Black, Asian and minority ethnic women and access to perinatal mental health services

Guest Blog by Elaine Amoah, Assistant Psychologist in South London and the Maudsley NHS Foundation NHS Trust

During this Maternal Mental Health Awareness Week 2021, led by the Perinatal Mental Health Partnership UK, I am reflecting on the theme 'Journeys to Recovery'. Before the Covid-19 pandemic, I completed a study on Black, Asian and minority ethnic women and access to perinatal mental health services for low mood and depression. The research highlighted inequalities in accessing services for Black, Asian and minority ethnic women which is ongoing and urgently needs addressing. This is especially important with the current circumstances of the pandemic as evidenced by the recent report commissioned by the Maternal Mental Health Alliance and conducted by Centre for Mental Health and the Parent-Infant Foundation ‘Babies in Lockdown’ report.

It's paramount that the mental health needs of women from Black, Asian and minority ethnic communities are recognised and that they receive adequate treatment supporting their journey to recovery in the perinatal period.

Key findings from my research:

• 98% of women surveyed were willing to receive treatment for their mental health, but around one-third (32%) had not received treatment including talking therapies such as CBT and counselling.
• Around one-quarter (20%) of women reported that they did not visit healthcare professionals to talk about their low mood and depression.
• One of the major barriers to accessing perinatal mental health services was 'Wanting to solve the problem on my own'.

Internalised stigma, perceived public (social stigma), and treatment stigma impact Black, Asian and minority ethnic women as barriers to receiving treatment.

• Internalised stigma (having stigmatising beliefs about oneself) was found to be a significant predictor of perinatal depression. Around 1 in 8 of the women surveyed were identified as having experienced alienation and social withdrawal (13% and 12% respectively).
• Around one-third (30%) of the women surveyed felt, 'Receiving treatment for emotional or mental problems carries social stigma'.
• The major treatment stigma-related barriers to accessing services were found to be, 'Concern that I might be seen as a bad parent', 'Not wanting a mental health problem to be on my medical records', 'Concern that my children may be taken into care or that I may lose access or custody without my agreement', and 'Concern that I might be seen as weak for having a mental health problem' – This is significant as Black and Brown women may feel that they have to uphold the narrative of being a 'Strong Black Woman’ or meet expectations to ‘deal with it’.

Recommendations from the research

Group-based intervention

A group-based intervention for Black, Asian and minority ethnic women may allow a safe space for opportunities and expressions of emotion regarding mental health and provide a space for a network of women with shared experiences to feel less alone. Internalised stigma was found to play a significant role in relation to perinatal depression and internalised, perceived public, and treatment stigma were found to have an association with one another. Preventing forms of internalised stigma such as alienation and social withdrawal is more important than ever before with Covid-19.

Support Network

Services need to ensure that any of the support networks (including possibly a partner and/or family) of Black, Asian and Minority ethnic women are included throughout care and treatment so that they have the support needed to recover and don’t feel that they need to walk the journey to recovery alone. Partners and/or families can also play an important role in identifying symptoms of perinatal mental depression. In addition, families can be supported to better understand mental health and wellbeing as a possible benefit to reducing perceived public and treatment stigma. Social networks can be used as a foundation of support, allowing women to talk about their issues and access service provision.

Meaningful clinical support

Services need to provide meaningful and helpful advice throughout the perinatal period. When asked to rank healthcare professionals, the women surveyed were most willing to talk to their doctor about their low mood and depression as ‘They will provide me with the most meaningful advice and treatment.’ Healthcare professionals (all ethnicities) also surveyed reported, ‘Initial response: initial advice and support given to women in the perinatal period’ as the highest demand in terms of care pathways for women from Black, Asian and minority ethnic communities, followed by ‘Initial response: initial advice and support given to health professionals (e.g. GPs or midwives)’. There is an opportunity to use maternity services, voluntary organisations and available social networks and resources within the local community to improve awareness through social capital, social exchange, and community empowerment. Services need to ensure early recognition of emotional difficulties and access to information and advice is provided as this is central to journeys to recovery and ensuring suitable interventions are in place.

Opening a conversation

Healthcare professionals, especially in primary care services, need to ensure that they bring up the topic of mood, for example ‘upsetting feelings around birth’. The women surveyed were found to be most comfortable answering questions about mood at home. Then subsequently discussing their responses in their next visit with their health provider. This suggests a safe space such as their home is preferable for expressing feelings as well as the opportunity to discuss responses. Approaches that enable women to describe their feelings to healthcare professionals will have an effect on whether mental health difficulties are detected, and the timeliness and nature of the support that is offered.

Co-production of services

Women from Black, Asian and minority ethnic communities can help with public health initiatives and NHS services to promote more helpful messages about mental health and seeking support as this allows the collaborative discovery of solutions to mental health difficulties using the power of lived experience to better build on cultural sensitivity, understanding and knowledge.