AMWA Executive Director, Dr. Eliza Chin, participated in an advisory workgroup meeting for the Mind the Gap Collective Impact Initiative hosted by the Postpartum Support International (PSI) in partnership with The Reilly Group. The goal for the initiative is to “set a strategic course to ensure perinatal mental health is a national priority and to improve outcomes for moms, dads, babies, families, and ultimately the community.”
The meeting started with a summary of the landscape analysis. The statistics are sobering. Data show that perinatal depression affects 1 in 7 pregnant and postpartum women.1
The impact of this is felt at both the individual, family, and societal level. Children born to mothers with depression may have challenges later in life with learning, behavior and overall functioning. Perinatal depression is also the strongest predictor of paternal depression.2 The societal burden of untreated perinatal mental health disorders was estimated at $14.2 billion in 2017.3
Despite the prevalence of perinatal mental health disorders, research funding as measured by NIH and CDC grants, ranks far below other disease funding that effects women, like heart disease, breast cancer, and lupus.4 As Wendy Davis, Executive Director of PSI stated, “Perinatal Mental Health is an invisible and costly medical condition and effects more women than breast cancer (1 out of 8) and lupus (1 out of 200).”
Over the past decade, national associations like the American Academy of Pediatrics (AAP), the American College of Obstetricians and Gynecologists (ACOG), Postpartum Support International (PSI), and the U.S. Preventive Services Task Force have issued guidelines to ensure adequate screening for perinatal and postpartum mental health disorders. But for a number of reasons, these guidelines have not been universally implemented, one of which is the reluctance to screen when access to care can be limited.7
One barrier to access is coverage. While the ACA provided access to maternity and childbirth coverage through all health plans, that coverage may be limited. For example, Medicaid coverage in 14 states ends 60 days postpartum. As of August 2019, 37 states have extended Medicaid coverage for up to one year postpartum, and legislative efforts are underway to extend coverage in the remaining states.
Another barrier to access is a shortage of providers who are adequately trained and equipped to treat perinatal mental health disorders. Organizations like PSI have been working to address this issue by providing a Frontline Provider Training course, a Mental Health Training and Certification course, an on-line perinatal mental health provider directory, and a PSI Psychiatric Consult Line with free perinatal psychiatry consultation for medical prescribers within 24 hours.
The Massachusetts Child Psychiatry Access Program (MCPAP) for Moms has also developed on-line training programs for obstetricians to improve screening, diagnosis, and treatment of perinatal mood and anxiety disorders. Through MCPAP for Moms, providers in Massachusetts also have ready access to perinatal psychiatry consultations. This model has been replicated in other states as well. An example is the Periscope initiative in Wisconsin.
Yet despite all of these efforts, an overall gap still remains for the appropriate detection, treatment, and access to care for women with perinatal mental health disorders here in the U.S.
Through a collective impact approach, Mind the Gap seeks to bridge that gap by forming a diverse coalition of leaders and stakeholders, including federal agencies, researchers, provider associations, patient advocacy groups, and industry.
“Mood and anxiety disorders are the most common complication of pregnancy. Maternal suicide is a leading cause of pregnancy-related deaths. More postpartum women die from suicide than from medical causes. This is why maternal mental health is everybody’s business,” said Dr. Nancy Byatt.
During the day-long workgroup meeting, attendees discussed strategies to align current initiatives to support a unified goal. Dawn Levinson, Behavioral Health Lead at the Health Resources and Services Administration (HRSA) spoke on initiatives at the federal level.
Leaders from front-line provider associations, such as ACOG, AAP, AMWA and Association of Women’s Health Obstetric and Neonatal Nurses (AWHONN) were present, as were leaders of mental health provider organizations, including the American Psychiatric Association (APA), and the Marcé Society of North America (MONA), a multidisciplinary association focused on research in puerperal mental health.
A number of important action items will identify next steps for the group. First and foremost will be a report from the workgroup meeting outlining a strategic roadmap for the collaborative work including national priorities to ensure universal perinatal mental health screening along with adequate resources for follow-up diagnosis, and treatment and improved access to comprehensive mental health care. In addition, a national public awareness campaign will be developed to educate and raise public awareness, among patients, providers, families, employers, and society at large. Research, advocacy, technology, and telepsychiatry will play an important role in the process, as will the collaboration of diverse organizations and stakeholders.
If you would like to participate in these efforts as an AMWA representative or liaison, please contact ExecutiveDirector@amwa-doc.org.
To find training, support groups for parents, and more information on postpartum depression and other perinatal mental health issues contact: Postpartum Support International (postpartum.net)
- Gavin NI, Gaynes BN, Lohr KN, Meltzer-Brody S, Gartlehner G, Swinson T: Perinatal depression: a systematic review of prevalence and incidence. Obstet Gynecol. 2005;106:1071-1083.
- Kim P, Swain JE: Sad dads: paternal postpartum depression. Psychiatry (Edgmont). 2007;4:35-47.
- Luca DL, Garlow N, Staatz C, Margiotta C, Zivin K: Societal Costs of Untreated Perinatal Mood and Anxiety Disorders in the United States. 2019.
- Data presented at Mind the Gap Workgroup Meeting, September 27, 2019
- Status of State Medicaid Expansion Decisions: Interactive Maps. (accessed August 2019)