Women with Disabilities: Barriers and Facilitators to Accessing ...

More documents

Recommendations

Info

WOMEN WITH DISABILITIES: BARRIERS AND FACILITATORS TO ACCESSING SERVICES DURING PREGNANCY,CHILDBIRTH AND EARLY MOTHERHOODSchool of Nursing and Midwifery, Trinity College Dublinservice and in a small number of trusts; the maximum wait for referral of womento specialist mental health services was described as a month, or more.5.2.2. In-patient and community servicesAcross Europe there are wide variations in access and use of services(Chisholm et al, 2004). Despite the recommendations that were made after theConfidential Enquiry into Maternal Deaths (Lewis, 2007) and the comprehensiveNational Institute of Clinical Excellence guidelines (NICE, 2007), very fewexisting services in England are resourced to fulfil the recommendations made.Specialist perinatal mental health services are developing in a piecemealfashion and evidence from a survey of specialist perinatal services in 78 trustsin England highlights inadequacies in provision, specialist training and staffing(Oluwatayo and Friedman, 2005). Of the 57 trusts who responded to thissurvey, only 13 (23%) had evidence of providing a full range of services,ranging from inpatient units, intensive home treatments to perinatal liaisonservices. Twenty of the trusts (35%) had designated perinatal multidisciplinaryteams, with 11 trusts reporting that they had one or more full time communitynurses. Less than 10 trusts reported having the services of a psychologist orsocial worker, and only 2 had a full-time perinatal psychiatrist; consequently,liaison psychiatrists with a special interest in prenatal health constituted themajority of consultants involved.In the more recent study by the Commission for Healthcare Audit andInspection (2008), only 40 of the 152 trusts were able to provide data on therecording of mental health needs by maternity care staff. Only 29 trustsprovided data on referrals of women to mental health teams, and the referralrate ranged from 0% to 7% (Commission for Healthcare Audit and Inspection,2008). Over half (55%) reported that the current mental health status of womenon booking was explored using specific questions recommended by NICE(NICE, 2007). However, only 24% of the 4,950 staff surveyed across all trustsagreed, and another 43% agreed to some extent, that there was support forwomen with mental health needs (Commission for Healthcare Audit andInspection, 2008).91
WOMEN WITH DISABILITIES: BARRIERS AND FACILITATORS TO ACCESSING SERVICES DURING PREGNANCY,CHILDBIRTH AND EARLY MOTHERHOODSchool of Nursing and Midwifery, Trinity College DublinDespite the report of the Confidential Enquiries into Maternal Deaths (Lewis,2005) in the United Kingdom identifying the need for women with mental healthdifficulties to be cared for in specialist mother and baby psychiatric units and notbe separated from their baby, Oluwatayo and Friedman (2005) found that only21 (37%) of the trusts had facilities for admissions of these mothers and theirbabies. Of these, one third consisted of designated beds in open wards, asopposed to designated units. In the more recent study described above(Commission for Healthcare Audit and Inspection, 2008), 95% of trusts statedthat they had some access to a mother and baby unit, which, if accurate, is aremarkable improvement in these facilities in the space of 3 years.Glangeaud-Freudenthal and Barnett (2004) in a audit of mother and baby unitsin different countries identified approximately 30 units in the United Kingdom,over 10 units in Australia and New Zealand, and 15 in France and Belgium. Inthe absence of specialised units, women with mental health difficulties areadmitted to mixed sex, acute psychiatric units that are ill equipped to meet theiror their baby’s specialist needs.Within Ireland, the Women’s Health Council (2005:pg. 7) point out that themental health services ‘are gender-neutral at best, and skewed towards theneeds of the male population at worst’. They also highlight the inadequateresourcing of maternity services to deal with postnatal depression. Althoughthere are consultant psychiatric attachments to the 3 main Dublin maternityhospitals, and a Mental Health Liaison Midwife was appointed at The RotundaHospital in 2001, there are very few resources outside of the Dublin region andno Mother and Baby Units (WHC, 2005).5.2.3. Provision of services appropriate to needsThe latest NICE guidelines recommend that the full range of therapeuticservices, such as psychology, psychiatry, nursing, social work andpsychotherapists, should be available to women (NICE, 2007). The lack ofavailability of such services to suit women’s needs is, however, evident in92
Page 1 and 2:
University of DublinTrinity College
Page 3 and 4:
WOMEN WITH DISABILITIES: BARRIERS A
Page 5 and 6:
Page 7 and 8:
Page 9 and 10:
Page 11 and 12:
Page 13 and 14:
Page 15 and 16:
Page 17 and 18:
Page 19 and 20:
Page 21 and 22:
Page 23 and 24:
Page 25 and 26:
Page 27 and 28:
Page 29 and 30:
Page 31 and 32:
Page 33 and 34:
Page 35 and 36:
Page 37 and 38:
Page 39 and 40:
Page 41 and 42:
Page 43 and 44:
Page 45 and 46:
Page 47 and 48:
Page 49 and 50:
Page 51 and 52:
Page 53 and 54:
Page 55 and 56:
Page 57 and 58:
Page 59 and 60: WOMEN WITH DISABILITIES: BARRIERS A
Page 109: WOMEN WITH DISABILITIES: BARRIERS A
Page 161 and 162:
Page 163 and 164:
Page 165 and 166:
Page 167 and 168:
Page 169 and 170:
Page 171 and 172:
Page 173 and 174:
Page 175 and 176:
Page 177 and 178:
Page 179 and 180:
Page 181 and 182:
Page 183 and 184:
Page 185 and 186:
Page 187 and 188:
Page 189 and 190:
Page 191 and 192:
Page 193 and 194:
Page 195 and 196:
Page 197 and 198:
Page 199 and 200:
Page 201 and 202:
Page 203 and 204:
Page 205 and 206:
Page 207 and 208:
Page 209 and 210:
Page 211 and 212:
Page 213 and 214:
show all

Women with Disabilities: Barriers and Facilitators to Accessing ...

Create successful ePaper yourself

Delete template?

Save as template?