Austria has some catching up to do in terms of prevention and care for mental disorders in the first year after pregnancy
"The international comparison showed how important an integrated overall concept for prevention, early detection and treatment is. However, the Austrian care structure deviates significantly from the international recommendations," says Ingrid Zechmeister-Koss, deputy director of the AIHTA. The Austrian Institute for Health Technology Assessment (AIHTA) has analyzed international care models and trajectories, as well as the situation in Austria with regard to perinatal mental health. The two published reports are part of an Austrian Science Fund (FWF) project to improve perinnatal mental health in Tyrol, which is led by the Medical University of Innsbruck. The AIHTA has now taken the lead in two research reports to analyze how other countries are dealing with this need for care structures and to examine the characteristics and capabilities of Austrian services. The report suggests that for integrated care models, different service providers and professional groups work together continuously and in a structured way throughout the entire treatment and care process, clearly defined pathways and stepped care concepts for the organization and implementation. However, Austria deviates significantly from this recommendation: the “Mother-Child Health Passport” which does not yet provide for routine screening for mental health problems, although components for mental Health will be integrated in the future. This strategy would be essential for the implementation of mental health models throughout Austria. In contrast to other countries, there is a lack of research on such models.
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The Austrian Institute for Health Technology Assessment (AIHTA) has analyzed international care models and trajectories, as well as the situation in Austria with regard to perinatal mental health. The two published reports are part of an Austrian Science Fund (FWF) project to improve perinatal mental health in Tyrol, which is led by the Medical University of Innsbruck.
“The international comparison showed how important an integrated overall concept for prevention, early detection and treatment is. However, the Austrian care structure deviates significantly from the international recommendations,” says Ingrid Zechmeister-Koss, deputy director of the AIHTA.
Psychiatric disorders in parents are a common and serious complication in the perinatal phase, that is, during pregnancy and the first year after birth. As many as one in five women and one in ten men struggle with psychological problems such as depression or anxiety disorders during this period.
Despite the potentially serious immediate and long-term consequences for mother, father and especially the child, ranging from behavioral problems to an increased risk of suicide and placing a heavy burden on health, social and education systems, no national strategy nor a national care model for perinatal mental health care in Austria. The existing offer shows large regional differences, which are often uncoordinated and not available in all provinces.
AIHTA has now taken the lead in two research reports to analyze how other countries are dealing with this need for care structures and to examine the characteristics and capabilities of Austrian services. The first report analyzed six documents from the UK, Ireland, Canada and Australia, prepared by multi-professional working groups, experts and stakeholders.
All documents contain information on various aspects of care, including primary prevention, screening, diagnosis, referral and treatment.
“An important finding is that for integrated care models, in which different service providers and professional groups work together continuously and in a structured way throughout the entire treatment and care process, clearly defined pathways and stepped care concepts for the organization and implementation of perinatal mental health care services are necessary,” explains Inanna Reinsperger, public health researcher at AIHTA.
As part of primary prevention, expectant parents should be educated about mental health in general and possible psychological problems during pregnancy and after birth. For women with pre-existing or previous mental health problems or an increased risk of mental illness, pre-pregnancy counseling is also recommended.
All documents identify early identification of people with perinatal mental illness as essential. “Maternal screening for these conditions is unanimously recommended, ideally at different times, for example early and later in pregnancy, but also 6-12 weeks after birth or at least once in the first year after birth,” emphasizes Reinsperger.
However, the situation in Austria deviates significantly from this recommendation: the “Mother-Child Health Passport”, the national screening program for pregnancy and the first five years of life of the child, does not yet provide for routine screening for mental health problems, although components for mental health will be integrated in the future.
“For serious, especially acute perinatal psychological problems, there are generally few specialized services,” explains Zechmeister-Koss. National programs such as “Frühe Hilfen” (the Austrian intervention program for young children) assess mental health problems and provide psychotherapeutic group services with limited capacity in Vienna and Tyrol, but these do not specifically target mental health problems.
In addition to an evidence-based and needs-based approach, an ideal model should include measures for primary prevention, counseling and early detection, have clear referral pathways, and take into account the mental health of both the parents and the child. However, the mapping of existing prevention, early detection and care services in Austria shows that the content and capacity of these services varies widely and that there are no national quality standards and guidelines for care pathways.
In addition, inpatient capacity for mother-infant beds is well below internationally recommended capacity and completely lacking in some provinces.
“For some services in Austria, it is unclear to what extent their benefits have been proven. There is also virtually no knowledge about their cost-effectiveness or the impact of structural determinants of mental health, such as family and reproductive policies. In contrast to other countries, Austria has a lack of research on this. Supporting parents with perinatal mental health problems has a low health and socio-political priority despite the frequency,” says project leader Jean Paul from the Medical University of Innsbruck.
According to the experts, stronger coordination and cooperation between different sectors, such as health care and the social sector, would ultimately be essential throughout Austria for the implementation and realization of perinatal mental health care models. This requires a national strategy and the demarcation of responsibilities.
The AIHTA also recommends a national guideline for defining care pathways, for example after a psychological problem has been identified. In addition, data from the national birth register should be expanded to include those on mental health and should also be available for research.
“Based on these findings, experts from all relevant professions, such as psychiatrists, midwives, gynaecologists, paediatricians, psychologists and administration representatives, together with affected mothers and fathers in Tyrol, will prioritize improvement approaches and then implement them alongside thorough scientific evaluation,” the study authors summarize.
Offered by the Austrian Institute for Health Technology Assessment GmbH