Service issues

There were also challenges identified in regards to services. Most HCPs agreed that there was a lack of services specifically for the treatment of PND due to various factors. It was suggested by one HCP that:

In the mental health world, it’s [PND] not seen as a massive illness so it is really hard to get into the mental health world, especially in Launceston. We don’t have any useful facilities. (HCP 8)

When services were identified for the treatment of PND, other challenges were commonly mentioned, such as long waiting lists, location, cost and age restrictions.

4.6.3.1 Waiting lists

Long waiting lists to see appropriate HCPs was the most common concern for HCPs in regards to service provision. It was recognised that both specialists and more accessible services, such as parenting centres, have long waiting times. For example, one HCP stated

We can refer women to them [parenting centres] if they could do with seeing our psychologist at the parenting centre but there is a very long waiting list at the parenting centre too. (HCP 4)

4.6.3.2 Location

Location of services was the second most common concern among HCPs regarding service provision. It was identified that there was a shortage of appropriate specialist HCPs for women with PND in the north and northwest regions of Tasmania. HCPs stated that:

There is a visiting psychiatrist once a month, I don’t know what the particular specialty is but, that is important with a psychiatrist just as with any other specialist. (HCP 1)

and

The support is just not out there; specifically for PND. There isn’t much at all in the northwest coast, if anything. (HCP 5)

There was a mother and baby unit in Hobart at a private hospital but that excluded a lot of people due to the requirement to have private health insurance. This limited the access to treatment for the lower socioeconomic as well as middle class women in Tasmania. There were also mixed reports back to HCPs by women who had stayed there. One HCP reported:

I have also had really mixed reports about it [mother and baby unit] as to how helpful it is. Women who have PND have gone down there and the PND wasn’t even raised as an issue. It’s not always helpful so, I think carefully before referring but really, there is nowhere else. (HCP 9)

4.6.3.3 Cost relating to treatment

In regards to service provision, cost was the third highest concern among the HCPs. One HCP shared her concern for the mums from the middle income bracket who were typically educated and used to functioning at a high level, but may not have private health insurance or the required funds to pay for specialist services:

My concern is what about all the middle class mums? …the husband or partner is working very hard to pay for all of the props and the lifestyle. I would say some of the most severely PND women I have seen are in the middle classes of the community. They don’t always have private health

insurance or the money to pay for services, and counselling can be very expensive…It’s very difficult because there is nothing for them. (HCP 9)

Another HCP stated:

I don’t know about private or public health care but it comes down to if people have the money to afford to see a psychologist, or afford their medications, or to be able to afford to get some support like child care. It’s the cost that determines what, if any, service they receive. I have to keep that in mind when I consider what [treatment or service] will be best for [the woman]. (HCP 10)

The issues around cost were also stated by a number of women who indicated, when discussing counselling, that the cost involved was more than just the cost of the counselling itself. For those who resided on the east and west coasts of Tasmania, or away from major centres, the ability to access counselling required hours of travel, which then required long-term baby-sitting as the baby was generally not welcome at the appointments because their presence could be distracting for the mother. This resulted in the partner typically taking time away from paid work and staying at home to take care of the child or children while the woman attended her appointment with the psychologist or psychiatrist. This then often resulted in lost wages, causing more economic stress for many of the women and their families.

4.6.3.4 Disregard for needs of family

Regardless of waiting lists, location, and cost, a disregard of the entire family unit within services, including the GP, was of concern to the psychologists, psychiatrist, social workers and CHNs. One HCP stated:

Women don’t have PND in a vacuum so that bothers me that there is a whole family behind all of this that may not be getting the help they need. (HCP 9)

How they are relating to their baby is a big, big thing and to make sure that the depression is not having a big impact [on the rest of the family]. Quite often when they go to the doctor they will go without their baby, or the social worker without their baby, or the counsellor or the psychologist or psychiatrist without their baby. There is nobody really watching what is going on between mum and bub. (HCP 3)