'I need help' An exploration of the PANDA - Perinatal Anxiety & Depression Australia National Helpline

Submission note: A thesis submitted in total fulfilment of the requirements of the degree of Doctor of Philosophy to the Judith Lumley Centre, School of Nursing and Midwifery, College of Science, Health and Engineering, La Trobe University, Victoria.

Perinatal mental health is a major public health issue. Research to date has primarily focused on prevention strategies and treatments, however little research has been conducted with existing community-based perinatal mental health supports. PANDA - Perinatal Anxiety and Depression Australia, first founded in 1983, provides telephone support to anyone impacted by perinatal mental health issues via the National Perinatal Anxiety and Depression Helpline, which is staffed by professional counsellors and peer support volunteers. This thesis used an exploratory, descriptive study design to evaluate the Australian National Perinatal Anxiety and Depression Helpline. The overall aim was to understand who calls the Helpline, their motivations for seeking help, the experiences of callers receiving support, and the experiences of volunteers providing peer support. The study comprises four Sub-studies. Sub-study one describes the characteristics, health history and assessment of new callers to the Helpline from July 2010, when the Helpline became a national service, and October 2013. Routinely collected data showed that most women calling the Helpline for the first time were aged between 25 and 40, married or partnered, and having their first child. A high proportion of callers were assessed as experiencing significant biopsychosocial symptoms, social complexity or inadequate care and support – also known as ‘high needs’ callers. Over the study period there was a 70 percent increase in the number of initial calls to the Helpline. Sub-study two considers the reasons why someone picks up the phone for the first time and asks PANDA for help. Helpline intake forms, completed when a new or re-engaging caller contacts the Helpline, were analysed to better understand help-seeking behaviours and factors which may have contributed to the callers’ emotional distress. Many callers described complex and interrelated psychosocial factors, such as social isolation, or difficult experiences in childhood. Close to a third of callers were identified as ‘at risk’, including a number who were experiencing thoughts of suicide and/or self-harm. Sub-study three describes the views and experiences of callers to the Helpline who made their first contact with the service between 1st May and 30th September 2013. Most callers were women, and had contacted the Helpline concerned about their own mental health. Although PANDA is not a crisis service, over a third of callers were seeking crisis support and help. Overall callers reported that their contact with the service had been very positive, and they described the Helpline as a safe space to be heard and receive support without judgement. Sub-study four describes the experiences of volunteers providing peer support on the Helpline. An online survey and two focus groups were used to explore volunteers’ motivations for becoming a peer support volunteer, if the role had any impact on their own emotional wellbeing, what they saw as the positive and negative aspects of the role, and experiences of training and supervision. Volunteers described a strong desire to help parents experiencing emotional distress, and they felt that the Helpline played a really important, positive role supporting the community. The PANDA Helpline provides a well utilised, specialised service which addresses barriers to support such as geographical isolation, stigma, and difficulty accessing face-to-face services. The PANDA telephone support model has been sustained over time and provides highly valued support to a complex population.