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Perinatal mental illness is an important public health issue. Conditions such as postnatal depression increase mothers' risk of suicide and can herald onset of recurrent and chronic mental health problems. Maternal mental illness can also adversely impact the cognitive, physical, and psychological health and development of children. In light of known psychosocial risks, there is concern that fewer than expected women from black and minority ethnic (BME) backgrounds access care and treatment. This paper aims to address this issue.

Responding to persistent reports of patchy service provision across the UK more generally and particular concerns about potentially unmet needs among BME women, mixed‐method research was undertaken between September 2009 and March 2010. Using survey questionnaires and telephone interviews, the study sought to explore professional stakeholders' perspectives on current perinatal mental health provision and the extent to which it meets the needs of BME women. Findings from the study were intended to inform policy and plans to improve provision by establishing managed care networks (MCNs) for perinatal mental healthcare.

In total, 45 questionnaires were returned from the national survey. One‐third of respondents (n=14) consented to follow‐up telephone interviews. There was evidence of multi‐agency working among the 27 professional groups which respondents reported as being directly involved in delivering perinatal mental healthcare across the country. However, there was also evidence of disjuncture and poor communication – particularly between statutory and voluntary sectors and NHS primary and secondary care. Some respondents had difficulty defining “BME” or identifying the women to whom the acronym might be applied. They also questioned the validity of providing “BME‐specific” services. Instead, they endorsed more ethnically “inclusive models” of provision and “signposting” women to appropriate “community” services.

Taken together, these findings suggests that whilst there might be a theoretical argument for perinatal mental health MCNs, considerable effort is required if policy‐makers' aspirations for more “joined‐up” services capable of meeting the needs of all women are to be fully realised. Furthermore, current proposals for public sector reform coupled with reduction in voluntary sector provision is likely to disproportionately affect women from BME and other marginalised communities as they provide significant amounts of “below the radar” care and support.

This paper is of particular relevance to policy makers and practitioners. Findings suggest that women from BME backgrounds might be particularly vulnerable to perinatal mental illness. Contraction of voluntary sector provision increases the likelihood that the needs of BME women will remain unmet with deleterious consequences for their health and wellbeing of their families. This has potentially serious public health implications. MCNs/clinical networks have the potential to reduce inequalities by providing more “joined up” care for all women. However, the evidence base for levels of need and appropriate service response to perinatal mental illness among BME women is weak. Further research is required to bridge the evidence gap and to evaluate the impact of health and social care reform on vulnerable groups.

The purpose of this study was to explore providers' and commissioners' perceptions of the extent to which services currently meet the perinatal mental health needs of black and minority ethnic (BME) women. A mixed method study involving a national survey and in‐depth interviews was undertaken in response to reports of patchy service provision and particular concerns about potentially unmet needs among BME women. Findings indicate that the surprising number of professional groups (n=27) involved in delivering perinatal mental health care were predominantly located in secondary care. Perceptions of the validity of ‘BME‐specific’ services were equivocal. Service delivery for minority women tended to focus on language and translation; which might facilitate assessment and physical (though not psychological) care but would do little to address women's cultural needs.

Perinatal mental health is a major concern among women of childbearing age. Women from a black and minority ethnic background are widely believed to have particular needs that are often not given the attention they deserve. NHS Croydon launched a perinatal mental health project to develop a closer and better partnership between the Primary Care Trust (PCT), Croydon Council and black and minority ethnic (BME) voluntary organisations through an action learning approach. Experience was shared to improve engagement and use of health services by mothers from BME communities in Croydon who had encountered mental health problems during pregnancy or following childbirth. By exploring and identifying such issues and problems, the action learning set endeavoured to find solutions for a joined‐up approach to achieve identifiable benefits. Some problems were encountered, such as a lack of communication between health professionals and BME community groups. The learning outcomes were to raise awareness and to recognise the cultural differences with mothers of BME background experiencing perinatal mental health problems. The learning from the project will be disseminated to a wider audience to promote best practice.

