Mothers’ experiences of acute perinatal mental health services in England and Wales: a qualitative analysis (original) (raw)
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Women’s experiences of specialist perinatal mental health services: a qualitative evidence synthesis
Archives of women's mental health, 2023
Purpose Specialist perinatal mental health services identify and treat women experiencing mental health conditions during pregnancy and up to one year post birth. There is limited knowledge about women's experiences of care from specialist services. Evaluation and optimisation of service delivery requires knowledge of women's care experiences. This review aimed to systematically identify, appraise, and synthesise qualitative evidence exploring women's experiences of specialist perinatal mental health services. Methods A systematic literature search of five databases: Medline (OVID), EMBASE (Elsevier), PsycINFO (EBSCO), CINAHL (EBSCO) and Scopus (Elsevier), grey literature searching, and backward citation, identified a total of 1035 papers of which sixteen met inclusion criteria. Methodological quality of the included studies was assessed using the Critical Appraisal Skills Program (CASP) tool. Results Thematic synthesis identified three themes: connected relationships; new beginnings; and meaningful service delivery. Findings identified that relationships developed with clinicians were significant to women and their experience of care. Women valued continuity of care from dedicated non-judgemental clinicians. Peer support from other mothers was perceived as meaningful to women. Through service interventions women gained new insights into their infant's needs and grew in confidence as a mother. Conclusions Women require provision of flexible and accessible specialist services with clinicians who are sensitive to their individual psychosocial needs and preferences. Examining discharge practices and continuing care needs is essential to ensure the best outcomes for women and their families.
Behavioural and cognitive psychotherapy, 2017
Perinatal mental health difficulties are highly prevalent. In England, the Improving Access to Psychological Therapy (IAPT) programme provides evidence-based psychological treatment, predominantly in the form of brief manualized cognitive behavioural therapy (CBT), to people with mild to moderate depression or anxiety. Yet little is known about the experiences of women referred to IAPT with perinatal mental health difficulties. The aim of this qualitative study was to investigate how women view IAPT support for perinatal mental health. We also gained the perspective of IAPT therapists. Semi-structured interviews were conducted with twelve women who had been referred to and/or received therapy from IAPT during the perinatal period. Additionally, fourteen IAPT therapists participated in two focus groups. Thematic analysis was used. Key themes centred on barriers to access and the need to tailor support to (expectant) mothers. Women and therapists suggested that experiences could be im...
Engagement with perinatal mental health services: a cross-sectional questionnaire survey
BMC Pregnancy and Childbirth, 2019
Background: Perinatal depression and/or anxiety disorders are undertreated pregnancy complications. This is partly due to low rates of engagement by women. This study aimed to identify barriers and facilitators to women accessing perinatal mental health services in an outer metropolitan hospital in Queensland, Australia. Methods: Data was collected from pregnant women through a cross-sectional survey. Women rated the extent certain factors influenced their engagement. Respondents were separated into three groups: women who were not offered a referral to perinatal mental health services, women who were offered a referral but did not engage, and women who engaged. Results: A total of 218 women participated. A response rate of 71% was achieved. 38.1% of participants did not believe themselves knowledgeable about mental illness in the perinatal period, and 14.7% did not recall being asked about their mental health during their pregnancy. Of those participants who recalled being asked about their mental health, 37.1% were offered a referral. Of these, just over a third (36.2%) accepted, and out of this group, 40% attended an appointment. Regardless of referral and engagement status, the factors identified as influencing participant engagement were time restraints, lack of childcare support, and encouragement by family and health care professionals. Stigma was not identified as a barrier. Conclusions: Perinatal mental health service engagement could be improved by health services: ensuring universal screening and actively engaging women in the process: assisting with childcare; improving appointment immediacy and accessibility; and educating health care professionals about their influence on women's engagement.
Patient experience of a psychiatric Mother Baby Unit
PLOS ONE, 2018
Background Mothers with severe mental illness are vulnerable and engage with services cautiously due to fears of stigma and custody loss. To develop best practice standards and patient-centred services, the subjective experience of those who use it must inform service improvement and policy. Method This study utilised exploratory concurrent mixed methods design with primarily qualitative data. Women admitted between April 2015 and December 2016 to a newly developed psychiatric Mother Baby Unit (MBU) in New Zealand were invited to participate in this study. Qualitative data were collected in three ways: (i) semi-structured interviews incorporating Māori concepts of health and wellness by research assistants near discharge; (ii) invitation to provide anonymous feedback in writing using an open format; (iii) unsolicited verbal feedback provided during a home visit three months after discharge. Thematic analysis was undertaken. Demographic and clinical information was collected prospectively for motherinfant pairs during the course of admission and three months post-discharge. Results Forty-five people participated in the study. High rates of satisfaction were described. Strengths of the service-as perceived by mothers-included co-admission of mother and infant, staff warmth and availability, transparent practice, inclusion of families, and having a comfortable environment. Mothers described intense distress and confusion, as well as negative self-perceptions when acutely unwell. Infant co-admission and the inclusion of partners and other family members alleviated mothers' distress. Personal attributes of staff, practical support with caregiving, a range of therapeutic approaches and holistic care were all valued. Feedback collected three months after discharge was the most reflective. Significant interethnic differences were not apparent.
Meta-review of the barriers and facilitators to women accessing perinatal mental healthcare
BMJ Open
Perinatal mental health (PMH) problems are common and can have an adverse impact on women and their families. However, research suggests that a substantial proportion of women with PMH problems do not access care.ObjectivesTo synthesise the results from previous systematic reviews of barriers and facilitators to women to seeking help, accessing help, and engaging in PMH care, and to suggest recommendations for clinical practice and policy.DesignA meta-review of systematic reviews.Review methodsSeven databases were searched and reviewed using a Preferred Reporting Items for Systematic Reviews and Meta Analyses search strategy. Studies that focused on the views of women seeking help and accessing PMH care were included. Data were analysed using thematic synthesis. Assessing the Methodological Quality of Systematic Reviews-2 was used to assess review methodology. To improve validity of results, a qualitative sensitivity analysis was conducted to assess whether themes remained consisten...
Midwifery, 2016
to explore the views and experiences of women with mental health difficulties, in the Republic of Ireland, accessing and receiving care from publicly-funded maternity care services during pregnancy, childbirth and immediate postnatal period in hospital. in total 20 women with a range of mental health problems were recruited. The women had given birth within maternity services with and without specialist perinatal mental health services. a qualitative descriptive design using in-depth face to face interviews was used to explore women׳s experience. Data were analysed using an inductive thematic process. the study offers valuable insights into the maternity care experiences of women with mental health problems, and highlights the deficits and fragmentation of care in maternity units that do not have a specialist mental health service. Even when the women voluntarily disclosed their difficulties, midwives appeared to lack the knowledge and skills to respond sensitively and responsively....
Journal of clinical nursing, 2018
To explore barriers to midwives and nurses addressing mental health issues with women during the perinatal period. Perinatal mental health is considered an important public health issue with health policy internationally identifying the importance of psychological support for women in the perinatal period. Midwives and primary care nurses are ideally positioned to detect mental distress early, but evidence suggests that they are reluctant to discuss mental health issues with women during pregnancy or in the postnatal period. The research used a descriptive design. A total of 809 midwives and nurses completed an anonymous, online or hard copy survey. Designed by the research team, the survey listed 26 potential barriers to the provision of perinatal mental health care. Participants identified organisational factors as presenting the greatest barriers. Organisational barriers included lack of perinatal mental health services, absence of care pathways, heavy workload, lack of time, lac...