Healthcare professionals' views on barriers, facilitators and optimisation of care for perinatal anxiety: A qualitative investigation

Background The experience of pregnancy and having a baby is a time of significant change and transition. One in five perinatal women experience problems with their emotional wellbeing and mental health in this period; adjustment, anxiety and depressive illnesses being most common. Whilst investment in specialist perinatal mental health pathways continues, there is limited understanding of healthcare professionals’ views and experiences of these pathways and of support available for women with mild or moderate mental health problems. This study explored healthcare professionals’ views on the barriers and facilitators to identification and management of perinatal anxiety, and on how to optimise care pathways. Methods In-depth semi-structured interviews were conducted with a purposive sample of healthcare professionals in universal perinatal services (including maternity, primary care, and health-visiting) and specialist (including talking therapies, maternal and perinatal) mental health services. Data were analysed using framework analysis. Results Interviews were conducted with 62 healthcare professionals from England and Scotland. 40% of the sample stated they had received no training in perinatal mental health, and 45% reported that they did not use standardised or validated questions or scales when enquiring about mental health. Themes related to barriers, facilitators, and service optimisation are presented for each stage of their care pathway: identification; disclosure; referral and assessment; care and treatment. Recommendations for optimising care included improving mental health education and training to strengthen perinatal healthcare and developing a sustainable perinatal mental health pathway, including for women with mild mental health problems. Conclusions Healthcare professionals considered that the healthcare pathway for women with severe mental health problems was clear and well-developed, but that healthcare for women with mild and moderate anxiety and mental health problems was under-developed. Improvements in perinatal mental health education, in mandatory training for all healthcare professionals, should be put in place in order to improve care. Increasing the number of staff and time available to address perinatal mental health is vital but requires additional resources and should be part of long-term strategies for funding.