Why is it still so damn hard for moms to find help for postpartum mood disorders?

We are in the 21st century.  It is now 2017.  We have someone leading the country and the GOPs in trying to make it even harder for people to get access to healthcare, and in particular, mental healthcare.  Check out the articles “How Trumpcare Will Affect Moms Fighting Postpartum Depression” and Psychology Today’s “How Trumpcare Will Affect Mental Health Care.”  But we mustn’t let such ignorant, selfish and typically capitalist initiatives impede progress.  We must never stop resisting any initiative to make conditions worse, to stop forward momentum!

It is 2017 and I am asking the question so many of the other attendees of last week’s Postpartum Support International (PSI) conference are asking: Why is it still so damn hard for moms to find help to treat their postpartum mood disorders, like postpartum depression (PPD), postpartum psychosis (PPP) and postpartum OCD?  A common theme across the training sessions offered at the PSI conference, and a common topic of my blog, is the fact that there are mothers seeking help across the country daily, and we may have names of therapists or social workers, but in many cases, these professionals aren’t anywhere near where the mothers are located.  Or there’s the issue of affordability.  Or when the professionals can see a new patient (could be weeks).  Or how about there just aren’t enough professionals who can see new mothers suffering from postpartum mood disorders, period.

A recent article by Crystal Edler Schiller, PhD, assistant professor in the Center for Women’s Mood Disorders and Department of Psychiatry at the University of North Carolina at Chapel Hill, titled “Maternity mental health care should be accessible” highlights the issues.

Although the numbers of professionals is increasing slowly over time, there is just not enough of them to treat the actual numbers of mothers needing care.  Many PSI members are social workers, registered nurses, peer group supporters, psychologists and psychiatrists, which is great.  But the numbers of people in these roles throughout the country fall pitifully short of the help that’s actually needed.   So many mothers suffer in silence, and you only really hear about the ones who openly discuss their experiences via social media (like me) or other articles or in the news.  Or you hear about the mothers in the news who weren’t able to get the right help and their illnesses led to their deaths and/or death of their babies.

I’m fortunate that I’m in New Jersey, a state that mandates screening for PPD and has a state initiative called “Speak Up When You’re Down.”  We also have The Perinatal Mood and Anxiety Disorder Center at Monmouth Medical Center, the very first center dedicated to maternal mental healthcare in the state, which I blogged about previously.  A group of PSI members in New Jersey have come together to form a PSI-New Jersey chapter.  These members meet monthly and we discuss the support they provide mothers via their own practices and/or via the Partnership for Maternal & Child Health of Northern New Jersey, Central Jersey Family Health Consortium, and the Southern New Jersey Perinatal Cooperative. My own experience with PPD pre-dates all of these initiatives, and needless to say, there was a whole lot more ignorance back in 2005.  It’s truly satisfying to see these initiatives take root, with more in the works.  However, this is just New Jersey and as far as I’m aware, only California, Massachusetts and Illinois have similar screening and care initiatives in place and/or in development.  There are 47 other states who are extremely behind when it comes to maternal mental healthcare.

The slow change I’ve seen just in New Jersey alone over the past 12 years since I suffered from PPD is unacceptable.  You would think that all therapists know how to diagnose and treat mothers suffering from a postpartum mood disorder.  Unfortunately, they don’t.

How do we speed up progress?  We need funding to make the printing of pamphlets/flyers available in ALL doctor’s offices that could potentially see new mothers (i.e., OB/GYNs, family doctors, general practitioners, pediatricians).  Medical schools must mandate that all training programs for all healthcare professionals (i.e., doctors, nurses, social workers, therapists) include a minimum of a semester in maternal mental health conditions and are led by PSI educators, and without these programs people cannot obtain their degrees/licenses.  Unless we start putting these measures in place, we are not going to see any significant improvement in addressing the scores of mothers needing help in our lifetime.

I’m going to leave you with the last sentences of Dr. Schiller’s article, which makes the common sense statement that, thanks to ignorance due to stigma, is all too often taken for granted by all too many people, healthcare professionals included:

Let’s dispense with the outdated idea that the body and mind are separate, which is at the foundation of decisions to pay for physical but not mental health care. Mental health is physical health, and our bodies and our babies are only as healthy as our minds.

