Help make perinatal mental health care easy to access for everyone
Research type
Research Study
Full title
Inequalities in identification and treatment of perinatal mental health
IRAS ID
293657
Contact name
Josie Dickerson
Contact email
Sponsor organisation
Bradford Teaching Hospitals NHS Foundation Trust
Clinicaltrials.gov Identifier
NA, NA
Duration of Study in the UK
0 years, 11 months, 27 days
Research summary
Summary of Research
Mental health problems in the perinatal period (during pregnancy and the first year following birth) are debilitating and costly. Parents living in disadvantaged circumstances may have worse mental health and may receive less health care. There is evidence of substantial inequality in the disclosure and identification of mental health problems in mothers who do not speak English, and to a slightly lesser extent for ethnic minority women who do speak English.The aim of the project is to understand the components that enable and hinder disclosure/identification of perinatal mental health in universal services and access /referral/take-up of targeted perinatal mental health (PMH) services.
The study will focus on a) inequalities: ethnicity; communication needs (e.g. due to language); low socioeconomic status (e.g. based on area-level Index of Multiple Deprivation; IMD, b) those experiencing moderate/severe symptoms (the group of most interest), c) the challenges of COVID-19 on access to services, and d) identify recommendations for improving services and reducing inequalities.
The study will be in conducted two parts:
Workpackage (WP) 4a: we will conduct one-to-one semi-structured interviews with service users (women who have experienced mild/moderate/severe PMH symptoms in the last 3 years).
WP4b: we will conduct an online survey (open/ closed-ended questions) with approximately 482 health professionals working in the area of Perinatal mental health across West Yorkshire. In addition to this, we will conduct semi-structured interviews with 6-10 key informants from the Voluntary and Community Organisations (VCO) and if necessary we will also conduct semi-structured interviews with 16 key-informants from the statutory services.
Summary of Results
Lay summary of study results: What was this research about?
Researchers from Born in Bradford and the Universities of Huddersfield and York have recently completed an in-depth study to understand the inequalities in identification and treatment of perinatal mental health (PMH) in order to develop recommendations and adaptations to address these inequalities. This research was funded by Wakefield CCGs on behalf of West Yorkshire Health and Care Partnership, in collaboration with the PMH Steering Group and took place across services within West Yorkshire (see Figure 1).
The team spent two years undertaking: Literature reviews, system and pathways evaluation, routine health data analyses, surveys with healthcare professionals and qualitative interviews with voluntary sector workers and women from ethnic minority and socio-economically deprived backgrounds to provide in-depth insights on the causes of these inequalities. These findings were taken to expert panels of healthcare practitioners, managers and commissioners to develop the recommendations.What did the research find?
A number of women experience inequalities in their care which means that their PMH concerns are less likely to be identified and/or supported. These include:
➢ women who do not speak English well
➢ women who are a recent migrant to the UK ➢ women from an ethnic minority ➢ women living in deprived areas • Women who live in different areas have access to different services and different levels of support from their health care professionals. The healthcare professionals have access to different guidance causing inconsistencies in healthcare pathways and referral pathways.
• The data captured in the systems is not good enough to tell us how many women struggle with PMH, and whether there are inequalities in the identification and treatment of women.
• Barriers to fair access to perinatal mental health care operate at different levels. These can be understood as: processes, people (women, practitioners, significant others), technology and the system. These barriers can deepen existing health inequalities. To tackle these barriers, change is needed at the system level.
These findings echo those in the recent national report on inequalities in perinatal healthcare more widely (https://eur03.safelinks.protection.outlook.com/?url=https%3A%2F%2Fu2790089.ct.sendgrid.net%2Fls%2Fclick%3Fupn%3DXv3JSvJ-2B3M71ppf7N9agbaCWbQhTVp7KwhUrDoWpJ38eaJV5UKBN4-2FDaULloB9cJQr5gxvd3Rsp6HwtSUxyYeA-3D-3DtrQx_E1aO2-2BZlVOSJJV-2FajQqskegTd6IRomHYTi-2Fbt8SH3YI9W1xBhYgkeO8CPW1spebLzNze8ZiLMGnWNEVGqYRznL13NRY-2BjuinuANDQYK5Hl9kUMTLQOoG99-2F-2FntTLLEkEpBhYdTfLmAankjlG64H10XYWSw2jg98S81ZGfnP8xpKweijIAk3LcCQDu8ZfSsASvOoVocZ-2Bofm-2BOZdmy1VCJw-3D-3D&data=05%7C01%7Capprovals%40hra.nhs.uk%7C0867f2285e1d41775bc508db29570e2c%7C8e1f0acad87d4f20939e36243d574267%7C0%7C0%7C638149226095935609%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C3000%7C%7C%7C&sdata=R9ScumBlaU%2FZKkax%2B4k6eUHGlTrKypXrrBE4IxF2gts%3D&reserved=0 https://eur03.safelinks.protection.outlook.com/?url=https%3A%2F%2Fu2790089.ct.sendgrid.net%2Fls%2Fclick%3Fupn%3DXv3JSvJ-2B3M71ppf7N9agbXmxVRHeN2vPWJ995ZsS9ow0OfKDL3TYeHAW7eIGF4-2FyCLRA_E1aO2-2BZlVOSJJV-2FajQqskegTd6IRomHYTi-2Fbt8SH3YI9W1xBhYgkeO8CPW1spebLaNufXuC0-2F3qoRbZTQhkixGQVo8M8O3kkMgWosuMSpuMaI6d1oGK3yz5Xmyg-2Bh6Sj-2FMXJRpW3khchd-2BbABKFLZ3shNI7cCUU42JmyWMuOb-2BhqkMlMlqjxr-2BVHXKq0DUCQuqLAnyOgzqdANn4-2FSkB22Q-3D-3D&data=05%7C01%7Capprovals%40hra.nhs.uk%7C0867f2285e1d41775bc508db29570e2c%7C8e1f0acad87d4f20939e36243d574267%7C0%7C0%7C638149226095935609%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C3000%7C%7C%7C&sdata=S7BKXR6WwWhWv34wtN3stXhoK0av3pcZPNqoDtcA4%2FE%3D&reserved=0Ten key recommendations were produced to reduce inequalities within the healthcare system.
1. Perinatal mental health needs to be viewed as ‘core business’
2. Enhanced partnership working between statutory and VCS organisations 3. A campaign to improve community understanding and awareness 4. Development of, and commitment to, routine staff skills training 5. A skilled and equipped interpreter workforce for PMH 6. Additional support for vulnerable women 7. An equitable service offer across areas 8. Consistency in guidance, services and referral pathways 9. Changes in data capture and sharing 10. A review of information provisionREC name
North West - Greater Manchester East Research Ethics Committee
REC reference
21/NW/0158
Date of REC Opinion
26 May 2021
REC opinion
Favourable Opinion