Alabama needs more mental health care for mothers, advocates claim ‘no treatment’

Editor’s Note: This article discusses mental health and data related to depression and suicide.

When Lauren Horne lost her second child to a miscarriage, she found herself battling the same postpartum depression and anxiety she faced after her first pregnancy.

Even after losing her child, whom she named Caroline, she still had many physical symptoms of pregnancy. She lost her hair and her milk came out. She was also haunted by her violent nightmares, similar to what she experienced years ago after the birth of her first child.

“I was holding dead babies, doing CPR and asking for help, trying to love them and bring them back to life,” Horn said.

But unlike previous pregnancies and births, when Ms. Horn also struggled with depression, anxiety and suicidal thoughts, after the miscarriage she was able to access the program through a gynecologist’s office. The Obstetrics and Gynecology Clinic is one of four registered in the Previa Alliance Program. She said the support and resources have helped her manage her symptoms and get help when she needs it.

read more: Alabama mothers say they need more help with breastfeeding, paid leave.

Previa was founded by Sarah Parkhurst, a Birmingham-based mother who herself struggled with postpartum depression. Currently serving about 200 women in the Birmingham area, Parkhurst said he hopes to expand statewide.

Postpartum depression and anxiety are relatively common. According to the Centers for Disease Control and Prevention, 1 in 8 women who have recently given birth experience symptoms of postpartum depression.

However, many new parents struggle to get the help they need. The Center for Mothers’ Mental Health Policy gave Alabama a failing grade on mental health support, according to the first Mothers’ Mental Health State Report Card. Of 17 awards for support structures, Alabama won her one.

2023 Alabama Maternal and Mental Health State Report Card produced by the Center for Maternal and Mental Health Policy in partnership with George Washington University. Courtesy of the Center for Maternal Mental Health Policy.

“I think at this point most people are aware that maternal mortality here, especially among women of color, is the highest in the developed world and is getting worse.” Caitlin Murphy, one of the principal investigators, said. About the report. “However, I think the fact that maternal mental health is the largest contributor to maternal mortality, largely due to suicide and overdose, has received less attention.”

Finding help can be difficult

After giving birth to her son four years ago, Horn found herself battling depression and anxiety.

She avoided therapy services for some time. Her main reason for this is that she was unaware that her symptoms could indicate her postpartum conflict. She pushed through her thoughts that her family would be better off without her and that her son would deserve a “better mother.”

Even when Ms. Horn decided to seek help after experiencing recurring nightmares, she struggled to find a mental health provider who would actually take care of her. She said once, after she finally found someone in her network, the provider she was scheduled to meet with left her clinic altogether. It took about 18 months before she started receiving regular care.

After making the decision to seek help, Horn said she wondered if the problems she experienced in finding a healthcare provider meant she “cannot be resolved.”

“I was like, ‘You know what?'” Maybe I’m just a psychopath and don’t need help. Or maybe it’s all in my head. I don’t understand,” she said. “‘I don’t think anyone feels the way I feel after giving birth.'”

Other mothers may also have difficulty finding care – Murphy said that in addition to lack of screening and diagnosis for mental health disorders, many mothers are not getting the treatment they need. rice field.

“We know that more than half of mental health disorders in mothers go undiagnosed. We know they go untreated,” Murphy said. “We know that more than half of mental health disorders in mothers go undiagnosed. We know they go untreated.”

In recent years, the number of maternal deaths has increased nationwide.

Black women are also more likely than white women to die during pregnancy or within the first year of pregnancy. In 2020, the maternal mortality rate was 55.3 per 100,000 births for black mothers compared to 19.1 for white mothers. The mortality difference increased with age, with 263.1 deaths for black mothers aged 40 and over, compared with 96.8 deaths for white women in the same age group.

read more: Northern Alabama woman charged with murder after authorities say methamphetamine use led to stillbirth.

read more: New Alabama Maternal Deaths Report Highlights Preventable Deaths and Substance Abuse.

read more: Birmingham doula group helping more mothers tackle pregnancy and parenting.

The Alabama Maternal Mortality Investigation Commission has released two reports since its inception. Of the 80 deaths that occurred during pregnancy or in the first year of pregnancy in 2016-2017, drug use disorder or alcohol or drug use was the third leading cause of death.

Experts say many deaths, including those related to mental health, are preventable.

Nearly two-thirds, or 67.5%, of Alabama mothers who died within the first year of giving birth had Medicaid coverage.

