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Experiences of Improving Access to Psychological Therapy Services for Perinatal Mental Health Difficulties: a Qualitative Study of Women's and Therapists’ Views

Published online by Cambridge University Press:  30 October 2017

Lottie Millett ,
Billie Lever Taylor ,
Louise M. Howard ,
Debra Bick ,
Nicky Stanley  and
Sonia Johnson
Lottie Millett
Affiliation:
Division of Psychiatry, University College London, UK
Billie Lever Taylor*
Affiliation:
Division of Psychiatry, University College London, UK
Louise M. Howard
Affiliation:
Section of Women's Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
Debra Bick
Affiliation:
Florence Nightingale Faculty of Nursing and Midwifery/Women's Health Division, King's College London, UK
Nicky Stanley
Affiliation:
School of Social Work, Care and Community, University of Central Lancashire, UK
Sonia Johnson
Affiliation:
Division of Psychiatry, University College London, UK
*
Correspondence to Billie Lever Taylor, Division of Psychiatry, University College London, Maple House, 149 Tottenham Court Road, London W1T 7NF, UK. E-mail: [email protected]
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Abstract

Background: Perinatal mental health difficulties are highly prevalent. In England, the Improving Access to Psychological Therapy (IAPT) programme provides evidence-based psychological treatment, predominantly in the form of brief manualized cognitive behavioural therapy (CBT), to people with mild to moderate depression or anxiety. Yet little is known about the experiences of women referred to IAPT with perinatal mental health difficulties. Aims: The aim of this qualitative study was to investigate how women view IAPT support for perinatal mental health. We also gained the perspective of IAPT therapists. Method: Semi-structured interviews were conducted with twelve women who had been referred to and/or received therapy from IAPT during the perinatal period. Additionally, fourteen IAPT therapists participated in two focus groups. Thematic analysis was used. Results: Key themes centred on barriers to access and the need to tailor support to (expectant) mothers. Women and therapists suggested that experiences could be improved by supporting healthcare professionals to provide women with more help with referrals, better tailoring support to the perinatal context, improving perinatal-specific training, supervision and resources, and offering a more individualized treatment environment. Conclusions: Overall, women reported positive experiences of support offered by IAPT for perinatal mental health difficulties. However, services should seek to facilitate access to support and to enable therapists to better tailor treatment.

Keywords

IAPTperinatal mental healthCBTqualitative methods
Type
Research Article
Information
Behavioural and Cognitive Psychotherapy , Volume 46 , Issue 4 , July 2018 , pp. 421 - 436
Copyright
Copyright © British Association for Behavioural and Cognitive Psychotherapies 2017 

