Barriers to access and utilisation of perinatal mental healthcare in the UK

ABSTRACT

Background Lack of access to mental health services during the perinatal period is a significant public health concern in the UK. Barriers to accessing services may occur at multiple points in the care pathway. However, no previous reviews have investigated multilevel system barriers or how they might interact to prevent women from accessing services. Aims and Objectives To explore 1) the barriers affecting women's access to PMH care at different points in the care pathway, 2) how women's access to and experience of PMH care has been affected by the COVID-19 pandemic. Methods Findings from two studies will be presented 1) A systematic review of women, their family members', and healthcare providers' perspectives of barriers to accessing PMH care in the UK;2) A qualitative study with women's (n = 18) experiences of accessing PMH services during the COVID-19 pandemic, in an ethnically diverse population in South East London. Results The systematic review identified several key barriers that affected help seeking and treatment during the perinatal period. Barriers were identified at four levels Individual (e.g. stigma, poor awareness), organisational (e.g. resource inadequacies, service fragmentation), sociocultural (e.g. language, cultural barriers) and structural (e.g. unclear policy). Interviews with women highlighted that pandemic restrictions and social distancing created additional difficulties and disruptions to accessing PMH care, and increased feelings of anxiety and isolation. Women expressed mixed feelings about remote delivery of PMH. Interpretation/Discussion Complex interlinked barriers to accessing PMH care exist within the UK and services have been further disrupted by the COVID-19 pandemic. To improve access to mental healthcare for women during the perinatal period, multilevel strategies are recommended which address individual, organisational, sociocultural and structural-level barriers at different stages of the care pathway. Conclusions To address barriers and reduce inequity in access to care, multilevel national strategies combined with targeted approaches to identifying and responding to local population needs are required.