Perinatal depression is common and increases the risk of adverse outcomes for both the mother and child. Despite regular contact with midwives and GPs during the perinatal period less than 50 per cent of women with depression are identified and treated. A number of reasons for this have been proposed; however, failure of health professionals to recognise the symptoms women present with may contribute. The purpose of this paper is twofold: to explore women’s self-report symptoms of perinatal depression and understand how the symptoms women present with might impact on identification.

Women were invited to post their experiences of perinatal depression on one of two online discussion forums over a nine-month period. Data were analysed using a process of deductive thematic analysis informed by cognitive behavioural therapy.

Women’s symptoms were presented using five headings: triggers (for perinatal depression), thoughts, moods, physical reactions and behaviours. Women believed having a previous mental health problem contributed to their depression. Women’s self-report symptoms included intrusive and violent thoughts; emotional responses including fear, worry and anger; and somatic symptoms including insomnia and weight changes. Women also reported aggressive behaviour and social withdrawal as part of their depressive symptomatology. Symptoms women present with may negatively impact on identification as they often overlap with those of pregnancy; may not be included in the criteria for mental health assessment and may involve undesirable and socially unacceptable behaviour, making disclosure difficult.

A more inclusive understanding of women’s self-report symptoms of perinatal depression is called for, if identification is to improve.

This paper offers an analysis of women’s self-report symptoms of depression, in the context of identification of perinatal mental health problems.

Work-life challenges experienced by employees navigating pregnancy, maternity, and parenting young children are well documented in the literature. Correspondingly, work-life balance policies and provisions aimed at supporting affected staff are well established in many modern organizations. Within this agenda however, complications within maternity journeys, and specifically the intersection with mental health has been neglected. In this chapter, we consider the work-life issues associated with perinatal (pregnancy and post-birth) mental illness. After introducing perinatal mental illness, and its impact on individuals and families, we consider the two-way relationship between illness and work: how employment factors influence the development of perinatal mental illness and recovery trajectories, with implications for family life; and how such illnesses impact work and employment. We offer key insights from our empirical research on this topic in the context of UK policing, highlighting challenges linked to the nature of police work and organization culture, and issues that are more broadly applicable to how maternity and mental illness are treated in the workplace. The chapter offers recommendations for people management practice aimed at reducing or mitigating occupational factors that exacerbate illness and maximizing those facilitating recovery in the perinatal period and beyond, thus advancing work-life inclusion.

The purpose of this paper is to describe some of the barriers and solutions to implementing good practice in perinatal mental health promotion in universal services, and propose some ways forward.

This paper describes the rationale and evidence base for proactive management of perinatal mental health in primary care and community services and good practice recommendations. There is considerable evidence that these recommendations have not been implemented nationally in the UK. A range of solutions and proposed ways forward to manage barriers to implementation are set out.

It is proposed that a number of factors need to be in place in order to deliver best practice in perinatal mental health.

The value of this paper is to set out what needs to be in place in order for services to promote good perinatal mental health and secure attachment and change the life chances of children and their parents, by intervening early. This will also ultimately save financial resources for public services, because the quality of early relationships is linked to health and mental health.

The purpose of this paper is to look at the positive future gains of reaching women with perinatal mental illness at the first midwifery booking-in appointment, a unique opportunity that could be more widely used as a point of detection, awareness and prevention of illness in the perinatal period.

A more robust section of this appointment that includes focussed detection and awareness of prior and current mental health concerns as well as the stigma attached to these conditions will allow midwives to signpost women to get much needed treatment prior to delivery. Suitable treatment options also need to be available and in place at this point.

The existing booking-in process, for highlighting and diagnosing mental health conditions, has limited suitability. Detection in the postnatal period has inherent difficulties due to time pressures on women, the costs to the mother, baby, family and the economic costs to society, which are considerable. The postnatal period may be too late for treatment, with the harm already done to the woman, their baby and their family.

Research is needed to assess the efficacy of such a strategy, including the costs to train the midwives to deliver this additional service, and the consideration of suitable treatment options at the antenatal stage. This may help to reduce the high levels of attrition within treatment programmes currently running.

This paper fulfils a need to diagnose and prevent perinatal mental illness at an earlier point in pregnancy.

