Too Few Docs to Treat Low-Income Mothers with Depression and Anxiety

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Pregnancy and the birth of a child stir up a complex mix of physical, emotional and behavioral changes in women. Following the birth of a child, most new mothers, as many as 80 percent, report feeling the baby blues, a brief period of stress, fatigue and weepiness that can last for days.

However, for one in seven new mothers, these symptoms last two weeks or longer and are more intense, severe and disabling. For these new mothers, symptoms of depression or anxiety can interfere with motivation and daily functioning, including care of the newborn. Both mother and infant can suffer when maternal depression or anxiety is not treated promptly. A National Institutes of Health study found that maternal depression puts a child at risk for numerous emotional and developmental issues.

Studies show that women living in poverty and women of color are disproportionately affected by maternal mental health conditions. So, it is critical to address the mother’s mental health needs within the health care safety net, including Medicaid, the insurance program for low-income people, known as Medi-Cal in California. Unfortunately, Medi-Cal’s mental health system is beset by a number of challenges.

At a time when one in five Americans has some sort of mental health condition, the United States has a severe shortage of psychiatrists and other mental health practitioners. A 2017 Kaiser Family Foundation analysis found that the U.S. has fewer psychiatrists per 100,000 people than every other industrialized nation except Sweden. And a recent report released by the National Council for Behavioral Health found that 77 percent of the counties across the U.S. are underserved for mental health.

Researchers cite a number of reasons for the paucity of mental health specialists, but a big one is low  reimbursement rates for mental health services. Limited reimbursement deters physicians and other clinicians from entering mental health fields, and this in turn increases the caseloads and waiting lists of the existing mental health workforce. Perhaps this helps explain why only 10 percent of all women with depression or anxiety receive treatment for their diagnosis.

For the benefit of new mothers and their families, we can and we must do more to address maternal mental health conditions.

In California, there are numerous efforts by nonprofits to educate health care providers and patients about maternal mental health conditions and their management.

I am the Medical Director for Behavioral Health at L.A. Care Health Plan, a publicly-operated plan with a large population of mothers and babies. We have awarded grants to nonprofits to increase community awareness about maternal mental health, including a grant to address health disparities within the African-American population. We have provided grants to community clinics to give providers specialty training in mental health screening and treatment, and the topic of maternal mental health will be included in one of our spring Continuing Medical Education workshops. We also support legislation that calls for more mental health screenings and increased Medi-Cal reimbursement for providers who detect and treat maternal mental health conditions.

These are steps in the right direction, but more work is needed.

We must start thinking of maternal mental health as an up-front investment in the well-being of the entire family. When mothers feel well, they have more time and energy available to attend to others in the household and the whole family can thrive. For children, the benefits of their mothers’ increased engagement and availability can last a lifetime.  For the newborns and new mothers of the present day, and for generations of future mothers and children, we have an obligation to build upon and improve our current initiatives to address maternal mental health.

Michael Brodsky, M.D., is Medical  Director, Behavioral Health at L.A. Care Health Plan

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