 

 

 

Spreading Awareness About PPD

I had my annual gyno exam the other day, and like previous years, I checked to see whether there were any pamphlets on postpartum depression (PPD) available to patients or a poster on PPD hanging anywhere in the waiting room or each of the patient rooms.   What did my search come up with?  Nothing.  Nada.  Not a single pamphlet or poster.  I was extremely disappointed.  In previous years, there was at least the “Speak Up When You’re Down” poster hanging in the general waiting room, but not this time.  Not sure what happened to the old poster.  Obviously, someone took it down….not sure why, it’s not like a hanging poster would get frayed or anything….and didn’t bother to hang another one up in its place.

I’ve said this before, and I’ll say it again a million times.  All it takes for more awareness is for information to be made available.  If a doctor doesn’t do his (or her) duty to inform an expectant mother about PPD–including its symptoms and its risk factors– by verbally spending a few minutes in an antenatal appointment going over them, the least he (or she) can do is provide pamphlets and hang a poster in each of his waiting and patient rooms.   I’ve also mentioned previously that–and this is from personal experience–a pamphlet is just a piece of paper that can easily be discarded especially if you don’t realize the significance of the information that is printed on it.   A pamphlet needs to be accompanied by a doctor’s emphasizing that this information is important and why.  Otherwise, that piece of paper is as good as garbage.  If my doctor had given me the pamphlet at a prenatal checkup without an explanation, I would’ve just tossed it away, thinking something like PPD could never happen to me.

Well, you don’t need to be an OB/GYN to read this post and do something.  You can be a patient that wants to be empowered with knowledge that can make a difference in her pregnancy and postpartum experience.  You can be a patient that asks the OB/GYN for information, and if that doctor doesn’t know much about PPD, you just might want to consider finding one that does.  You can ask your OB/GYN why he (or she) doesn’t have any pamphlets available to patients or posters hanging on his walls.  You can tell him (or her) how to get free posters.  Or you can be like me and look into ordering free posters to hang up in your OB/GYN’s office.  I am going to order a Postpartum Support International (PSI) poster for my OB/GYN’s office.

Click here to find out how to order free PSI posters.

April 13, 2010 is 4th Anniversary of New Jersey’s Postpartum Depression Law

Four years ago today, New Jersey became the first state in the country to pass legislation requiring healthcare professionals to educate and screen all new mothers for postpartum depression (PPD). 

Since then, New Jersey’s Dept of Health and Senior Services’ Speak Up When You’re Down campaign has:

The key to helping mothers and their families minimize the risk (or effects, if it does occur) of PPD is early identification (via screening) and education (via awareness campaigns and ensuring healthcare providers are all aware).   Through knowledge of risk factors, symptoms, and services available locally, mothers and their families will be able to recognize sumptoms of PPD early on, as well as take immediate action to ensure proper diagnosis and treatment.

I’d just like to clarify what screening is.  It sounds like poking and prodding is involved.  No, women are not treated like lab rats or anything like that.  Screening is merely a doctor proactively asking some questions to ascertain whether a new mother entrusted to his care is exhibiting any signs of PPD.   The most widely-used screening tool for PPD is The Edinburgh Postnatal Depression Scale (EPDS), which many hospitals in New Jersey have elected to use.   It’s also important to note that, though doctors are required to screen all new mothers in their care, a mother has the right to refuse to answer some or all of the questions. 

I wish this legislation were in effect back when I had my daughter!  There are many others that feel the same way as I do.  Before this legislation went into effect four years ago, some doctors were already asking all new moms fundamental questions at each visit to ascertain if there are any symptoms of PPD, since after all it does occur in as many as one in eight new mothers!  One of the reasons why this legislation was necessary is because there are still so many doctors out there who don’t go the extra mile where their patients are concerned–and worse fail to diagnose PPD properly.  The screening should currently be taking place as the new mom leaves the hospital after having her baby, plus at her 6-week follow-up with her OB/GYN.   Since so many cases of PPD develop before the six-week follow-up visit, at some point–and I fear this may never happen because it would require a huge change in health insurance and ACOG (and whatever other organization that would have anything to do with this) — a 3- or 4-week follow-up visit becomes a requirement/standard.    What a HUGE difference this would make, wouldn’t it?!   Maybe if enough people push for this, it will happen.  One can only hope…and dream.