Women from culturally and linguistically diverse communities face barriers to accessing perinatal mental health care. Victorian Transcultural Mental Health (VTMH) is a state-wide service in Victoria, Australia, that supports specialist mental health service providers to improve cultural responsiveness. VTMH provided training for perinatal health professionals in cultural responsiveness. The paper aims to discuss these issues.

A curriculum was specifically developed based on a literature review, consultation forum, and input from members of an industry-based reference group. An Evaluation Tool was designed to collect participants’ feedback regarding the perceived relevance of the training content and its impact on practice. Responses were analysed using quantitative techniques and thematic analysis.

Nine face-to-face training sessions were provided, in metropolitan and rural regions. In all, 174 professionals of various backgrounds (including midwives, mental health professionals, and maternal child health nurses) attended. In all, 161 completed evaluations were received and responses indicated that the training was of high relevance to the target workforce, that the training would have implications for their practice, and support was given for further training to be delivered using online methods.

First, an assessment of the cultural competence of participants prior to enrolment in the course was not conducted, and no matched control group was available for comparison with the participants. Second, generalisability of these findings to other settings requires further investigation. Third, the sustainability of the project is an area for further study in the future. Fourth, other methods including direct interviews of focus groups with participants may have yielded more detailed qualitative feedback regarding the effectiveness of the programme.

To facilitate the sustainability of the project, following the face-to-face training, an online training module and a resource portal were developed, offering links to relevant web sites and resources for health professionals working in this field.

The training addressed a significant unmet need for cultural responsiveness training for a diverse range of practitioners in the field of perinatal mental health. Online training can be adapted from face-to-face training and it is anticipated that online training will facilitate the sustainability of this initiative.

Refugee and asylum-seeking women are particularly vulnerable to experiencing mental health difficulties during the perinatal period, with social factors compounding these experiences. Research is limited into the mental health needs of perinatal women who are refugees or seeking asylum. The purpose of this paper is to examine the best available international evidence on this topic and to discuss the findings with relevance to the UK context.

A modified population, intervention, comparison, outcome was used to formulate the research question and search strategy. Databases searched were: cumulative index of nursing and allied health literature, Medline, PsychINFO, Web of Science and Scopus. Guided by the Preferred Reporting Items for Systematic Reviews and Meta-analysis framework, results were screened against an inclusion and exclusion criteria. Each study underwent a quality assessment in which they were appraised using the mixed methods appraisal tool.

Eight papers were retrieved, and a thematic analysis was conducted. Two major themes were identified: mental health needs and social influences. Refugees and asylum seekers are likely to have experienced trauma as reasons for migration. Post-migration stressors, including hostility and dispersal from social networks, lead to cumulative trauma. These each add to the mental health needs of perinatal refugee and asylum-seeking women that cannot be ignored by policymakers, health and social care services or professionals.

Refugee and asylum-seeking women are particularly vulnerable to mental health difficulties in the perinatal period. Stressors accumulated pre-, during and post-migration to the host country exacerbate mental distress. In the UK, the treatment of this population may be detrimental to their mental health, prompting the need for greater critical awareness of the socioecological environment that refugee or asylum-seeking women experience.

Up to 25 per cent of women will experience depression during their pregnancy. Perinatal mental health problems are a leading cause of maternal morbidity and mortality, however care provided to women is often a low priority. The purpose of this paper is to explore women’s perspective of care from GPs and midwives, when they experience symptoms of depression during pregnancy.

Women, with self-reported symptoms of depression, were invited to post comments in response to a series of on-line questions posted on two discussion forums over a nine month period. The questions were related to the care women received from GPs and midwives. Data were analysed using thematic analysis.

In total, 22 women responded to the on-line questions. A number of themes were identified from the data including women’s disclosure of symptoms to GPs and midwives; lack of knowledge of perinatal mental health among health providers; attitudes of staff and systemic issues as barriers to good care; anti-depressant therapy and care that women found helpful.

Women often face significant emotional and psychological health issues in the transition to motherhood. This small study indicates women often experience difficulties in interacting with their GP and midwife in seeking help. This research has identified some contributing factors, however more rigorous research is needed to explore these complex issues.

This paper highlights service provision in the care of women with depression in pregnancy.