In response to the COVID-19 public health crisis in 2020, PCORI launched an initiative to enhance existing research projects so that they could offer findings related to COVID-19. The initiative funded this study and others.
People with low incomes have less access to mental health care during the perinatal period than those with higher incomes. Perinatal Psychiatry Access Programs increase access to mental health care by building the capacity of perinatal care professionals, including obstetric clinicians, doulas, and midwives. Understanding strategies used by Access Programs and experiences of perinatal people with low incomes in getting mental health care during the COVID-19 pandemic could help improve care in future public health emergencies.
(1) To understand strategies used by Access Programs to mitigate the impact of the COVID-19 pandemic on mental health care; (2) To determine what affected access to mental health care during the pandemic for perinatal people with low incomes
|Mixed methods; online surveys and phone interviews
|Survey: 15 Access Program team members from across the United States Interviews: 24 perinatal people with low incomes who sought mental health care during the COVID-19 pandemic; 24 perinatal care professionals, including 14 obstetric clinicians and 10 doulas; and 33 Access Program team members from 15 programs
Primary: Strategies intended to (1) help members of the Access Programs respond to the pandemic, (2) teach perinatal care professionals the skills needed to recognize crisis-related symptoms, or (3) adapt the delivery of services to pandemic-related restrictions.
Secondary: Barriers and facilitators to access to mental health care during the pandemic
|Data Collection Timeframe
|March 2021–April 2022
This study identified strategies Access Programs used to increase access to mental health care for perinatal people during the COVID-19 pandemic and investigated barriers and facilitators to care.
Researchers administered an online survey to 15 Access Program team members about strategies used to support access to mental health services during COVID-19. They conducted interviews with perinatal people with low incomes, perinatal care professionals, and Access Program team members. Of the perinatal people interviewed, 50% were white, 29% were Black, and 21% identified as other races; 38% were Hispanic or Latino. Of the 57 perinatal care professionals, 81% were white, 11% were Black, and 2% identified as other races; 4% were Latino, and 4% identified as other ethnicities. Of these professionals, 91% were female.
Individuals with lived expertise of perinatal mood and anxiety disorders, perinatal care professionals, community and government leaders, and health insurers gave input throughout the study.
Access Programs responded to the pandemic by improving capacity, developing quality improvement and evaluation strategies, and initiating new or adapting services. Programs implemented a range of 0–10 strategies, with an average of 4.5 strategies responding to the pandemic and 3.5 equity-focused strategies. For example, of the 15 programs:
- 7 started to provide patients with information on whether the mental health professionals offered telehealth
- 9 initiated training on pandemic-specific challenges to the management of mood and anxiety disorders and tailored responses
- 10 developed new approaches to address the unique needs of marginalized populations
Perinatal people reported barriers and facilitators to accessing mental health care at the individual, interpersonal, practice and organizational, and sociopolitical levels, including stigma, racism, lack of telehealth availability, and few mental health professionals who accept health insurance. Facilitators included having private insurance, sharing the same race or ethnicity as the mental health professional, access to telehealth, and increased recognition of mental health disorders in the media.
Because Access Program team members may have had different understandings about what counted as pandemic- and equity-focused strategies, they may not have consistently reported on the adoption of these strategies.
Conclusions and Relevance
This study found that perinatal people and professionals reported a unique set of barriers and facilitators to accessing perinatal mental health care during the pandemic. This information may help mental healthcare professionals and systems provide care during future public health emergencies.