A mixed methods study of collaboration between perinatal and infant mental health clinicians and other service providers: Do they sit in silos?

Abstract

BackgroundWomen at risk of poor perinatal mental health benefit from coordinated approaches to care. Perinatal and infant mental health (PIMH) services have been established to support women with social and emotional needs. This paper examines the nature and extent of collaboration within two PIMH services in Australia.MethodsA convergent, embedded, mixed methods design was used. Two hundred and forty four medical records were reviewed, 13 professionals (six PIMH clinicians, two PIMH service managers, and five key stakeholders) and 11 women service-users participated in semi-structured interviews.ResultsThree broad themes were drawn from the data, Theme 1: We don’t sit in silos … but they do, Theme 2: We need to enhance communication, and Theme 3: Collaboration is hard work. Perinatal and infant mental health clinicians believe they work collaboratively with other service providers. Key stakeholders and documentation in the medical records reveal that collaboration is nominal.ConclusionsProfessionals believe that collaboration is essential for women with complex needs. Perinatal and infant mental health clinicians are skilled at building relationships with women, however further support is needed to build trusting relationships with other service providers. Women service-users also need to be involved in the collaborative process to become equal partners in their care.

The role and competence of midwives in supporting women with mental health concerns during the perinatal period: A scoping review

“…The review process identified 30 papers that met inclusion criteria (see Table ). Included studies regard the knowledge, skills and attitudes of midwives (Hauck et al., ; Higgins et al., ; Jones, Creedy, & Gamble, , ,; Lau, McCauley, Barnfield, Moss, & Cross, ; Legere et al., ; Mathibe‐Neke, Rothberg, & Langley, ; McCauley et al., ; Noonan, Doody, Jomeen, & Galvin, ; Noonan et al., ; Ross‐Davie, Elliott, Sarkar, & Green, ; Rothera & Oates, ), and student midwives (Higgins, Carroll, & Sharek, ; Jarrett, , ; Phillips, ); the effectiveness of educational interventions in improving knowledge and skills (Davies et al., ; Fenwick, Toohill, Slavin, Creedy, & Gamble, ; McLachlan, Forster, Collins, Gunn, & Hegarty, ; Reed, Fenwick, Hauck, Gamble, & Creedy, ); the delivery of counselling or psychosocial interventions by midwives (Clarke, King, & Prost, ; Fenwick et al., , ; Larsson, Karlström, Rubertsson, & Hildingsson, ; Toohill et al., ); and barriers and enablers to embedding midwife‐led mental healthcare in practice (Bayrampour et al., ; Fenwick et al., ; Gamble, Toohill, Slavin, Creedy, & Fenwick, ; Higgins et al., ; Myors, Schmied, Johnson, & Cleary, ; Myors et al., ).…”

“…Studies in relation to the delivery of counselling or psychosocial interventions by midwives include a systematic review and meta‐analysis of 10 randomised controlled trials (RCTs) (Clarke et al., ), a single RCT (published in two papers) (Fenwick et al., ; Toohill et al., ), a qualitative interview study (Fenwick et al., ) and a national survey study (Larsson et al., ). Studies that outline barriers and enablers to embedding midwife‐led mental healthcare (other than knowledge and skills deficits), include two integrative reviews (Bayrampour et al., ; Myors et al., ) and three mixed method studies (Fenwick et al., ; Gamble et al., ; Myors et al., ).…”

“…A further study by Myors et al. () into the extent of collaboration within two perinatal mental health services in Australia found that although maternity and mental health stakeholders believe collaboration is essential, collaboration is nominal and midwives are not supported by specialist mental health professionals to provide mental healthcare.…”

“…Furthermore, women are often reluctant to engage with specialist mental health services (Schmied et al., , ), for a myriad of reasons including fear of mental health stigma (Byatt et al., ; McLoughlin, ), and personal values and beliefs in relation to specialist mental healthcare (Bilszta, Erickken, Buist, & Milgrom, ; Evans & Bullock, ). Another reason women fall between the gap of maternity and specialist mental health services is because of the lag time between the antenatal screening process and being contacted by a mental health clinician (Myors, Johnson, Cleary, & Schmied, ). While screening is effective at identifying women at risk of poor perinatal mental health outcomes, the current service system is fragmented (Bayrampour, Hapsari, & Pavlovic, ) and women report that their mental health needs are mostly left unaddressed (Royal College of Obstetricians and Gynaecologists, ).…”

“…To address this gap, a growing body of literature calls for reform in the way in which perinatal mental healthcare is delivered (Centre for Perinatal Excellence, ; Cox et al., ; Davies, Page, Glover, & Sudbury, ; Laios, Rio, & Judd, ; Myors et al, ). It is increasingly suggested that midwives play an important role in the provision of mental healthcare beyond screening and referring, and are well placed to provide counselling interventions (Centre for Perinatal Excellence, ; Cox et al., ; Johnson & Galal, ).…”