Oxleas Perinatal Mental Health Services: Barriers and facilitators to access among women from Black and minority ethnic groups

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Adopted project
1 May 2020 — adopted May 2020 • completed February 2021

Oxleas Perinatal Mental Health Services: Barriers and facilitators to access among women from Black and minority ethnic groups

Oxleas NHS Foundation Trust has established a new trust-wide perinatal mental health service based at Queen Mary’s Hospital, consisting of a multidisciplinary team divided into three teams for Bromley, Bexley and Greenwich.

The service offers specialist assessment, care and treatment for women who are planning a pregnancy, pregnant, or up to 12 months postnatal.

A recent systematic review highlighted several complex multilevel barriers to accessing mental health services for women with perinatal mental illness. There is evidence that women from Black and minority ethnic groups are less likely to seek help for perinatal mental illness, yet few studies have explored the specific factors affecting service use in this group.

Those that have explored this indicate specific difficulties, including cultural differences in how mental illness is conceptualised, inability to disclose feelings due to differences in the ethnic and cultural backgrounds of healthcare professionals, and lack of perceived culturally sensitive support — such as the absence of female doctors and interpreters.

As a new perinatal mental health service, it is important to evaluate what factors may prevent women from accessing the service and what the needs of these groups of women are, to facilitate greater access as the service develops.

Project aims

Evaluate patterns of service use at the Oxleas Perinatal Mental Health Service among women from BME groups (including women from Gypsy and Travelling communities)

Explore the barriers and facilitators to accessing the Oxleas Perinatal Mental Health Service among women from BME groups

Develop joint clinical recommendations to improve access to and experiences of perinatal mental health services for women from BME groups

How the research was carried out

A mixed methods service evaluation was conducted across three components:

Patterns of service use

Clinical data extracted over a 12-month period on the ethnicity and religion of women referred to Oxleas perinatal mental health services — including the number of referrals from BME groups, appointments offered, and take-up of services.

Qualitative interviews with women (n=20–25)

In-depth semi-structured interviews with women from BME groups — including women from Gypsy and Travelling communities — to explore barriers and facilitators to access, support needs and experiences. Purposeful sampling aimed to recruit an equal proportion of women who had and had not accessed the service.

The team worked closely with local voluntary and community organisations and primary health care professionals to identify and recruit more marginalised groups of women.

Stakeholder perceptions

An online survey sent to all healthcare professionals within the service catchment area (midwives, obstetricians, health visitors, GPs, secondary mental health services) to explore perceptions of barriers and facilitators. A sample of survey respondents were invited to take part in one of two focus groups to explore perceptions in greater depth.

Covid-19 adaptation

In response to the Covid-19 pandemic, interviews and focus groups also considered the reconfiguration of services and remote delivery of perinatal mental health care, and the impact this had on women from BME backgrounds and patterns of service use.

Meeting the needs of the diverse population of south London

17–34%
of Bromley, Bexley & Greenwich populations are from BME groups (latest estimates)

Black African
community with highest proportion of BME residents across all three boroughs

The proportion of BME residents has increased significantly over the last decade. These estimates do not include Gypsy Travellers as an ethnic minority, although they form a distinct ethnic group with particular needs. Bromley in particular has a large Gypsy Traveller community, concentrated predominantly in the Crays.

There is evidence that Gypsies and Travellers are the most excluded ethnic minority in this country, and therefore access to perinatal mental health care is also likely to be restricted.