PhD Studentship: Pathways into perinatal mental health care: the role of service context, stigma, and discrimination

Perinatal mental health difficulties are common, representing a major public health concern, with significant consequences for women, infants, and families. Improving access to timely and effective support during the perinatal period is therefore a priority for both women’s mental health and child and family wellbeing.

Recent national policy emphasises prevention, digitalisation, and a shift from hospital-centered to community-based provision (e.g., NHS Mental Health 10 Year Plan, Fit for the Future plan, National Family Hub expansion). Family Hubs and voluntary care sector enterprise (VCSE) partnerships are explicitly promoted as accessible, de-stigmatising “one-stop” settings for early support, including for perinatal parents with “mild to moderate” mental health problems. However, despite increased provision and screening, access remains low: only an estimated 8–30% of women with perinatal mental health difficulties receive care during this period (compared with 50% for women’s mental health outside the perinatal period). Patterns of engagement vary by socioeconomic position, ethnicity and social complexity, with those with more complex situations at greatest risk of only receiving treatment at the most acute end of care.

Research suggests that variations in access to care are driven by a combination of factors, including structural and support barriers that, critically, interact with psychological factors such as stigma and fear of discrimination. Understanding how these processes operate and what forms of support make a difference at the early stages of mental health treatment is critical to ensuring equitable access to early, effective care (i.e., Family Hubs/community provision, NHS Talking Therapies, VCSE). 

2. Problem or issue to be investigated.

Policy assumes community-based models are less stigmatising and more accessible than specialist NHS services, yet empirical evidence is limited and largely drawn from people who have already been engaged with services. Little comparative work examines how women navigate between services, which groups attend which settings, what support they actually receive, or whether community settings are de-stigmatising for whom. This is particularly problematic given that women from ethnically minoritised groups, lower socioeconomic backgrounds, or complex social circumstances are more likely to be found in community/VCSE settings, where provision can be lighter-touch and may be less consistently evidence-based. Without cross-service evidence about stigma, identity processes, and pathways into care, investments in community provision risk failing to reach those most in need or unintentionally reinforcing inequities.

There is a need for applied research that compares service contexts, captures the views of women who do not engage with formal care, and identifies psychological mechanisms that could be targeted to improve early disclosure, uptake, retention and equity of perinatal mental health support.

3. Research questions/aims and objectives.

1. How do women experiencing perinatal mental health difficulties perceive and navigate different forms of support across services? 2. How are identity, stigma and fears of discrimination experienced across service contexts, and how do these experiences vary by setting? 3. How do these psychological processes influence disclosure, engagement and retention in perinatal mental health care? 4. How do pathways into care and experiences of support differ according to ethnicity, socioeconomic position and social complexity?

4. Proposed methodology and methods.

A mixed-method PhD integrating state-of-the art theory and evidence from psychology about factors driving stigma, discrimination and identity with applied, public-health and PPIE driven solutions. Approaches should include both qualitative and quantitative methods, including experimental design.

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