Task Sharing to Increase Access to Perinatal Mental Healthcare: Qualitative Findings from a Multi-stakeholder Perspective


Nicole Andrejek, CAMH; Zoe Lea, CAMH

Mental illness in the perinatal period is common but often treatable through access to mental healthcare services, particularly psychotherapy (talk therapy). However, there are numerous service gaps and barriers to care that impede perinatal individuals from accessing mental healthcare, especially the increasingly limited access to specialist psychotherapy providers (SPPS). Due to the finite nature of the perinatal period, prompt access to mental healthcare services is essential. Further, evidence suggests that lack of access to mental health treatment during the perinatal period has an extensive reach, impacting the individual, their family, and their community beyond the length of the perinatal period. One proposed solution is “tasks-sharing,” in which “non-specialist psychotherapy providers” (NSPPS), such as peers or people with lived experience, are trained and supervised to deliver brief, structured forms of psychotherapy. In order to effectively implement a task-sharing model to reduce burdens on SPPS and improve access to care, it is necessary to explore the perspectives of both relevant stakeholders and NSPPS with experience delivering psychotherapy. Through this approach, we can produce strategic facilitators to minimize barriers to implementing NSPP-delivered psychotherapy. The leveraging of NSPPS to deliver brief psychotherapy to perinatal individuals seeks to bridge the gap in the increasingly burdened SPPS within the Canadian and American healthcare systems. For this study, we collected qualitative data from prominent stakeholders (n=31), which was comprised of key decision-makers, advocates, and mental healthcare experts from across Canada and the U.S. on their perspectives of the barriers and facilitators to leveraging task-sharing with NSPPS to increase access to psychotherapy. In addition, we simultaneously examined provider-facing barriers and facilitators of task-sharing. Specifically, we interviewed NSPPS (n=15) who participated in the scaling up for maternal mental healthcare by increasing access to treatment (summit [1]) trial, which is a clinical trial aimed at increasing access to mental health treatment among perinatal women with symptoms of depression and anxiety in Canada and the United States. A central way that summit aims to increase access for perinatal individuals is by using a task-sharing model in which NSPPS are trained to deliver a brief, evidence-based psychotherapy called “behavioural activation (BA).” Through a thematic analysis of both qualitative datasets, we explore the policy-facing and provider-facing barriers and facilitators to the implementation of NSPP-delivered task-sharing to improve access to care. Stakeholder interviews highlighted two primary policy-facing barriers to implementation: (1) pushback from SPPS and their regulatory associations and colleges and (2) financial barriers. To facilitate implementation, stakeholders proposed forming a strategic business plan and creating multiple-targeted messaging approaches to get buy-in from SPPS, associated regulatory bodies, and clinical partners, such as hospitals that could house the implementation of an NSPP-delivered psychotherapy program, political leaders, and insurance groups. In addition, based on our interviews with NSPPS, barriers they encountered include (1) scheduling due to work-family conflict and (2) having to learn new socio-emotional and delivery skills to effectively administer psychotherapy. Perceived facilitators for NSPPS to deliver psychotherapy to perinatal individuals included (1) sufficient training; (2) ongoing supervision by experienced SPPS; and (3) a brief, structured psychotherapy modality to ensure NSPPS can efficiently learn and implement treatment to perinatal individuals as new providers. Although it is important to understand barriers from a sociological perspective, it is necessary to work towards actionable solutions to reduce mental health service gaps for vulnerable and underserved populations. Our findings suggest that, from a policy standpoint, a multi-pronged strategic approach working at the level of governing associations (ie. Psychotherapy regulatory bodies and insurance groups), institutional structures (ie. Hospitals), and political engagement (ie. Policy makers) will be pivotal in informing task-sharing policy development and implementation. From an NSPP standpoint, implementation will require effective task-sharing and collaboration with SPPS to provide sufficient training and supervision. We propose evidence-based solutions to improve access to mental health care for perinatal individuals while simultaneously reducing the existing burden placed on SPPS who are currently solely serving this population within the current Canadian and American healthcare structures.

Non-presenting authors: Daisy Singla, University of Toronto; Nour Schoueri-Mychasiw, Mount Sinai Hospital

This paper will be presented at the following session: