Infant Ment Health J. 2017;38(4):523-535. doi:10.1002/imhj.21656 Ganann R, Sword W, Newbold KB, Thabane L, Armour L, Kint B. Provider Perspectives on Facilitators and Barriers to Accessible Service Provision for Immigrant Women With Postpartum Depression: A Qualitative Study. Can J Nurs Res. 2019;51(3):191-201. doi:10.1177/0844562119852868 Hadfield H, Wittkowski A. Women's Experiences of Seeking and Receiving Psychological and Psychosocial Interventions for Postpartum Depression: A Systematic Review and Thematic Synthesis of the Qualitative Literature. J Midwifery Womens Health. 2017;62(6):723-736. doi:10.1111/jmwh.12669 Hadfield, H., Glendenning, S., Bee, P. et al. Psychological Therapy for Postnatal Depression in UK Primary Care Mental Health Services: A Qualitative Investigation Using Framework Analysis. J Child Fam Stud 28, 3519–3532 (2019). https://doi.org/10.1007/s10826-019-01535-0 Hansotte E, Payne SI, Babich SM. Positive postpartum depression screening practices and subsequent mental health treatment for low-income women in Western countries: a systematic literature review. Public Health Rev. 2017;38:3. Published 2017 Jan 31. doi:10.1186/s40985-017-0050-y Jallo N, Salyer J, Ruiz RJ, French E. Perceptions of guided imagery for stress management in pregnant African American women. Arch Psychiatr Nurs. 2015;29(4):249-254. doi:10.1016/j.apnu.2015.04.004 Jones CC, Jomeen J, Hayter M. The impact of peer support in the context of perinatal mental illness: a meta-ethnography. Midwifery. 2014;30(5):491-498. doi:10.1016/j.midw.2013.08.003 Kim JJ, La Porte LM, Adams MG, Gordon TE, Kuendig JM, Silver RK. Obstetric care provider engagement in a perinatal depression screening program. Arch Womens Ment Health. 2009;12(3):167-172. doi:10.1007/s00737-009-0057-6 Lucas G, Olander EK, Ayers S et al. No straight lines – young women’s perceptions of their mental health and wellbeing during and after pregnancy: a systematic review and meta-ethnography. BMC Women's Health 19, 152 (2019). https://doi.org/10.1186/s12905-019-0848-5 Masood Y, Lovell K, Lunat F, et al. Group psychological intervention for postnatal depression: a nested qualitative study with British South Asian women. BMC Womens Health. 2015;15:109. Published 2015 Nov 25. doi:10.1186/s12905-015-0263-5 Megnin-Viggars O, Symington I, Howard LM, Pilling S. Experience of care for mental health problems in the antenatal or postnatal period for women in the UK: a systematic review and meta-synthesis of qualitative research. Arch Womens Ment Health. 2015;18(6):745-759. doi:10.1007/s00737-015-0548-6 Morrell CJ, Sutcliffe P, Booth A, et al. A systematic review, evidence synthesis and meta-analysis of quantitative and qualitative studies evaluating the clinical effectiveness, the cost-effectiveness, safety and acceptability of interventions to prevent postnatal depression. Health Technol Assess. 2016;20(37):1-414. doi:10.3310/hta20370 Myors KA, Johnson M, Cleary M, Schmied V. Engaging women at risk for poor perinatal mental health outcomes: a mixed-methods study. Int J Ment Health Nurs. 2015;24(3):241-252. doi:10.1111/inm.12109 Nithianandan, N., Gibson-Helm, M., McBride, J. et al. Factors affecting implementation of perinatal mental health screening in women of refugee background. Implementation Sci 11, 150 (2016). https://doi.org/10.1186/s13012-016-0515-2 Noonan, M., Doody, O., O’Regan, A. et al. Irish general practitioners' view of perinatal mental health in general practice: a qualitative study. BMC Fam Pract 19, 196 (2018). https://doi.org/10.1186/s12875-018-0884-5 Pugh NE, Hadjistavropoulos HD, Hampton AJD, Bowen A, Williams J. Client experiences of guided internet cognitive behavior therapy for postpartum depression: a qualitative study. Arch Womens Ment Health. 2015;18(2):209-219. doi:10.1007/s00737-014-0449-0 Rowan C, McCourt C, & Bick D. (2010). Provision of perinatal mental health services in two English strategic health authorities: views and perspectives of the multi-professional team. Evidence Based Midwifery, 8(3), 98-106. Smith, M. S., Lawrence, V., Sadler, E., & Easter, A. (2019). Barriers to accessing mental health services for women with perinatal mental illness: systematic review and meta-synthesis of qualitative studies in the UK. BMJ open, 9(1), e024803. Schmied V, Black E, Naidoo N, Dahlen HG, Liamputtong P (2017) Migrant women’s experiences, meanings and ways of dealing with postnatal depression: A meta-ethnographic study. PLoS ONE 12(3): e0172385. https://doi.org/10.1371/journal.pone.0172385 Shakespeare J, Blake F, & Garcia J. A qualitative study of the acceptability of routine screening of postnatal women using the Edinburgh Postnatal Depression Scale. British Journal of General Practice. 2003; 53(493), 614-619. Sorsa MA, Kylmä J, Bondas TE. Contemplating Help-Seeking in Perinatal Psychological Distress-A Meta-Ethnography. Int J Environ Res Public Health. 2021;18(10):5226. doi:10.3390/ijerph18105226 Staneva AA, Bogossian F, & Wittkowski A. The experience of psychological distress, depression, and anxiety during pregnancy: A meta-synthesis of qualitative research. Midwifery. 2015; 31(6), 563-573. Watson H, Harrop D, Walton E, Young A, Soltani H. A systematic review of ethnic minority women's experiences of perinatal mental health conditions and services in Europe. PLoS One. 2019;14(1):e0210587. Published 2019 Jan 29. doi:10.1371/journal.pone.0210587 Willey S, Gibson-Helm M, Finch T, East C, Khan N, Boyd L, & Boyle J. Implementing innovative evidence-based perinatal mental health screening for refugee women. Women and Birth. 2018; 31, S8. Williams CJ, Turner KM, Burns A, Evans J, Bennert K. Midwives and women's views on using UK recommended depression case finding questions in antenatal care. Midwifery. 2016;35:39-46. doi:10.1016/j.midw.2016.01.015 Young CA, Burnett H, Ballinger A, et al. Embedded Maternal Mental Health Care in a Pediatric Primary Care Clinic: A Qualitative Exploration of Mothers' Experiences. Acad Pediatr. 2019;19(8):934-941. doi:10.1016/j.acap.2019.08.004

