Healthcare professionals’ views on the accessibility and acceptability of perinatal mental health services for South Asian and Black women: a qualitative study

Abstract

Background Perinatal mental illness affects one third of new and expectant mothers. Individuals from ethnic minority groups experience higher rates of mental health problems and higher suicide rates. Despite this, women from ethnic minorities—Black and South Asian women in particular—are less likely to receive support from mental health services in the perinatal period. Healthcare professionals (HCPs) who have contact with women during this period have a unique perspective, and their views may provide insights to understand and remedy this health inequality. This study aimed to identify healthcare professionals’ views on the current accessibility and acceptability of perinatal mental health services, and ways of improving services by addressing the barriers for these women. Methods Semi-structured interviews were conducted with twenty-four healthcare professionals who work with patients in the perinatal period. Purposive sampling was used to select HCPs from a range of different professions (including mental health staff, midwifery, primary care, social care). The data were analysed using Framework Analysis. Results Three main themes were identified from the data: (1) lack of awareness and understanding of perinatal mental illness and service structure in both healthcare professionals and patients; (2) patients’ relationships with family, friends and healthcare professionals can both hinder and facilitate access to services; (3) healthcare professionals encourage raising awareness, flexibility, developing shared understandings and questioning assumptions to improve the accessibility and acceptability of services. Conclusion Key insights into explaining and remedying the health inequalities observed between ethnic groups were proposed by healthcare professionals. Recommendations included sharing information; taking steps to ensure each woman was considered as an individual in her relationship with her culture, ethnicity and childrearing practices; and healthcare professionals addressing their possible unconscious biases through engaging in personal reflexive practices. Reasons these are currently not being implemented deserve further research, and the potential of novel roles such as peer support workers in bridging the space between ideals and practice needs further investigation.

South Asian and black women’s perinatal mental health care services require careful work with families, translators and peer supporters to reduce stigma and ensure confidentiality

“…This relates to the study findings around confidentiality when using translators 1 . In this study, the potential lack of anonymity was feared by women, which in the context of other research 5 may be fear of reflected shame and risk to family reputation, particularly in South Asian women.…”

“…The context of Bains et al's study is centred around the inequalities currently experienced by ethnic minority mothers when accessing perinatal mental health services in the United Kingdom 1 . They are less likely to access community mental health services perinatally and are more likely to experience involuntary admissions 2 .…”