Barriers to accessing mental health services for women with perinatal mental illness: systematic review and meta-synthesis of qualitative studies in the UK

Megan Sambrook Smith, Vanessa Lawrence, Euan Sadler, Abigail Easter, Megan Sambrook Smith, Vanessa Lawrence, Euan Sadler, Abigail Easter

Abstract

Objective: 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. This review examines women, their family members' and healthcare providers' perspectives of barriers to accessing mental health services for women with perinatal mental illness in the UK.

Design: A systematic review and meta-synthesis of qualitative studies.

Data sources: Qualitative studies, published between January 2007 and September 2018, were identified in MEDLINE, PsycINFO, EMBASE and CINAHL electronic databases, handsearching of reference lists and citation tracking of included studies. Papers eligible for inclusion were conducted in the UK, used qualitative methods and were focused on women, family or healthcare providers working with/or at risk of perinatal mental health conditions. Quality assessment was conducted using the Critical Appraisal Skills Programme for qualitative studies.

Results: Of 9882 papers identified, 35 studies met the inclusion criteria. Reporting of emergent themes was informed by an existing multilevel conceptual model. Barriers to accessing mental health services for women with perinatal mental illness were identified at four levels: Individual (eg, stigma, poor awareness), organisational (eg, resource inadequacies, service fragmentation), sociocultural (eg, language/cultural barriers) and structural (eg, unclear policy) levels.

Conclusions: Complex, interlinking, multilevel barriers to accessing mental health services for women with perinatal mental illness exist. To improve access to mental healthcare for women with perinatal mental illness multilevel strategies are recommended which address individual, organisational, sociocultural and structural-level barriers at different stages of the care pathway.

Prospero registration number: CRD42017060389.

Keywords: barriers; mental health; pregnancy; qualitative research; systematic review.

Conflict of interest statement

Competing interests: None declared.

© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY. Published by BMJ.

Figures

Figure 1
Figure 1
Adapted model showing multilevel conceptual framework for barriers to mental health services in the perinatal period.
Figure 2
Figure 2
Study selection. HCP, healthcare professional; PMI, perinatal mental illnesses; PNMH, perinatal mental health.
Figure 3
Figure 3
Conceptual model of key barriers in the care pathway to accessing mental health services during the perinatal period. PNMH, perinatal mental health.

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