Experiences of how services supporting women with perinatal mental health difficulties work with their families: a qualitative study in England

Abstract

ObjectivesPartners and wider family members play a vital role in relation to women’s perinatal mental health. Clinical guidelines in the UK and internationally recommend that services supporting women with perinatal mental health difficulties involve and support their families too. However, little is known about family members’ needs and experiences, or whether they feel included by mental health services. This study set out to explore this.MethodsThis research formed part of a wider study exploring experiences of perinatal mental health care in England. The broader study included semi-structured interviews with 52 women across England who received treatment for a perinatal mental health difficulty, and 32 family members identified by the women as offering them some support. Data from these 84 interviews relating to how services work with partners and families were extracted and analysed thematically.ResultsAnalysis identified three overarching themes: (1) the centrality of women’s families to their perinatal mental health/access to support, (2) experiences of partners and families being excluded by services and (3) ambivalence among women and their families about increasing family involvement/support. We found that partners and families appear to have an important influence on women’s perinatal mental health, access to care and interactions with services, but that services tend to focus on individual women (and babies) with little regard for their wider family context. The complexity of involving and supporting partners and families, coupled with anxiety about this among women and their families, reinforces the tendency to marginalise them.ConclusionInvolving women’s families and providing the support they need is challenging, but important. Experiences of women and their families of services treating perinatal mental health difficulties suggests greater focus is needed on overcoming barriers to family inclusion and on challenging underlying gender roles and expectations, rather than allowing these to shape and guide practice.

Postnatal consultations with an obstetrician after critical perinatal events: a qualitative study of what women and their partners experience

“…Previous research has shown that partners often feel overlooked in the perinatal period and that the healthcare professionals focus exclusively on the women and babies. 12 18 Our findings did not indicate that the partners felt marginalised in relation to the ObPostCons. However, future research may benefit from including more on partners’ perspective.…”

“… 17 The partners also emphasised a need for information and dialogue but were often not met in their needs, and described a feeling of being marginalised because of a mother–baby focus. 12 18 Although there is no evidence of reducing psychological trauma, it seems like there is a need for a postnatal consultation following a traumatic childbirth.…”

Perinatal mental health: a review of progress and challenges

“…A meta‐synthesis of 20 studies of the experiences of fathers reported that services tend to focus on individual women (and babies), with a marginalization and neglect of women's partners and an unmet need for information by these partners 168 . A recent qualitative study, based on separate interviews with women with mental illness and a participant‐nominated “significant other”, also emphasized the complexity of involving and supporting partners and families, particularly when relationships are poor 169 .…”

“…In practice, many countries do not have practitioners trained specifically for the perinatal period. Qualitative studies suggest that receiving interventions within generic services can be experienced as unhelpful by women 189,195 , partly due to the therapists' failure to understand the potential impact of mental disorders on maternal functioning 195 , and poor facilities for infants 169,195 , though, as RCTs in LMICs demonstrate, task‐shifting is possible if staff are suitably trained 96 .…”

Assessing the Mental Health of Fathers, Other Co-parents, and Partners in the Perinatal Period: Mixed Methods Evidence Synthesis

“…Therefore, alongside establishing a measure's accuracy, we need to understand the acceptability of both the measure and of the identification strategy more broadly, from the perspectives of parents and health professionals. There are known barriers to seeking and accepting help, both for new and expectant parents, and for men (47)(48)(49)(50)(51)(52). Other relevant considerations include the ability of services to both identify and respond to needs, and any possible impact of these assessments on women's care or the couple relationship.…”