The United States is undergoing a mental health crisis. Data shows that mental health concerns increased for the overall population during the pandemic, and the recent economic downturn has only exacerbated the conditions that contribute to what the Surgeon General has called a “devastating” mental health crisis. As a segment of the population that is already disposed to anxiety, pregnant and postpartum women are some of the greatest sufferers.
The statistics are sobering. According to the Maternal Mental Health Alliance, one in five women will experience maternal mental health (MMH) conditions during pregnancy or the first year postpartum, and seventy-five percent of those women will go untreated. The cost of not treating these conditions is up to $32,000 per mother-infant pair — about $14 billion annually.
There are positives, however. Recent initiatives are shedding light on and driving funds toward an issue that has been under-diagnosed and overlooked for far too long.
In May 2022, the Department of Health and Human Services (HHS) launched the Maternal Mental Health Hotline; a confidential, toll-free hotline for mothers experiencing mental health challenges. In 2019, the National Committee for Quality Assurance (NCQA) developed two measures for health insurance plans to monitor how often screening and follow up for maternal depression is occurring in the U.S. This year, NCQA announced that these measure results will now be publicly reported by private plans, and advocates are urging The Centers for Medicaid and Medicare Services to add these two depression screening measures to their Adult Measure Core Set.
Despite positive strides in awareness and services, challenges still exist.
Health systems have limited resources, and are struggling to find and keep qualified staff in the midst of a labor shortage. Data collection is inconsistent, and the consumer need for mental health services has outpaced regulatory services. Additionally, while there is more public awareness of mental health issues now than historically, stigma still exists, particularly in more conservative cultures, preventing some women from speaking up about their concerns.
In a 10-15 minute appointment, the typical length of an in-person prenatal visit, patient education gets the least air-time, especially if a patient has anything medically complicated going on. Even if a woman is well-attuned to mental health issues (and many are not due to lack of education around symptoms), the likelihood that she will feel comfortable addressing them with her provider in such a compressed time frame is low.
Asynchronous digital communication and tracking tools can circumvent existing challenges.
A digital safety net can ensure that even if a patient misses an appointment or fails to process and remember important info in the moment, they still have 24/7 access to that information to reference at need. Regular assessments of mental health symptoms delivered through remote tools can capture data that might be overlooked or not shared by the patient at an in-person appointment. With a connection to the provider or health plan, such digital tools can trigger support resources or follow-up protocols for the patient depending on their risk.
Currently, postpartum screening and follow-up measure data is collected by health insurers via electronic data capture systems, not just medical records or claims data, as HEDIS measures were limited to in the past. This means screening from any type of provider (OB, Midwife, Pediatrician) as well as non-providers, like insurance plan high-risk pregnancy case managers, can be counted. Supporting screening through the health system, whether in-person or through digital infrastructure, can potentially increase adherence on the part of the postpartum mother.
Screenings must widen in scope to address perinatal period and SDoH.
Extending these screenings back through the prenatal period, and even to pre-conception, offers a key opportunity to take preventative measures and improve outcomes, as more research has come out around the consequences of undetected MMH issues pre-childbirth.
Screening for social determinants of health in the prenatal period and pre-conception is another vital avenue for addressing MMH issues, as women who experience poverty, intimate partner violence, food or housing insecurity, et al. are much more likely to experience postpartum depression, an issue which can resurface years after childbirth and has been linked to negative outcomes in the child’s health as well.
Technology provides the means to deliver screenings directly to the patient at their convenience and communicate data back to the provider and health plan, facilitating better care management and support. Additionally, if a maternity patient is already using technology to monitor other parts of her care, such as blood pressure or weight management, there is a much higher likelihood of compliance.
While there is still an inadequate understanding of the scale and impact of MMH problems, and concerns around liability, regulation, and data privacy are still at issue, innovators and policy-makers are making slow but positive strides to address the issues and provoke systemic change.
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