The Maternal Mortality Review Board recommended expanding Medicaid in its report. Alabama is one of only 10 states that have not expanded Medicaid.

The state extends postpartum Medicaid coverage up to one year after birth, making it the only report card to receive the award.

A report specifically examining 36 pregnancy-related or related deaths in 2016 found five of them to be suicides.

“Most postpartum suicides occur in the late postpartum period, six to nine months postpartum. The question is, why has anything changed in that time? It can be very debilitating if you don’t sleep, right?” said Adrian Griffen, executive director of the Mother’s Mental Health Leadership Alliance.

Murphy said therapy in general can be a great tool for struggling mothers, but it’s most helpful when you have access to a certified therapist or counselor, especially in treating perinatal mental health woes. .

The Policy Center report categorizes specialty providers as follows:

  • Healthcare providers with Perinatal Mental Health Certification (PMH-C) from Postpartum Support International
  • Health care providers who are psychiatrists, psychiatric nurses, some certified nurse midwives, and other qualified drug prescribers who are registered with PSI as having undergone some perinatal mental health training person

There are 21 perinatal mental health providers across Alabama, with a specialist-to-patient ratio of 0.36.

Montana is the only state in the United States that has enough perinatal mental health professionals to meet the needs of its patients, Murphy said.

“I don’t think there is enough knowledge in the world about these specialty care providers and the need for specialty care, and this lack of access to specialty care actually continues to cause a lack of access to services. And unfortunately, a mother’s mental health can lead to suicide,” Murphy said. “We believe it is absolutely essential to increase these ratios.”

He said the state of Alabama is committed to helping mothers with post-pregnancy mental health issues, including adding maternal mental health providers and programs statewide, promoting community-based resources, and screening requirements for maternal mental health disorders. He added that some steps could be taken that would be beneficial. and refunds for those showings.

Improved access

Parkhurst said she launched the Previa Alliance because she felt there was a lack of knowledge in her field and lack of access to care for postpartum mental illness. She launched the program in her February 2022 and has worked with specific OB/GYN clinics as the program has grown.

Obstetricians and gynecologists enrolled in the Previa Alliance program can refer clients to HIPAA-compliant websites where they can be screened for mental health issues. If the scores indicate they are having difficulty, Previa will help connect her to a local contract maternal mental health professional within two days.

Parkhurst and her team set up appointments for mothers using an online scheduling tool and then follow them constantly to make sure their needs are being met, she said. said. Health care providers are working with Parkhurst and his team to ensure the mother’s insurance aligns with their services. Parkhurst calls this the “mother’s circle.”

Previa also has a digital library of evidence-based videos and learning tools created by qualified professionals, and Parkhurst also hosts podcasts.

She hopes to work with Medicaid to expand this service and reach women across Alabama. Currently, Previa does not charge obstetricians and gynecologists a participation fee, nor does it charge women to access their tests or digital library.

“Some people were like, ‘Why not go direct-to-consumer?’” Parkhurst said. “I’m thinking, ‘How can it be fair for this mother to have an education because she can afford it?’ And this mother probably honestly needs more of it and can’t?

Mr Horn said he would not know where he would have been if he had not been able to access Previa’s services. She said this removes the embarrassment of having to share intrusive thoughts when asking for her help.

“It’s a great resource, and I’m glad it’s offered. I hate that it’s not offered to every woman in Alabama, but no, really, across the country, especially in Alabama,” Horn said. said of Previa.

The Center for Policy on Maternal Mental Health has put together a roadmap for improving maternal mental health and a guide to recommended state policies.

They are also compiling a list of community-based organizations that provide maternal mental health services. Organizations that provide maternal mental health services to the perinatal population must be registered under 501(c)3 and include talk therapy, support groups, or prenatal or postnatal services, Murphy said. Other services specifically useful for mothers’ mental health are included.

Horn, who was expecting a baby this month, has had some good days, but she said her faith and therapy efforts have helped her find peace. She said she will continue to talk about her own challenges with postpartum depression and anxiety, even if it’s uncomfortable, given the opportunity to shed light on her postpartum mental illness. Told.

“If I can help people because of the hardships I’ve been through, it will be of value to me,” she said.

If you’re struggling with suicidal thoughts or a mental health emergency, call us. 988 connect to Suicide and Crisis Lifeline.

New parents who want unlimited use 24/7 Mother’s Mental Health Hotline You can call or text us at 1-833-852-6262 (1-833-TLC-MAMA).

to reach crisis text linetext HOME to 741741.

list of Alabama’s Crisis Center Is Here.

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