Barriers and Facilitators to Implementing Perinatal Mental Health Care in Health and Social Care Settings: A Systematic Review

Abstract

The improvement of perinatal mental health forms part of the World Health Organization’s Millennium Development goals. However, research suggests implementation of perinatal mental healthcare is variable. To ensure successful implementation, barriers and facilitators to implementing perinatal mental health services need to be identified. The objectives of this review were to determine the barriers and facilitators to implementing perinatal mental health assessment, care, referral and treatment into health and social care services. A systematic review was carried out by conducting literature searches in CINAHL (1982- present); Embase (1974 – present); Medline (1946- present); and PsycINFO (1806 – present). The date of the last search was 11th December 2019 and forward and backward were completed by the 31st March 2020. Studies were included if they made statements about factors that either facilitated or impeded implementation of perinatal mental health assessment, care, or treatment. Partial (10%) dual screening and data extraction was carried out. Data were analysed using thematic synthesis. A total of 46 studies were included in the review. Implementation occurred in a wide range of settings. Implementation was affected by individual (e.g. inability to attend), healthcare professional (e.g. training), interpersonal (e.g. trusting relationships), organisational (e.g. clear referral pathways), political (e.g. funding) and societal factors (stigma and culture). There are a complex range of barriers and facilitators that can support the implementation of perinatal mental health policy and practice. Perinatal mental health services should be flexible, woman-centred and delivered by well-trained healthcare professionals working within a structure that facilitates continuity of carer. Strategies that can be used to improve implementation include, but are not limited to, co-production of services, implementation team meetings, funding and coalition building. Future research should focus on implementation barriers and facilitators dependent on illness severity, healthcare setting and inpatient care.