Maternal mental health is a pressing set of issues affecting millions of women in the United States, yet it often remains overlooked in public discourse and healthcare initiatives. At ViVE 2024 this spring, Malekeh Amini, CEO of Trayt Health, sat down with Dr. Nancy Byatt, a leading perinatal psychiatrist and physician scientist, to explore the topic and understand what can be done to better serve those in need.
What’s at stake?
Maternal mental health issues, such as perinatal depression and anxiety, can have significant and long-lasting effects on both mothers and their children. Research conducted by Dr. Byatt and her collaborators at the University of Massachusetts Chan Medical School finds that up to 75% of women experiencing maternal mental health conditions do not get the care they need.
If untreated, maternal mental health conditions can lead to adverse outcomes, including impaired parent-child relationships, developmental delays in children, and increased risk of mental health issues for children later in their lives. The cost is staggering, economically and emotionally. Untreated perinatal mood and anxiety disorders (PMADs) inflict an average cost per affected mother–child dyad of about $31,800 in the United States (nearly $40,000 adjusted for inflation). A working paper from Harvard University summarizes the stakes: “as the magnitude and societal consequences of this problem have become better understood, increasing numbers of clinicians and policymakers have begun to realize that it is unacceptable to ignore what science tells us and have made the prevention and treatment of maternal depression an important goal.”
A silent emergency
While advocated by organizations as far ranging as the World Health Organization, the integration of perinatal mental health support into maternal care and child services is often absent, inconsistent, or cursory, leaving many mothers in need and unassessed. According to the Maternal Mental Health Leadership Alliance, “patient education and screening remains elusive” and standards for how, when, or by whom patient education and screening should be provided to pregnant and postpartum patients, “leading to wide disparities and inequities in screening and treatment.”
Screening can be a relatively straightforward and effective intervention when coupled with the availability of downstream care. Research highlights the fact that “depression screening in perinatal care settings is associated with increased participation in depression care when coupled with interventions that target patient, health care provider, and practice-level barriers.” However, these barriers have historically proven difficult for a variety of reasons, including education of both provider and patient, stigma around mental health, and the lack of mental health professionals or toolkits in primary care or obstetric settings.
Dr. Byatt centers her current work in both the personal and professional experiences she’s witnessed, recounting the story of a severely depressed patient who had suffered for a year alone and silent before seeking care. “It wasn’t until she came out of it until she realized she wasn’t herself,” Dr. Byatt related. Several things stood out to Dr. Byatt from this encounter. “One, she was extremely depressed and had no idea. Two, no one asked her about it. She was seen in obstetrics settings, she was seen in pediatrics settings. Nobody asked her about her mental health, nobody mentioned mental health. There were many opportunities to treat her, but she and her baby suffered unnecessarily. During all this, I had a months-long waitlist to see me…I thought there has to be a better way.”
A system of empowerment
Galvanized by what she saw, Dr. Byatt created the Massachusetts Child Psychiatry Access Program for Moms (MCPAP for Moms) as an innovative model for addressing maternal mental health. MCPAP for Moms ensures psychiatric advice a phone call away for obstetric, pediatric, family medicine and psychiatric providers. MCPAP for Moms offers frontline providers access to online training, screening, diagnosis and treatment toolkits, as well as telephone and face-to-face psychiatric consultation. “Our intent with this program is to set up obstetrics settings or perinatal health settings more broadly to address mental health care themselves,” Dr. Byatt told the audience at ViVE. “There will never be enough psychiatrists or mental health providers to see the individuals who need one as we all know, and so we’ve found a way to expand that model of care.”
Importantly, these types of “Access Programs demonstrate potential to implement interventions to address well-documented inequities in perinatal mental health care access at the patient-, clinician-, practice-, community-, and policy-levels.” And just as importantly, they are effective at supporting patients in need: “we now have data that suggests, at least with the Massachusetts version of MCPAP for Moms, patients served by obstetric practices that use the model experience an improvement in depression symptoms,” Dr. Byatt shared this year. And as evidence of both efficacy and need, the MPAP model has been replicated in more than half of states, including Trayt partner PeriPAN in Texas.
For Dr. Byatt, her work and momentum on building access and ensuring equitable care doesn’t stop. She recently secured a $21 million award to compare a health care model of implementing care for perinatal mood and anxiety disorders in OB-GYN practices with a health care-community partnership model, with the end goal of “training perinatal psychiatry access program teams across seven states to implement the models and then continue training others after the life of the study.” This research will include an explicit focus on equity through anti-racism training and trauma-informed care training, as well as screening and referrals for social determinants of health. By better understanding and adapting to how individuals, communities, and health care coalesce, innovative models like MCPAP for Moms bring us closer to a world where every mother receives the support and care she needs to thrive.
As part of Maternal Mental Health Month, learn more about maternal mental health efforts and advocacy through organizations like these:
- The Maternal Mental Health Leadership Alliance: https://www.mmhla.org
- Alliance for Innovation on Maternal Health: https://saferbirth.org
- Postpartum Support International: https://www.postpartum.net
Read more from our Leaders in Maternal Mental Health series below, dedicated to Maternal Mental Health Month in May 2024 and celebrating the voices and perspectives of those at the forefront of maternal mental health policies and programs.
Get to know Abby Koch, Director of Population Health and Analytics at Trayt Health
Learn more about the Texas Perinatal Psychiatric Access Network from Dr. Sarah Wakefield