Strategies and resources to help you address your clients’ barriers to disclosure and help-seeking.
Anxiety and depression affect up to one in five women and one in ten men in the perinatal period. Many struggle for weeks or months before seeking help, while others never get treatment.
Even after a health professional has identified an issue and offered referrals, many people still don’t get the support they need. How does this happen, and what can you do to help?
The barriers to new and expecting parents getting mental health support are varied. Some barriers are internal, while others are external, including those that arise from limitations within the health system or in health professional practices.
“My family noticed that things didn’t seem right, and urged me to speak to my Nurse or GP. But I was too afraid that if I told anyone my horrible scary thoughts, they would take my daughter away.”
On the PANDA National Helpline, callers often disclose feelings of shame, self-blame and fear of judgement or child removal. Others have little understanding of mental illness, treatment options or the health system. For some, cultural or family attitudes towards mental health and help-seeking can be a barrier.
"It looks like you’ve got a bit of postnatal depression,’ the nurse said. ‘You should probably go and see someone.’ And that was it. No suggestion of who to see or talk to, no follow up, no further discussion. I was too tired and overwhelmed to do anything about it and I didn’t tell anyone.”
Mental health screening works best when there are clear pathways for management, treatment and follow-up (Milgrom & Gemmill, 2014). However, practice in following up screening results or other mental health disclosures varies widely.
The information below will provide strategies and practical tools to help you make effective referrals and ensure vulnerable clients get the help they need.
When people have a good understanding of their health condition and support options, they feel more empowered and able to work towards recovery. Yet sometimes health information can be difficult to comprehend or overwhelming.
Psycho-education means sharing accessible information in a way that helps someone to make sense of their experiences and understand their options. This could include information about anxiety and depression, signs and symptoms, the impact on their function and daily life, their diagnosis, prognosis and treatment options, recovery, self-care strategies and information for carers.
How PANDA can help: Use our websites, fact sheets and other print resources to inform clients and partners/carers, reduce stigma and promote help-seeking. These resources include easy-to-read information and personal stories. Use the resources for group-based or individual education, e.g. to help open up a conversation with a client about their emotional wellbeing or mental health that might lead to referral.
There are many support options, depending on the nature and severity of a client’s symptoms, their circumstances and preferences. It’s also important to offer options appropriate to their culture and/or identity e.g. if they are Aboriginal and/or culturally and linguistically diverse and/or lesbian, gay, bisexual, trans or intersex.
By exploring options and offering choice, you empower your client and make it more likely that they will access treatment that works for them.
Multiple supports may be helpful, and people often need different supports along their recovery journey. When a person is very unwell, they may need hospitalisation and/or medication before they can access counselling or group support.
How PANDA can help: Our Health Professional resource Perinatal Emotional and Wellbeing Interventions explains the types of referrals that our Helpline counsellors commonly offer callers. Call the PANDA Helpline to enhance your referral resources; we have a national database of perinatal services, groups and programs. Or refer your client to us, to more fully explore their support options.
Some barriers to help-seeking can be addressed through psycho-education. Others relate to preference (e.g. discomfort with therapy, groups or medications); it’s important to address this by offering clients a range of support options.
Some barriers are personal (e.g. those that tap into feelings of shame or fear) and require a sensitive exploratory approach. Here is some language we use with callers that you might find useful:
Some people’s barriers are such that they find it difficult to accept any referrals.
Try gently exploring with them what they imagine life might be like in the coming months if they don’t get additional help, and then what things might be like if they do.
You can also share other clients’ (de-identified) experiences of the positive effects of getting help.
How PANDA can help: Refer to the Helpline – much of our work is about addressing callers’ barriers to help-seeking. The personal stories on our websites can also help to address stigma and fear e.g. related to mental health, diagnosis and treatment.
Callers often say that they feel apprehensive about sharing symptoms and concerns with their GP or specialist, and that in appointments they forget things that they wanted to say or to ask.
Coaching can help them feel more confident and ensure they mention key symptoms that will lead to appropriate treatment. Help them to make a list of symptoms or concerns they have shared with you, and questions to ask. If you have used a screening test like the EPDS, give them a copy to take along.
How PANDA can help: Our ‘Talking to your doctor’ fact sheet is full of tips to help clients prepare for their appointment. Our online Mental Health Checklists can also help. They provide an interactive tool to support referral to a GP or specialist - see below. If your client needs more one-on-one coaching to support their referral than you have time to provide, you can refer them to the PANDA Helpline.
Follow up to ensure referrals are successful. There are many reasons why referrals don’t work out, and unsuccessful help-seeking contributes to even greater barriers. Sometimes clients need you (with consent) to make the appointment for them and/or share information with the professional you are referring to. This enables you to share your concerns, and means they don’t have to tell their story again.
How PANDA can help: Helpline services can include follow-up calls and ongoing support, as well as active referral and handover for some callers.
PANDA has a suite of online Mental Health Checklists for expecting and new parents. The Checklists are not diagnostic, but will help your client (or their partner/carer) to explore a range of potential symptoms or concerns. They can then take a print summary of their Checklist responses along to their consultation with their GP or specialist. This can help them start the conversation and perhaps disclose symptoms they may find difficult to discuss.
PANDA operates Australia’s only national specialist perinatal helpline. The National Perinatal Anxiety and Depression Helpline provides risk assessment, support, counselling and referral to mothers, fathers, family and friends, and secondary consultation to health professionals.
To refer your client/patient into one of our extensive telephone based programs please complete the Health Professional Referral Form. Please be sure to include your email address as we will provide confirmation of receipt of referral, and initial engagement via email. Read more > National Helpline Programs
PANDA's National Helpline operates Monday to Friday 9am - 7.30pm (AEST/AEDT)
National Helpline Programs
Health Professional Referral Form (PDF)