Accessibility and acceptability of perinatal mental health services for women from ethnic minority groups: a synopsis of the PAAM study.

内容摘要

Ethnic minority women face worse maternity outcomes and increased risk of perinatal mental health issues, yet research on the accessibility and acceptability of perinatal mental health services for these groups is limited. (1) To explore access to and utilisation of mental health services during the perinatal period among ethnic minority women; (2) to explore care pathways to community and inpatient perinatal mental health services; (3) to explore the attitudes, experiences and service improvement suggestions of ethnic minority women with perinatal mental health problems, as well as those of their partners, family members and healthcare professionals and (4) to produce recommendations for improving clinical practice. Mixed-methods study was conducted during 2018-23, encompassing four studies aligned with specific aims: (1) a population-based study of 615,092 women who gave birth in National Health Services hospitals in England, using data from the National Commissioning Data Repository; (2) a retrospective evaluation of patients accessing community perinatal mental health services in Birmingham and London (n = 228) and inpatient services in Birmingham, London and Nottingham (n = 198) using an adapted World Health Organization care pathways questionnaire; (3) a qualitative study with four cohorts across England: service users (n = 37), non-users or those who disengaged (n = 23), partners/family (n = 15) and healthcare professionals (n = 24); (4) findings informed recommendations for practice improvements, coproduced with individuals with lived experience of perinatal mental illness and of being in a minoritised ethnic group. Data were analysed using quantitative and qualitative approaches. Access issues to mental health services were evident for Black African, Asian and White other women compared to White British women. Variability in patient journeys to community perinatal mental health services seem to stem from service-level factors rather than patient needs. Asian patients had more emergency admissions to Mother and Baby Units, while Black patients were less likely to experience multiple services before Mother and Baby Unit admission. Barriers to access included limited service awareness, fear of child removal, stigma, remote clinical appointments and unresponsive services. Despite these challenges, many women found services helpful. Family members noted gaps in family-focused care. Recommendations for improvement include raising awareness, monitoring access for different ethnic groups and addressing concerns about child removal, with a focus on consistent care, family involvement and cultural sensitivity. These findings shed light on health inequalities in perinatal mental health care for ethnic minority women. The results can be utilised to address existing barriers and improve outcomes for mothers, infants and families. Diversity within merged ethnic groups; limited sample of non-English-speaking women; reliance on self-reported measures; use of pre-COVID-19 data; under-representation of Black women who did not engage with services, and over-representation of Black and Asian patients in Birmingham and London samples in the study exploring patient pathways to Mother and Baby Units (compared to maternity population). Implementation of good practices in perinatal mental health care, targeted interventions to address the fear of child removal, innovative strategies to recruit Black and non-English-speaking women and exploring the experiences of 'White other' women. This synopsis presents independent research funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme as award number 17/105/14. In the United Kingdom, people from ethnic minority groups are more likely to experience mental health problems during pregnancy and after having a baby. However, they are less likely to access help from services. This unfairness is why we did this study. We explored how people from different ethnic backgrounds in England use mental health services. We studied patient records to understand the journey to perinatal mental health services in Birmingham, London and Nottingham. We also spoke with women, families and clinicians about their experiences. This research was conducted from 2018 to 2023. Ethnicity affects how people access care. Black African, Asian and White other women used community mental health services less often than White British women and were more likely to be admitted to hospital against their will. Asian women had more emergency admissions to Mother and Baby Units. Black patients were less likely than White British patients to use multiple services before being admitted to a Mother and Baby Unit. The study also found that where women lived had a bigger impact on their experiences of care than their clinical or personal circumstances. Asian and Black women, their partners and family members and their clinicians shared what gets in the way of getting help. This includes stigma, fear of having their children taken away and the confusing way services are set up. People need clear information about available support, how to access it and what seeking help means for their future with their child. Stakeholders should focus on raising awareness of services, tracking service use across ethnic groups, addressing stigma and fears of child removal.