Barriers to Acccessing Pyschological Support Following Early Miscarriage. Perspectives of the IAPT Perinatal Champion.

Early miscarriage has been linked to a wide variety of subsequent psychological difficulties. Despite this, challenges in accessing appropriate psychological support following early miscarriage are emphasised throughout the literature. Few studies have explored barriers to accessing support following early miscarriage from the perspective of healthcare professionals providing support, and none of these have focused solely on NHS primary mental healthcare settings. This study therefore sought to address the gap in the literature through a qualitative exploration of the perspectives of Increasing Access to Psychological Therapies (IAPT) perinatal champions, deemed to be in a position most likely to be providing support for people following early miscarriage. The aim of this study was to elicit a fuller, critical understanding of the potential barriers to accessing psychological support following early miscarriage, with the hope of eliciting suggestions for how to improve it.

12 participants, who had all at some point held the role of IAPT perinatal champion, took part in semi-structured interviews exploring their experiences of providing psychological support for people following early miscarriage. Thematic analysis of the interview transcripts yielded four key themes: unclear guidance, service-centred care, journey to role, and societal stigma.

The findings revealed a variety of potential barriers to accessing support following early miscarriage. Unclear guidance was thought to influence referrals and create uncertainty regarding perinatal labelling and the remit of IAPT in providing post-miscarriage support. Services were reported to be built around prioritising commissioning and financial objectives over client need, resulting in structural constraints and a diagnosis-focused system that was not set-up for providing the individualised support required following early miscarriage. Participants described their journeys to the role of perinatal champions as often lacking the autonomy, training, support and resources required. The role of services in perpetuating societal stigma around early miscarriage, including shame, blame, silence and invalidation was also highlighted. This study has implications in terms of informing service structure, roles and training within IAPT to improve pathways to support, following early miscarriage.