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References

Bauer, A., Parsonage, M., Knapp, M., Iemmi, V. and Adelaja, B. (2014). Costs of perinatal mental health problems. London: Centre for Mental Health. Available at: http://eprints.lse.ac.uk/59885/Google Scholar
Braun, V. and Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3, 77–101. doi: 10.1191/1478088706qp063oaGoogle Scholar
Clark, D. M. (2011). Implementing NICE guidelines for the psychological treatment of depression and anxiety disorders: the IAPT experience. International Review of Psychiatry, 23, 318–327. doi: 10.3109/09540261.2011.606803CrossRefGoogle ScholarPubMed
Cuijpers, P., Brännmark, J. G. and van Straten, A. (2008). Psychological treatment of postpartum depression: a meta‐analysis. Journal of Clinical Psychology, 64, 103–118. doi: 10.1002/jclp. 20432Google Scholar
Cuijpers, P., van Straten, A., Bohlmeijer, E., Hollon, S. D. and Andersson, G. (2010). The effects of psychotherapy for adult depression are overestimated: a meta-analysis of study quality and effect size. Psychological Medicine, 40, 211–223. doi: 10.1017/S0033291709006114Google Scholar
Dagher, R. K., McGovern, P. M., Dowd, B. E. and Gjerdingen, D. K. (2012). Postpartum depression and health services expenditures among employed women. Journal of Occupational and Environmental Medicine, 54, 210–215. doi: 10.1097/JOM.0b013e31823fdf85Google Scholar
Department of Health (2013). IAPT Perinatal Positive Practice Guide. London. Available at: https://www.uea.ac.uk/documents/246046/11919343/perinatal-positive-practice-guide-2013.pdf/aa054d07-2e0d-4942-a21f-38fba2cbccebGoogle Scholar
Gavin, N. I., Meltzer‐Brody, S., Glover, V. and Gaynes, B. N. (2015). Is population‐based identification of perinatal depression and anxiety desirable? Identifying Perinatal Depression and Anxiety: Evidence-Based Practice in Screening, Psychosocial Assessment and Management, 11–31. doi: 10.1002/9781118509722.ch1CrossRefGoogle Scholar
Guest, G., Bunce, A. and Johnson, L. (2006). How many interviews are enough? An experiment with data saturation and variability. Field Methods, 18, 59–82. doi: 10.1177/1525822X05279903Google Scholar
Hamilton, S., Hicks, A., Sayers, R., Faulkner, A., Larsen, J., Patterson, S. and Pinfold, V. (2011). A user-focused evaluation of IAPT services in London. Report for Commissioning Support for London. Available at: https://www.researchgate.net/profile/John_Larsen/publication/279694132_A_user-focused_evaluation_of_IAPT_services_in_London/links/5597bbc008ae21086d222659.pdf.Google Scholar
Health and Social Care Information Centre (2014). Psychological Therapies: Annual Report on the use of IAPT services: England 2014/15. Available at: http://content.digital.nhs.uk/catalogue/PUB19098/psyc-ther-ann-rep-2014-15.pdfGoogle Scholar
Health Education England (2017). Perinatal mental health: England 2017. Available at: https://hee.nhs.uk/our-work/hospitals-primary-community-care/mental-health-learning-disability/mental-health/perinatal-mental-healthGoogle Scholar
Howard, L. M., Oram, S., Galley, H., Trevillion, K. and Feder, G. (2013). Domestic violence and perinatal mental disorders: a systematic review and meta-analysis. PLoS Medicine, 10, e1001452.Google Scholar
Howard, L. M., Molyneaux, E., Dennis, C. L., Rochat, T., Stein, A. and Milgrom, J. (2014). Non-psychotic mental disorders in the perinatal period. The Lancet, 384, 1775–1788. doi: 10.1016/S0140-6736(14)61276-9Google Scholar
Joint Commissioning Panel for Mental Health (2012). Guidance for commissioners of primary mental health care services. London: Royal College of Psychiatrists. Available at: https://www.rcpsych.ac.uk/pdf/perinatal_web.pdfGoogle Scholar
Khan, L. (2015). Falling through the gaps: perinatal mental health and general practice. London: Centre for Mental Health. Available at: http://www.rcgp.org.uk/~/~/media/Files/CIRC/Perinatal-Mental-Health/RCGP-Exec-Summary-Falling-through-the-gaps-PMH-and-generalpractice-Mar-2015.ashxGoogle Scholar
Megnin-Viggars, O., Symington, I., Howard, L. M. and Pilling, S. (2015). Experience of care for mental health problems in the antenatal or postnatal period for women in the UK: a systematic review and meta-synthesis of qualitative research. Archives of Women's Mental Health, 18, 745–759. doi: 10.1007%2Fs00737-015-0548-6CrossRefGoogle ScholarPubMed
O'Mahen, H., Fedock, G., Henshaw, E., Himle, J. A., Forman, J. and Flynn, H. A. (2012). Modifying CBT for perinatal depression: what do women want?: a qualitative study. Cognitive and Behavioral Practice, 19, 359–371. doi: 10.1016/j.cbpra.2011.05.005CrossRefGoogle Scholar
O'Mahen, H., Richards, D.A., Woodford, J., Wilkinson, E., McGinley, J., Taylor, R.S. et al. (2014). Netmums: a phase II randomized controlled trial of a guided Internet behavioural activation treatment for postpartum depression. Psychological Medicine, 44, 1675–1689. doi: 10.1017/S0033291713002092CrossRefGoogle ScholarPubMed
Richards, D. A., Weaver, A., Utley, M., Bower, P., Cape, J., Gallivan, S. et al. (2010). Developing evidence-based and acceptable stepped care systems in mental health care: an operational research project. Final Report, NIHR Service Delivery and Organisation Programme. Available at: http://www.netscc.ac.uk/hsdr/files/project/SDO_ES_08-1504-109_V01.pdfGoogle Scholar
Stein, A., Pearson, R. M., Goodman, S. H., Rapa, E., Rahman, A., McCallum, M. and Pariante, C. M. (2014). Effects of perinatal mental disorders on the fetus and child. The Lancet, 384, 1800–1819. doi: 10.1016/S0140-6736(14)61277-0CrossRefGoogle ScholarPubMed
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