National Perinatal Mental Health Project Report Perinatal Mental Health of Black and Minority Ethnic Women: A Review of Current Provision in England, Scotland, and Wales

Mental ill health during pregnancy and early motherhood, or ‘perinatal mental illness’, is a serious public health issue with potentially deleterious consequences for women’s life-long mental health and the health and wellbeing of their children and families. For example, postnatal depression (the most common of the potentially serious perinatal mental illnesses) can precipitate relapse or recurrence of previous mental illness. It can also herald the onset of long-term mental health problems and is associated with increased risk of maternal suicide. Postnatal depression has also been linked with depression in fathers and with high rates of family breakdown. In addition, depression in mothers appears to increase the risk of poor birth and child outcomes. These include higher rates of spontaneous abortion, low birth weight babies, developmental delay, retarded physical growth, and physical illnesses such as chronic diarrhoeal illness. There is also evidence that children born to depressed mothers do less well educationally, experience higher levels of behavioural problems and are more likely to develop psychological problems in later life.The relationship between ethnicity/culture and mental illness is highly contested and falls outside the scope of this report. In terms of perinatal mental illness among Black and minority ethnic (BME) women, evidence on aetiology, course of illness and effective interventions is lacking and/or poorly understood. This may be because research into mental illness and ethnic minorities in the UK has mostly focused on Black men and evidence about perinatal mental illness is based largely on research among white Western women. Although there is emerging research about perinatal mental illness in BME women, this area of psychiatry remains relatively under-explored. What is known is that there is a strong correlation between social and material deprivation and onset of perinatal mental illness – particularly depression. Limited clinical and research evidence indicates that, despite high rates of community-level morbidity and disproportionate exposure to psychosocial risk factors, fewer than expected BME women receive diagnosis and treatment. This may be for a number of reasons. BME communities’ fear and mistrust of mental health services might reduce the likelihood of women from minority groups either self-referring or being referred to services by their families. Additionally, BME women are more likely to live in the most deprived communities in the UK. Such communities tend to have poorer access to health care. The confluence of structural factors, such as unavailability of BME therapists and lack of ‘culturally-sensitive’ care pathways, with personal and cultural factors, such as attitudes and beliefs about mental health and illness, might represent significant (sometimes insurmountable) barriers to accessing care for BME women. Further research is needed to understand the complex relationships between these issues and to devise effective strategies for reducing the inequalities in access, care and treatment experienced by some communities.