By Catharine McDonald, MS, NCC, LPC
There is never a dull moment working in the psychiatric emergency department. I love the hustle and bustle, and the variety of cases we see and the stories I could never confabulate in my wildest dreams. Each of the clinicians has their certain areas of passion [as well as dread!] and we complement each other in our interests and skills. I love perinatal mental health. I am a self-diagnosed birth junkie. I have always found pregnancy and birth enthralling. I learned as much as I could about prenatal and maternity care while pregnant with my daughter, and I have seen this fascination spill over into my work life. I have a soft spot for pregnant and postpartum mothers in our emergency room. I bombard psychiatry consult requests for postpartum mothers with resources and ideas for treatment, going above and beyond to help in any way I can. Perinatal mental health is important for the mother, the baby, and the entire family. This population certainly has my undivided attention, but then comes the question--now what?
I can rattle off the names of at least twenty substance abuse programs in my tiny little state of Connecticut off the top of my head. Perinatal mood disorders? One. There is one outpatient program that specializes in mood disorders and mentions postpartum mental health. Yes, I recognize that there are private practitioners who have experience or even expertise in perinatal emotional complications, yet I challenge you to find one in a timely fashion. New moms don't have time or energy to do this detective work. Mothers suffering from depression, anxiety, or intrusive thoughts are often so overwhelmed they feel paralyzed, unable to ask for help, much less actively search for it. My community is greatly lacking in perinatal mental health services and I am left feeling helpless when a mother does come in needing help and I have little to offer her.
One client in particular whom I have encountered still stirs up my emotions. I was asked to find a patient in ICU a psychiatric bed elsewhere because my hospital was out of network with her insurance. When I opened her chart, my heart broke. She was a first-time mom, two weeks postpartum and was in ICU after a serious overdose. This woman was a well-educated, working woman who was struggling so much that she felt her daughter would be better off without her. The despair is still palpable and I get emotional when I think about her case.
How is it that we have over a dozen mental health graduate training programs in this tiny state, yet no specialized treatment? In searching for resources [for hours] I was able to connect her with Postpartum Support International's local contact, who was able to connect her with private practice clinicians, however for the interim she had to go to a general inpatient psychiatry unit where her tiny newborn wouldn't be allowed to visit. Nursing was out the window, and her husband was left to worry about his wife at home while caring for their daughter.
Had she been 700 miles southbound, this patient could potentially have gone to UNC Psychiatry, home of the only Inpatient Perinatal Psychiatry Clinic in the country. This program welcomes infants to mothers' treatment; offers extended visiting hours, lactation support, and a variety of other specialized services to meet expectant and postpartum mothers' needs. This is a five-bed unit. 1 in 6 women suffer perinatal emotional complications. While most of that 1 in 6 does not require inpatient hospitalization, there are certainly more than five at any given time in America. These women are falling. Falling through the cracks. Falling deeper into depression or anxiety. Falling deeper into feelings of suicide or infanticide.
In large part, our mental health system is failing them. Common psychiatric screenings do not involve questions about pregnancy or nursing, births or birth complications, or perinatal symptoms. The American Psychiatric Association authors the DSM, the psychiatry bible of sorts, classifying all mental health diagnoses (diagnosis means insurance reimbursement)--there is no code for postpartum related depression, anxiety, OCD, or psychosis.
Grassroots-style efforts are sprouting up in local communities, while few and far between. These programs touch the lives of countless women and children daily, offering group therapy or support groups, counseling resources, home visitors, and other supports. Some public health departments offer screening and free or sliding-scale services. MotherWoman out of Massachusetts advocates for family-sensitive legislation, provides training to mental health and community-based providers, holds monthly support groups, and helps organize Perinatal Support Coalitions to develop support networks, referral lists, provider training and implementation of universal screening programs.
Massachusetts is certainly a leader in the area of Perinatal Mental Health, now we need to work on the other 49 states. What resources are in your area? Where would you refer a mother you love?
Catharine McDonald, MS, NCC, LPC works as a Senior Clinical Therapist and Access Specialist in Crisis and Behavioral Health at a community hospital. Her clinical interests include trauma, family therapy, and maternal mental health. Catharine is also active in La Leche League and Holistic Moms Network in supporting pregnant and postpartum mothers in her area. She lives in Connecticut with her husband, daughter, and their two spoiled dogs.
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