**1.5 Barriers to antenatal psychosocial assessment and depression screening in private hospital settings**

Sources of barriers to the implementation of psychosocial and depression screening in private obstetric settings include barriers for women and their families, Health professional barriers, Organisation or provider barriers [40].

Collaborative postnatal care pathways have been suggested for improving liaison between mental health maternity, and primary care services [51], with a specific point of contact enabling this process by providing specialist information and advice. Therefore, a sustainable model of postnatal mental health care in private obstetrics may involve psychoeducation provided by the midwife at the various clinic appointments and during antenatal classes and a postnatal liaison nurse to screen/assess, support, refer and follow-up women identified as at risk and correspond with women who decline help. Working within a collaborative care model with a postnatal liaison nurse and mental health care providers could guide treatment options to ensure women's support. There is also some evidence that nurse-led counselling, peer support models of care and home visitors may also be effective supports for women [52]. Additionally, the Australian Government initiative "My Health Record" may be able to connect additional information regarding women's health for their various healthcare providers [53].

Women who have private obstetric care have a continuity of care with their obstetrician; however, obstetric appointments are mainly focused on physiological factors associated with the pregnancy rather than psychosocial/mental health factors. Given the known prevalence of antenatal depression, anxiety and other risk factors, it is essential that health care providers view the assessment of mental health as being equally important as the assessment of physical health [13]. The Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) have recommended that all obstetricians screen and assess women for postnatal mental health risks and disorders [54]. Since obstetricians see women consistently during the perinatal period, they are in a prime position to assess, screen and refer women, partially because they have built a rapport with the woman and may notice changes in her circumstances, or psychosocial/mental health risk factors. Although there are identified barriers, there are solutions/recommendations to address these barriers.
