OAKHAM — Jennifer Ford knew something was wrong after the birth of her second child, McKinley.
It was hard labor and after four days in St. Vincent’s Hospital following an emergency C-section, Ford was back home in Oakham to live a family life.
But within a few days, his mood changed: “All of a sudden, the house didn’t feel like my house anymore. »
Ford struggled to bond with Mckinley, cried nonstop, and her mood deteriorated to the point that she contemplated suicide: “I felt like (my family) deserved better. That they would be better off without my presence.
She shared these feelings with her husband, Andrew, and he immediately took action. A call was made to Ford’s obstetrician and the final diagnosis was postpartum depression.
Ford was in contact with the Massachusetts Moms Child Psychiatry Access Program, which provided the mental health services she needed. Her medications were adjusted, she had immediate appointments with a psychiatrist, and a social worker managed her care.
“After a few months, I noticed a change,” said Ford, who finally realized the joy of her second child.
“After three months, I started to think (Mckinley) was kind of cute. It hit me: “Wow, I can’t believe she’s 12 weeks old and I’m just having this thought now.”
“Before, it was like looking at someone else’s baby.”
Desired for discussions on postpartum depression
Ford thinks 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 conversations during pregnancy about the risks of postpartum depression.
Depression is something Ford has dealt with on and off for years, and in the back of her mind, she wondered if her mood might change during and after pregnancy. But she didn’t fully understand the risks.
She spoke to her obstetrician about continuing to take Zoloft during pregnancy, a medication prescribed to treat depression. But she doesn’t remember discussing postpartum depression with a doctor.
“I wasn’t prepared enough for what happened after pregnancy. There’s no discussion about mental health after pregnancy,” Ford said. “Looking back, I think, ‘Didn’t I do enough to prepare?’ What did me and the doctor miss? I don’t know how to improve this.
Access to care generally insufficient
Dr. Nancy Byatt, a perinatal psychiatrist at UMass Chan School of Medicine, said access to mental health care during and after pregnancy is generally insufficient.
To highlight the scale of the problem, Byatt said that even if a woman is identified as having depression during a perinatal screening, fewer than 25 percent of those women get an initial mental health appointment. The perinatal period is generally defined as the weeks leading up to birth and continuing throughout the first year of the baby’s life.
Another statistic that highlights the problem is that mental health issues account for the largest percentage (23%) of pregnancy-related deaths in the United States, according to the U.S. Centers for Disease Control and Prevention.
At Worcester Family Health Center, patients face an increased risk of perinatal mental health problems, said Stephany Giraldo Eierle, a doctor of osteopathic medicine and primary care psychiatry fellow.
Most of the center’s patients are low-income immigrants and refugees. Pregnant mothers in this demographic may face socioeconomic challenges that may predispose them to mental health issues.
“(Perinatal mental health) has long been a major topic that has not received the attention it deserves. But that’s starting to change,” Eierle said.
Eierle’s research team is trained in perinatal mental health. The team then trains primary care providers to screen, treat and connect patients to needed resources.
“Many obstacles” to care
There are “many barriers” to accessing mental health services during and after pregnancy, Byatt said.
Some patients are not comfortable talking about their difficulties. If they talk about it, Byatt said some doctors don’t know what to do because they haven’t received proper training.
Supply and demand are at play. There are not enough psychiatrists and therapists to treat the number of women who need services. Even if the number of suppliers increased significantly, Byatt said, “We’re in such a hole that we’ll probably never catch up with demand.” »
Burnout is another reason, said Dr. Robert Zavoski, clinical director of the Family Health Center. Some doctors left medicine or retired, burned out before the COVID-19 pandemic. When the pandemic hit, it only exacerbated the problem.
Additionally, many medical students want a work-life balance, so they choose a specialty with manageable work hours and less stress. As a result, many students don’t pursue primary care or obstetrics, Zavoski said.
Additionally, perinatal mental health training in medical schools is disappointing, Eierle said, and it applies to psychiatry residents.
Concerns about fairness are also relevant. Patients with commercial insurance and those paying cash have better access to services than patients with public insurance like MassHealth, the state’s Medicaid insurance program, and reimbursements for care are low. As a result, many doctors don’t carry public insurance, Byatt said.
What are the solutions ?
Byatt said there is a need for parity, so that payments for mental health care match higher payments for physical care. Policymakers, insurance companies and lawmakers will need to find ways to make that happen, she said.
Sen. John Velis, D-Westfield, Senate chairman of the Massachusetts Joint Committee on Mental Health, was not available for comment. State Rep. Adrian Madaro, D-East Boston, co-chair of the committee, did not respond to a request for comment.
At the same time, creative approaches are underway to improve access to mental health care. The Massachusetts Moms Child Psychiatry Access Program trains providers across the state to better deliver mental health and substance abuse services. Byatt is the founding medical director of the program and the training is primarily focused on obstetrical practices.
The program, modeled on the Massachusetts Child Psychiatry Access Program for Moms, is replicated in 28 U.S. states, funded by the federal Health Resources and Services Administration and state budgets.
Writing in next month’s Lancet, Byatt said the results of a research study would show improvement in depression symptoms among patients at obstetric practices enrolled 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 care.
The study will also show higher treatment rates compared to previous studies. Byatt shared his findings on this point:
● Under the Massachusetts Child Psychiatry Access Program for Moms Suffering from Depression, 52% of patients began mental health treatment; 43% for the Massachusetts Child Psychiatry Access Program for Moms. These percentages compare to Byatt’s earlier point that even if a woman is identified as having depression during a perinatal screening, fewer than 25% of those women get an initial mental health appointment.
● The study also showed follow-up rates of 25% for the Massachusetts Child Psychiatry Access Program for Moms with Depression and 20% for the Massachusetts Child Psychiatry Access Program for Moms.
“There is still room for improvement, but it is significantly higher than what we have 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 the study published in the Lancet. Among the details: Of the 28 states using the Massachusetts Child Psychiatry Access Program for Moms, eight will be trained to use the study interventions. Results will be compared to interventions that also include peer support in obstetric practices.
Essentially, a health care model will be 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 grateful to have had a strong family support system to help her through her bout of postpartum depression. She plans to study nursing next year at Mount Wachusett Community College and is considering a career that would help postpartum mothers.
Ford has this advice for all mothers: don’t be afraid to seek help if depression sets in during pregnancy.
“The first thing you need to be a great mom is to make sure all your needs are met. It’s the only way,” she said.
Contact Henry Schwan at henry.schwan@telegram.com. Follow him on X: @henrytelegram.
