AbstractMaternal refusal of psychiatric services can pose a problem for both the family and mental health practitioners. With a sample of mothers who had refused psychiatric services in the past, the present study examined the effectiveness of initiating and maintaining mental health services when midwives acted as mediators. After the midwives had developed a relationship with the mothers, suggestions for mental health services were made again. For part of the sample, therapists accompanied the midwife on a home visit and scheduled subsequent therapy sessions in the home. For the remaining subjects, referrals were made to the local community mental health center. Results indicated substantially greater success in both the initiation and maintenance of therapy when midwives acted as mediators and therapy continued in the home.