Examining the gaps in perinatal mental health care: A qualitative study of the perceptions of perinatal service providers in Canada

Abstract

In Canada, access to perinatal mental health services is disparate across districts, regions, provinces, and territories. Questions remain as to how gaps in service are being experienced by Canadian service providers and clinicians. This paper examines three key questions: 1) What are the experiences of care providers with respect to the screening, identifying, and managing perinatal mental health disorders? 2) What gaps in perinatal mental health care have been identified? and 3) What approaches have been taken by providers, communities, and regions in addressing the needs of their populations? To address these questions, 435 participants from across Canada were surveyed using an online survey constructed by the research members of the CPMHC. A qualitative analysis of the data revealed three key themes: groups marginalized by the current perinatal mental health system, gaps and supports identified by communities; and systemic and policy issues. From these three themes we have identified the key components of changes required in the national approach to perinatal mental health disorders. We identify key resources that could be utilized to create policy change and provide recommendations for change.

Developing consensus to enhance perinatal mental health through a model of integrated care: Delphi study

“…Qualitative findings from our study extend these findings and indicate the need for centralized processes to support care coordination, referrals, and education. Indeed, adopting a national strategy to provide a coordinated approach to PMH care holds the potential to harmonize screening practices and care standards across provinces and territories, while also enhancing integration and access to care through centralized funding and resource allocation [ 20 , 22 , 23 ].…”

“…Moreover, the majority of care providers (87%) reported that many parents encounter significant barriers to accessing perinatal services, including limited availability, out-of-pocket costs, and a failure to address cultural safety [ 20 ]. As such, PMH services remain uncoordinated, with access often determined by ‘postal code lottery’, with those from urban, affluent, and well-resourced communities faring better than those from historically marginalized communities [ 20 , 22 ]. Because available services are often narrow in focus and ignore the broader social determinants of health—such as income and housing—pathways to screening, treatment, and follow-up tend to be unclear and difficult to navigate [ 20 , 23 ].…”

“…Because available services are often narrow in focus and ignore the broader social determinants of health—such as income and housing—pathways to screening, treatment, and follow-up tend to be unclear and difficult to navigate [ 20 , 23 ]. In the existing system, white, higher-income women with mild-to-moderate depression or anxiety often have better access to care and resources [ 22 ]. Parents who belong to historically underrepresented or marginalized groups, including rural residents, or those who are racialized, 2SLGBTQIA+, and/or living with complex mental illnesses, are particularly vulnerable to unmet PMH care needs [ 24 , 25 ].…”

Current perspectives on perinatal mental health and neurobehavioral development: focus on regulation, coregulation and self-regulation

“…Within science, integration from diverse disciplines and building transdisciplinary evidence is critical to address the challenge of promoting neurobehavioral development globally. That researchers have an important responsibility in perinatal mental healthcare and in communicating results concerning perinatal environmental exposure, neurodevelopment, and interventions is emphasized in several fields [15 ▪ ,118,154,193,205,208,230,240–251,257 ▪ ]. Community-oriented participatory research with key stakeholders [252], and community engagement [238] to gather ‘bottom-up’ concerns from parents and practitioners [253] is needed, and may contribute to advocacy [239,253].…”

Perinatal anxiety disorders screening study: A study protocol

“…Further, screening provides signi cant cost savings [4][5][6][7][8] by ensuring that only those who require more time and labour-intensive diagnostic assessments are offered them [4,[8][9][10]. Although screening for mental health conditions has been shown to lead to improved mental health even in the absence of a clear pathway to treatment [11,12], there are still several gaps in screening for mental health conditions in Canada, particularly in the perinatal period [13].…”