Levers of care in the health system: A qualitative study of experiences with perinatal mental health screening, referrals, and treatment among birthing people of color in California

Perinatal depression and anxiety are major contributors to maternal and infant morbidity and mortality. Perinatal mental health screening is recommended to identify patients in need of mental healthcare and make appropriate referrals. Additionally, in 2019, California implemented a law to mandate maternal mental health screening. Despite these recommendations and laws, gaps remain in continuity of maternal mental healthcare from screening to referral to treatment options. This study expands existing literature on perinatal mental healthcare by examining how birthing people of color experience perinatal mental healthcare, including screening, referrals, and treatment, guided by the person-centered care domains of respect and dignity, communication and autonomy, and responsive care. This study leverages 31 in-depth interviews conducted with postpartum patients of color at one academic health institution in California who self-identified as experiencing perinatal depression and/or anxiety. Interview transcripts were coded and themes were identified through thematic analysis. This study found challenges with person-centered perinatal mental healthcare, including inappropriate screening questionnaires, limited explanation of the screening process and results, inappropriate support for referral mechanisms, and challenges in navigating the process of identifying an appropriate mental healthcare provider. Among those who received treatment, results were mixed in terms of whether care provided was person-centered. This study identifies a number of institutional levers that may improve person-centered perinatal mental healthcare and continuity of care to improve health equity.