Title: Accessibility and acceptability of perinatal mental health services for women from Ethnic Minority groups (PAAM)
Funder: Department of Health and Social Care

Abstract: Women who have mental health problems during pregnancy and in the first year after giving birth (called the perinatal period) can face a number of difficulties in seeking professional help. This can happen because of personal reasons (such as concerns that the baby may be removed by social services), because they do not know where to ask for help or believe they would have to wait a long time to receive it. As a result, many women with mental health problems in this period do not receive treatment. This has unfavourable effects on their own health and the health of their children. The difficulties in seeking help are probably more pronounced for women from ethnic minorities. In order to improve services for these women we need to better understand how women from ethnic minorities get into contact with perinatal mental health services and whether these services are acceptable to them. We will explore this in the proposed research which will be carried out in four steps. In the first step we will investigate two large national databases in order to see to what extent women from different ethnic minorities use mental health services during the perinatal period. This will include specialist perinatal as well as general mental health services. We will also look into what happens after a woman’s first contact with services and whether there is a difference in type of services, frequency of contact or admissions to psychiatric hospital amongst women from different ethnic backgrounds. In the second step, we will collect additional information from specialist perinatal mental health services in two areas with large ethnic minority populations- Birmingham and East London. We will assess to what extent women from ethnic minorities do not attend appointments at specialist services and how they are referred to two Mother and Baby psychiatric hospital units. In the third step we will carry out in-depth interviews with women from South Asian and Black ethnic minority groups who experienced perinatal mental health problems, with their partners and family members/carers, and with different health professionals about their attitudes, expectations and experiences. The interview questions will be informed by the findings of the first two steps and will be developed in collaboration with a Lived Experience Advisory Panel. This in-depth understanding is particularly important as there may be important differences between different ethnic minority groups. In the fourth step we will, together with other stakeholders (women with lived experience and their families, commissioners, health professionals and community organisations), discuss the best way to make use of our study findings in order to improve mental health services that women from different ethnic minorities receive during the perinatal period. We will widely distribute the findings of our research, including to commissioners who are responsible for designing and funding services and who can translate findings from our research into improved perinatal mental health services for women from ethnic minorities. We will set up a Lived Experience Advisory Panel to support the research throughout and to help ensure that all the research information is accessible and meaningful to other women with perinatal mental health problems.

Lay abstract: Women who experience mental health problems in the perinatal period often face a number of barriers in seeking help. As a consequence, mental illness frequently remains untreated which has a significant negative impact on mothers’ health, the health of their children, the wider family and society as a whole. The barriers can be even bigger for women from ethnic minorities, reflecting their disproportionate exposure to psychosocial risks. There is little information available about the use of mental health services by women from ethnic minorities in the perinatal period. Therefore, research is required to assess the accessibility and acceptability of perinatal mental health services for women from ethnic minorities. For this, we propose a mixed method research study with these objectives: 1. Establish the rates of women from ethnic minorities who use mental health services in the perinatal period; 2. Identify pathways to accessing community and inpatient perinatal mental health services in two localities with large ethnic minority populations in the UK; 3. Explore the attitudes, expectations and experiences of women from ethnic minorities who experienced perinatal mental health problems, their partners and family members/carers and of health professionals; 4. Disseminate the findings to a range of stakeholders. The research will be carried out in four steps and be supported by a Lived Experience Advisory Panel (LEAP). In the first step WP1 (M1-M5) we will link and investigate two large national databases (Hospital Episode Statistics and Mental Health Service Data Set) in order to explore to what extent women from different ethnic minorities use perinatal and general mental health services during the perinatal period, what happens after a woman’s first contact with services and whether there is a difference in type of services, frequency of contact or admissions to psychiatric hospital amongst women from different ethnicities. In the second step WP2 (M6-M9), we will collect additional information from specialist perinatal mental health services in two areas with large ethnic minority populations - Birmingham and East London. We will assess the extent to which women from ethnic minorities do not attend appointments at specialist services and the pathways to admission to two Mother and Baby psychiatric hospital units. In the third step WP3 (M10-M23), we will carry out in-depth qualitative interviews with women of South Asian and Black ethnic background who experienced perinatal mental health problems, with their partners and family members/carers, and with different health professionals about their attitudes, expectations and experiences. The interview questions will be informed by the findings the first two steps and will be developed in collaboration with LEAP. In the fourth step WP4 (M24-M26) we will discuss with different stakeholders (women with lived experience and their families, commissioners, different health professionals and community organisations) the best way to translate research results into policy guidelines and will then disseminate these results. The expected knowledge gain will help to improve the design and delivery of perinatal mental health services for women from ethnic minorities.

Research activity codes: 8.1 ORGANISATION AND DELIVERY OF SERVICES
Health categories: MENTAL HEALTH;REPRODUCTIVE HEALTH AND CHILDBIRTH