Taking care of the whole mom: Three ways health systems can support maternal mental health

Screening mothers early and systematically throughout pregnancy provides more opportunities to identify and address warning signs of mental and emotional complications.

In 2013, The Ohio State University Wexner Medical Center created Women's Behavioral Health—an outpatient service—to provide medication management and therapy across the reproductive lifespan, including pregnancy. This team of therapists, psychologists and psychiatrists works closely with the Department of Obstetrics and Gynecology and a handful of private practices that use their services.

Director of Women's Behavioral Health Kristen M. Carpenter, PhD, said over the past six years they have become much more strategic about implementing screening protocols. They recommend mothers be screened at the first obstetrician visit and at several other regular visits throughout the pregnancy using the Edinburgh Postnatal Depression Scale.

Carpenter said having the Women's Behavioral Health service in the system helps OB-GYN providers know that once a patient screens positive, there is a clear path of what to do next and a line drawn to treatment. A psychiatrist can do a consult and decide whether to direct a mom back to an existing provider or psychiatrist she trusts to discuss next steps, or refer her to Women's Behavioral Health if the case has more complexity than a current provider or psychiatrist feels comfortable treating.

“We have evolved more recently and become more coordinated in our care for these patients," Carpenter said.

Mothers have touchpoints with multiple healthcare providers during and after their pregnancies: primary care providers, OB-GYNs, pediatricians and sometimes specialists, psychiatrists or psychologists. Strong care for moms requires coordinated communication among different providers. It also depends on education for moms that treats pregnancy-related mental health complications with the same urgency as other physical risks.

The Women's Behavioral Health outpatient service is an example of a common model among health systems to operate as a specialty service that works closely with the OB-GYN department and refers to inpatient services as needed. Other models include dedicated inpatient beds and partial hospitalization services.

“The needs of these women are not being met. Teams like ours crop up because there are unmet needs," said Carpenter.

Carpenter's team communicates with and educates other providers – in areas like behavioral health, labor and delivery, and social work – on an ongoing basis to stay on top of changes in personnel and nursing staff.

Communication must also happen between providers inside and outside the hospital setting to provide next-steps for moms who may need further support.

Marie Cooper, MBA, BSN, RNC-LRN, director of Women's Health at OhioHealth Riverside Methodist Hospital, said that if a mom scores high on a screening, the bedside RN notifies the patient's OB provider.

“The provider will bring her in sooner than a normal check-up—maybe at a week or two," Cooper said.

OhioHealth also focuses on educating moms and building trust between moms and their bedside nurses so that mothers with concerns feel safe sharing their feelings. They provide literature for mothers and their support people to take home since postpartum depression may occur well after the limited time a mother spends in the hospital.

“Postpartum depression is on the forefront much more than it was 10 years ago," Cooper said.

Health systems can also rely on other organizations with maternal mental health services to extend a mother's access to care and support beyond her time in the hospital. National organizations such as Postpartum Support International and 2020 Mom offer resources and also can connect providers and patients to local organizations.

Maureen Provenzale serves as the program coordinator for POEM (Perinatal Outreach and Encouragement for Moms), a program through Mental Health America Franklin County (MHAFC) in Ohio that provided the peer and mentor support that made the biggest difference for her when she experienced postpartum depression after the birth of her son. Even as a registered nurse, she didn't recognize the signs of postpartum depression.

POEM provides a one-stop-shop for both mothers in need of mental health services and their providers. POEM Co-founder and MHAFC Associate Director Tonya Fulwider said the organization was founded in 2005 with the heart of its service being support groups based on “mountains of anecdotal and actual evidence about how efficacious a peer-support model is." She also considers this model her own lifesaver. But nearly 15 years later, the program also serves as a clearinghouse of providers specializing in maternal mental health. In 2018, POEM served 1,000 women, connecting them to anything from housing services to legal aid to a physician comfortable prescribing medication to a breastfeeding mother.

POEM most often partners with front-line providers, who refer about 70 percent of the mothers who come to POEM. Even hospital NICU partners and pediatricians identify moms needing support through screenings and discussions and connect them to POEM.

Health systems can list community resources on educational materials for mothers, but providers can really benefit a mom by reaching out to organizations like POEM directly to make the connection “instead of giving a sleep-deprived mom one more thing to do," said Fulwider.

Top health systems should also keep an eye on new developments in the treatment of maternal mental health issues. New advancements in medications and other clinical resources make this an evolving service area.

In March 2019, the U.S. Food and Drug Administration approved the first drug focused specifically on postpartum depression, Zulresso. The drug must be administered by a healthcare provider in a certified healthcare facility.

Beyond medication advancements, health systems are also continuing to improve in the existing areas of screening, education and referrals. Carpenter, with the OSU Wexner Medical Center, hopes her team will continue to grow, perhaps adding dedicated inpatient beds. Some systems already have this model in place.

POEM's Fulwider appreciates the growth in conversations and awareness about mental health, but sees many improvements yet to be made. Because, as she said, “There's no health without mental health."