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Perinatal mental health lacks awareness, needs funding, report says

Proponents want Medicaid and private insurers to extend coverage for one year postpartum.

A new report puts a spotlight on women suffering from untreated perinatal mental health disorders and the lack of a national framework for improving the condition for this population of new mothers and their children.

"Mind the Gap," released April 1 by Postpartum Support International, calls for more awareness, research and education around perinatal mental health, as well as more screening and treatment for young mothers who suffer from perinatal mental disorders.

The national initiative is led by a broad-based coalition of experts and stakeholder groups and a panel of experts in the Mind the Gap Advisory Working Group. The group lays out a coordinated blueprint of priorities and actions needed to save lives and improve the health and well-being of the perinatal population, which refers to pregnancy and the first 12 months after delivery.

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WHY THIS MATTERS

PSI says one in seven of the 4 million women who give birth each year in the United States will experience perinatal depression, but less than 30% seek or receive care. Disorders that can affect mothers during this period include depression, anxiety, post-traumatic stress and bipolar disorders.

Screening for such disorders, the report says, has not yet become universal or standard, and referrals, diagnosis and access to treatment are not always coordinated or provided.

In addition, health payers may either limit access to services and treatment or not provide it at all.

The report also found healthcare workers involved in pregnancy and childcare are often under-trained in perinatal mental health. Institutional barriers also exist. The report claims that some pediatricians are prohibited from directly participating in a mother's healthcare due to regulations on treatment, services and billing.

"Mind the Gap" makes the case for expanded clinical training and continuing education for healthcare professionals in perinatal mental health, not only for those who deal specifically with pregnancies like OB/GYN providers and midwives, but also general practitioners and emergency medical technicians.

Gaps exist for data collection and funding and more research and epidemiological studies are needed.

Mental health overall, the authors said, should be made a priority in healthcare systems and by Congress.

They want lawmakers to extend Medicaid coverage for one year postpartum, and expand Medicaid in non-expansion states, since 50% of pregnancies in the U.S. are covered by Medicaid.

In the private sector, PSI wants insurers to prioritize perinatal mental health in healthcare coverage.

THE LARGER TREND

Perinatal mental health disorders are both acute and long-term, according to the report, affecting not only the health of mothers but also the mental health of fathers and infants, potentially impacting child development.

Children born to mothers with untreated depression can experience physical changes in their brain architecture that are linked to negative long-term outcomes for learning, behavior, future mental illness and overall functioning in adulthood.

The ongoing coronavirus pandemic poses a higher risk to those with conditions that cause immunosuppression. Health officials say this includes pregnant women and new mothers.

The Center for Disease Control and Prevention has said that mental health conditions are the second leading cause of pregnancy-related deaths within 43 days to a year after pregnancy.

In 2017, the cost to the health system of untreated perinatal mental health disorders was $14.2 billion, with an average cost per mother-child pair of $32,000.

ON THE RECORD

"Mind the Gap presents a strategic, cohesive roadmap for launching a national conversation and spurring specific, targeted actions in the areas of policy, outreach, and healthcare delivery in order to turn the tide on this crisis and save lives and ease suffering," said PSI Executive Director Wendy N. Davis.

Max Sullivan is a freelance writer and reporter who, in addition to writing about healthcare, has covered business stories, municipal government, education and crime. Twitter: @maxsullivanlive maxesullivan@gmail.com 

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