COMMISSIONERS Funding This refers to how services are paid for. A lack of funding. Funding complexities. A lack of funding A lack of funding or complexities in accessing funding can be a barrier to care. "We are unable to serve every woman in need of ongoing care. We are therefore working on additional funds, both internally and externally, to secure long-term physical and behavioural health care for our patients." Evidence level: Moderate Parts of the care pathway affected: Decision to consult, Assessment, Referral, Access to treatment, Provision of optimal treatment. Key literature: Doering JJ, et al. 2017 Funding complexities The government’s spending plans can be changed within the financial year. This can make it hard for services to plan their spending at the beginning of the year. See How Funding Flows by The King’s Fund for more information. Recommendations A clear and easy to access funding structure for commissioners and service managers. Continued policy support from NHS England, and the NHS related to perinatal mental health care, such as the publication of the Five Year Forward View and Long Term Plan for NHS England, and Delivering Effective Services report for NHS Scotland. We recommend the provision of a comprehensively researched and adequate budget provided to the Department of Health and Social Care, Health and Social Care Directorates so all healthcare needs for that financial year can be met. Where possible, a reduction of in-year funding changes is needed to allow for more thorough and comprehensive service planning. Back to Commissioners

INTERPERSONAL Trusting relationship and rapport The development of a trusting relationship and rapport between health professionals and women. Trusting relationship and rapport. Difficulties developing a trusting relationship. Trusting relationship and rapport The development of a trusting relationship is a facilitator to perinatal mental health care. "It’s like family, almost. You know what I mean? It’ s somewhere where you already feel comfortable.." Evidence level: High Parts of the care pathway affected: Deciding to consult, Assessment, Decision to disclose, Access to treatment, Provision of optimal treatment, Women’s experience of treatment. Key literature: Young CA, et al. 2019 Difficulties developing a trusting relationship Difficulties developing a trusting relationship and rapport between health professionals and women is a barrier to perinatal mental health care. "I didn’t trust them I suppose so I didn’t tell the health visitors how I was feeling". Evidence level: High Parts of the care pathway affected: Deciding to consult, Assessment, Decision to disclose, Access to treatment, Provision of optimal treatment, Women’s experience of treatment Key literature: Shakespeare J, et al. 2003 Recommendations To ensure there are opportunities for health professionals and women to form trusting relationships, we recommend continuity of carer across the care pathway. A good example of this is The Tower Team based in the Tower Hamlets, London is a high-risk caseload midwifery team that works closely with the perinatal mental health team and the consultant obstetrician for mental health at St. Thomas’ hospital. The Tower Team offers continuity of care for women with severe mental illness from their maternity booking appointment, throughout pregnancy, intrapartum and for up to 28 days postpartum. Back to Interpersonal

INDIVIDUAL Beliefs About Health Services Certain beliefs about health services can impact whether services are implemented and delivered successfully, and whether women seek help and access services. These beliefs include: Services only offer medication Services are stretched Services are too complicated No trust in health services Services only offer medication Believing health services will only offer medication for perinatal mental illness may act as a barrier to perinatal mental health care. "I knew she would just write me a prescription and send me away…that wasn’t what I wanted." Evidence level: Low Parts of the care pathway affected: Deciding to consult, Assessment, Deciding to disclose, Access to treatment, Provision of optimal treatment. Key literature: Button S, et al. 2017 Services Are Too Complicated Believing health services are too complicated may act as a barrier to perinatal mental health care "Consistently identified barriers to care for immigrant women were: ‘not understanding the health-care system’” Evidence level: Low Parts of the care pathway affected: Deciding to consult, Access to treatment. Key literature: Ganann R, et al. 2019 Services Are Stretched Believing perinatal mental health services are too stretched and therefore will be unable to help, may act as a barrier to perinatal mental health care. "I think it was just that they were really busy and just didn’t really have enough time for everybody with their kids". Evidence level: Low Parts of the care pathway affected: Deciding to consult, Deciding to disclose. Key literature: Hadfield H, et al. 2017 No trust in health services Having little trust in health services may act as a barrier to perinatal mental health care "The personal barriers described were mistrust, [and] fear of mental health service systems". Evidence level: Low Parts of the care pathway affected: Access to treatment Key literature: Boyd RC, et al. 2011 Recommendations More research is needed into beliefs about health systems using rigorous methodology, before recommendations for policy and practice can be made. Back to Individual

Interpersonal Trusting relationship and rapport Language barriers Shared decision making Open and honest communication Back to Conceptual Framework

Health Professionals Health professionals' knowledge Getting it right first time Health professionals’ attributes Back to Conceptual Framework

Further Resources Infographics Infographic for women Recommendations for health professionals Recommendations for service managers Recommendations for commissioners Recommendations for policy makers Animations Animation for women and families Animation for health professionals Animation for service managers Conceptual frameworks MATRIx Facilitators Framework MATRIx Barriers Framework Summary report Publications Review 1 publication Review 2 publication Conceptual frameworks publication NIHR Publication Other Perinatal Mental Health Partnership - Matrix videos Recommendations Twitter (X) References