OAKHAM Jennifer Ford knew something was wrong after the birth of her second child, Mckinley.
It was a difficult birth and four days after an emergency C-section at St. Vincent’s Hospital, Ford returned home to Oakham and settled into family life.
But within days her mood changed: “Suddenly the house didn’t feel like my house.”
Ford had a hard time connecting with Mckinley, had constant bouts of crying, and his mood plummeted to the point where he contemplated suicide: I felt like (my family) deserved better. That they would be better off without me.
She shared these feelings with her husband, Andrew, who immediately took action. Ford’s obstetrician was called and the final diagnosis was postpartum depression.
Ford connected with the Massachusetts Child Psychiatry Access Program for Moms, which provided the mental health services she needed. His medication was adjusted, he immediately got an appointment with a psychiatrist and a social worker managed his treatment.
“After a few months, I noticed a change,” said Ford, who finally realized the joy of her second child.
After three months, I started thinking that (Mckinley) is kind of cute. It hit me, Wow, I can’t believe she’s 12 weeks old, and that’s all I have now.
Before, it was like looking at someone else’s baby.
I hope for a discussion about postpartum depression
Ford believes it took about a year for his mood to return to normal. She doesn’t blame her obstetrician for her struggles, but she wishes there had been direct discussions during her pregnancy about the risks of postpartum depression.
Depression is something Ford has dealt with on and off for years, and in the back of his mind, he wondered if his mood could change during and after pregnancy. But he didn’t really understand the risks.
She talked to her obstetrician about continuing to take Zoloft, a medication prescribed for depression, during her pregnancy. But she doesn’t remember talking to any doctor about postpartum depression.
I was not sufficiently prepared for the events after the pregnancy. There is a lack of discussion about mental health after pregnancy, Ford said. In retrospect, I think, “Didn’t I do enough to prepare?” What did I and the doctor miss?’ I don’t know how to improve it.
Access to treatment is usually insufficient
Dr. Nancy Byatt, a perinatal psychiatrist at UMass Chan Medical School, said access to mental health care during and after pregnancy is generally inadequate.
To highlight the extent of the problem, Byatt said that even when a woman is diagnosed with depression during perinatal screening, less than 25% of these women receive an initial mental health appointment. The perinatal period is usually defined as the weeks before birth and continues through the first year of the baby’s life.
Another statistic that brings the challenge into focus is that, according to the US Centers for Disease Control and Prevention, mental health disorders account for the largest share of pregnancy-related deaths (23%) in the US.
At Family Health Center in Worcester, patients are at increased risk for perinatal mental health problems, said Stephany Giraldo Eierle, MD, a doctor of osteopathic medicine and a primary care psychiatry fellow.
Many of the centers’ patients are low-income immigrants and refugees. Pregnant mothers in this demographic may face socioeconomic challenges that may predispose them to mental health problems.
(Perinatal mental health) has been a huge topic for a long time that hasn’t gotten the attention it deserves. But that’s starting to change, said Eierle.
Eierle’s scholarship team is trained in perinatal mental health. The team then trains primary care providers to screen, treat and connect patients to the necessary resources.
“Many barriers” to treatment
There are “many barriers” to accessing mental health services during and after pregnancy, Byatt said.
Some patients feel uncomfortable talking about their struggles. If they do bring them up, Byatt said some doctors don’t know what to do because they haven’t received the proper training.
Supply and demand are at play. There are not enough psychiatrists and therapists to treat the number of women who need services. While the number of providers grew significantly, Byatt said, “They were so bogged down that they probably never caught up with the demand.”
Burnout is another reason, said Dr. Robert Zavoski, clinical director of the Center for Family Health. Some doctors left medicine or retired and burned out before the COVID-19 pandemic. When the pandemic hit, it only made the problem worse.
In addition, many medical students want work-life balance, so they choose a specialty with manageable hours and less stress. As a result, many students don’t go to primary care or obstetrics, Zavoski said.
In addition, medical school training in perinatal mental health is Eierle said, and it applies to psychiatry residents.
Capital concerns are also in trouble. Patients with commercial insurance who pay cash have better access to services than patients with public insurance, such as MassHealth, the state’s Medicaid insurance program, and that comes with low copays. As a result, many doctors don’t take public insurance, said Byatt.
What are the solutions?
Byatt said there is a need for equity, so payments for mental health care match higher levels of payments for physical care. Policymakers, insurance companies and lawmakers need to develop ways to make this happen, he said.
Sen. John Velis, D-Westfield, chairman of the Massachusetts Senate Committee on Mental Health, was unavailable for comment. State Rep. Adrian Madaro, D-East Boston, the committee’s co-chairman, did not return a request for comment.
At the same time, creative approaches are being developed to improve access to mental health care. The Massachusetts Child Psychiatry Access Program for Moms trains providers across the state to improve the delivery of mental health and substance abuse services. Byatt is the founding physician of the programs and the training focuses primarily on obstetrics.
Modeled after the Massachusetts Child Psychiatry Access Program for Moms, the program is replicated in 28 US states and is funded by the federal Health Resources and Services Administration and state budgets.
In the coming months in the Lancet, Byatt said the study results show an improvement in symptoms of depression among the patients who participated in the study. Byatt explained that the study compared the Massachusetts Child Psychiatry Access Program for Moms to programs that combined the Massachusetts Child Psychiatry Access Program for Moms with depression treatment.
The study also shows a higher treatment rate compared to previous studies. Byatt shared his findings on this issue:
In the Massachusetts Child Psychiatry Access Program for Moms with depression treatment, 52% of patients started mental health treatment; 43% Massachusetts Child Psychiatry Access Program for Moms. These percentages compared to Byatts show that even if a woman is diagnosed with depression during perinatal screening, less than 25% of these women receive an initial mental health appointment.
The study also showed a 25% follow-up rate for the Massachusetts Child Psychiatry Access Program for Moms with depression treatment and a 20% follow-up rate for the Massachusetts Child Psychiatry Access Program for Moms.
There’s still room for improvement, but it’s significantly higher than seen in previous studies, Byatt said.
Meanwhile, Byatt is part of a $21 million study funded by the Patient-Centered Outcomes Research Institute. It is based on a study published in the Lancet. Among the details: Eight of the 28 states that use the Massachusetts Child Psychiatry Access Program for Moms are being trained to use the interventions in research. The results are compared to interventions that also include peer support in childbirth.
Essentially, the health care model is compared to a health care model that includes what is called a “community partnership” that provides peer support.
Grateful and ready for the future
Ford is thankful that she had a solid family support system that helped her overcome postpartum depression. She plans to study nursing next year at Mount Wachusett Community College and is considering a career helping postpartum mothers.
Ford has this advice for all moms. Don’t be afraid to ask for help if depression starts during pregnancy.
The first thing you need to do to be an excellent mother is to make sure all your needs are met. It’s the only way,” he said.
Contact Henry Schwan at firstname.lastname@example.org. Follow him with X:@henrytelegram.
#services #improve #perinatal #mental #health #care #required
Image Source : www.telegram.com