Policy wins in maternal mental health with Jamie Zahlaway Belsito

Policy is an instrumental tool of progress in healthcare, yet policies supporting maternal health, especially maternal mental health, have often lacked the attention and action they deserve. Yet, leaders and visionaries across the nation are taking key strides in changing that dynamic.

As part of Maternal Mental Health Month, Trayt spoke with Jamie Zahlaway Belsito, Founder and Director of Policy and Partnerships at the Maternal Mental Health Leadership Alliance about the impact a fresh set of ideas and insights is having on maternal mental health across the country.

Q: What led you to start the Maternal Mental Health Leadership Alliance?

I come to this space through my own lived experience.  I was personally affected by maternal mental health conditions with both of my daughters.  I experienced debilitating anxiety and OCD with my first, and postpartum rage and OCD with my second daughter.  Both of my pregnancies were wanted, I was married, heterosexual, had a house, a car, private insurance and spoke English.  I simply could not find maternal mental health support for myself, nor was I supported appropriately by my providers. If I couldn’t find help, with all the advantages I had, what did that mean for everyone else?  I took my career in immigration policy and transitioned to maternal mental health policy.  I knew we could make a difference by way of positive policy outcomes.  We have since been able to pass three pieces of legislation and get $70 million in federal funding appropriated to maternal mental health!

Q: As the Alliance has grown, how have the priorities changed within the organization and where are you focusing efforts now?

The MMH policy journey has been lightning fast.  First, it was explaining to members on Capitol Hill about the number one complication of pregnancy, maternal mental health challenges. Then, we transitioned to identifying the need for maternal mortality review committees to collect and research data on maternal mortality in perinatal women, which led to the finding that deaths related to substance use disorder (SUD) and suicide were the leading cause of death.  In both initiatives, quantitative and qualitative data began to highlight what so many of us always knew: black, brown, and indigenous women were dying at 2-3 times the rate. We at MMHLA have made racial equity a pillar in our mission and vision. We must address this crisis head on with our intentions and policy initiatives.

Q: At the state and federal levels, where are you seeing the greatest progress for maternal mental health and where is there still opportunity?

The most amazing progress, from my perspective, has been the implementation of the National 1-833-TLC-MAMA, available 24/7 to new and expecting parents.  It has served over 35,000 families in two years. The other big accomplishment from the federal government in 2024 has been the Maternal Mental Health Task Force’s National Strategy to Improve Maternal Mental Health Care (release here, report PDF here). This report lays out Five Pillars, Priorities and Recommendations on how to educate, inform, access support, destigmatize and address racial disparities in maternal mental health care.

At a state level, Medicaid expansion has occurred in forty states, boosting eligibility from 60 days to a full twelve months for postpartum birthing parents. In one great example, the Kentucky legislature just passed a “momnibus” which established a maternal mortality review committee (MMRC) and added pregnancy to the list of qualifying life events for health insurance coverage.  MMRC’s have been instrumental in finding out the leading causes of maternal mortality and have helped to identify that maternal mental health challenges have been the leading cause of death during the perinatal period.

However, there are states that still have not expanded Medicaid for a full year for postpartum parents. There are states that have maternal mental health access, expansion, community and workforce bills that are waiting to be brought to the floor for a vote, like the Commonwealth of Massachusetts. Talk to your elected officials and make your voice heard!

Q: As providers, policymakers, or other stakeholders consider ensuring equitable access to care for all communities, especially historically disenfranchised or minority groups, what advice would you give or where have there been successes?

Federal programs and grant money need to go directly to the community-based organizations that serve indigenous, black/brown, Latinx, and LGBTQIA+ groups. Departments of Labor and Departments of Education, both at the federal and state levels, should be focusing on growing a diversified maternal health care network, uplifting cultural competency and multilingual access.  This could be done through our community colleges, DOL training grants, or other avenues. Importantly, we have seen grant money heading to states and communities via HRSA, through initiatives such as the HHS Racial Equity in Postpartum Care Challenge.

Q: Who or what would you point readers to for learning more about the topic of maternal mental health (individuals or organizations or research) or learning how they can get involved?

I would suggest the following organizations, that cover a breadth and depth of research, policy and boots-on-the-ground: Postpartum Support International; Shades of Blue; MMH Policy Center; and the National Partnership for Women & Families.

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.

  • Explore profile of Dr. Nancy Byatt, leading perinatal mental health researcher and clinician
  • 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