Clinician perspectives on specialist perinatal mental health service care pathways: An integrative review

BACKGROUND: The international development of specialist perinatal mental health care pathways aims to align practice with evidence-based guidelines and strengthen the effectiveness and equity of support. Clinicians working directly with women and families are ideally placed to assess care pathways and provide valuable insights to enhance clinical processes, coordination, and optimisation of care. AIM: To synthesise the current evidence on clinicians' perspectives on specialist perinatal mental health service care pathways. METHOD: This systematic integrative review was guided by Whittemore and Knafl's integrative review framework and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A search of six international databases, including MEDLINE, EMBASE, PsycINFO, CINAHL, Scopus, and Web of Science, was conducted with no date, language, or geographical limits. The initial search yielded 5081 studies. Data were extracted from the final 35 included papers and synthesised using narrative synthesis. FINDINGS: This review identified three primary themes and subthemes: (1) pathways defined by criteria, (2) engaging and inclusive pathways, and (3) perspectives on service integration. Across the included studies, care pathways were described as highly criteria-driven, with complex referral processes and gaps in provision that risked women being lost between services. Structural and relational factors that shape service accessibility, engagement, and inclusion were consistently reported. CONCLUSION: Specialist perinatal mental health care pathways require timely, equitable access and seamless continuity, particularly for women with complex needs and minority groups. Clinicians highlight the importance of flexible, culturally sensitive, trauma‑informed care within collaborative integrated systems, where open communication and clear pathways ensure a consistent, coordinated care experience.