Advocating for better perinatal mental health

Dr Nicole Votruba is a Senior Postdoctoral Researcher in the Nuffield Department of Women's & Reproductive Health.

With a background in political science, international law and psychology, Dr Votruba’s research is centred on global mental health.

Dr Votruba’s work has a particular focus on perinatal mental health in women living in rural India. Her work advocates for the development of equal and accessible health systems for vulnerable populations.

In low and middle income countries, mental health is often neglected due to limited resources and engrained stigma.

Dr Votruba’s work aims to address the lack of mental health services and barriers to care that women face in rural India.

This involves what Dr Votruba describes as ‘health system strengthening for mental health.’ 

It includes developing and strengthening systems in areas where mental health services do not yet exist, or where there is very little access to mental health care.

At the heart of the research is the SMARThealth Pregnancy And Mental Health programme (PRAMH), which develops a community intervention to support pregnant women and new mothers in rural India.

As a first step, the programme aims to identify the needs of women and the community, their understanding of mental health, and the challenges they encounter.

Understanding what the local community needs is key to the success of the PRAMH research programme.

Poverty, livelihood struggles, domestic violence, and stigma are all factors to be considered when developing mental health care in these communities.

Stigma surrounding mental health conditions is one of the main barriers for women accessing care.

Dr Votruba and her team are developing and identifying ways to best address this stigma and reduce discrimination, to provide the best solutions for the people in these communities.

Being part of the Oxford community provides a network of researchers and academics.

Dr Votruba notes the exchange of ideas, collaboration on grant applications and valuable connections to colleagues working both in India and Oxford, as highlights of the community.

Dr Votruba points out three key challenges for the future of mental health care.

The first is integrating mental health interventions into broader health and social systems approaches.

The second challenge revolves around tackling stigma, which not only prevents people from seeking care, but also creates a barrier to effective policymaking and implementation.

The third key point, according to Dr Votruba, is to involve individuals with lived experience of mental health problems throughout the process to effectively reduce stigma and ensure the lasting success of interventions.

Interdisciplinary, multi-sectoral approaches are vital for sustainable change.

When asked what she would do with a blank cheque, Dr Votruba says she would form an interdisciplinary group including researchers and practitioners alongside policymakers and people with lived experience.

A multi-sectoral approach will then identify what priorities people in a particular setting have around mental health, understanding systems, and develop and implement sustainable approaches tailored to these contexts.

Driven by a passion for the cause, Dr Votruba acknowledges that she embodies elements of activism.

She notes that combining activism with rigorous scientific research and data-driven methods can be a driver for meaningful change.

For young researchers Dr Votruba advises balance is key. ‘Watch out for your own mental health,' she says, ‘to take care that you're balancing your research, your work and your private life.’