Care for Your Mind acknowledges and appreciates the collaboration of the National Network of Depression Centers in developing this series.
How MCPAP for Moms Offers a Lifeline to Providers and Women in Need
Nancy Byatt, D.O., M.S., M.B.A., F.A.P.M., with contributions by Jamie Belsito and Amanda Martin
With nearly 15% of pregnant or postpartum women suffering from depression and very few medical providers able to offer effective treatment, it’s clear there’s a serious gap in available care.
As we’ve discussed throughout this series, this is a national health crisis, and the answer, in short, is for the system to expand its capacity for care.
Through our work in Massachusetts, we’ve found that a centralized program allows us to easily increase the care that physicians are able to offer. Doing so simultaneously solves a major dilemma for providers, who have long felt frustrated at their inability to help mothers in need— and helps patients feel secure and supported. That’s the role the MCPAP for Moms (Massachusetts Child Psychiatry Access Project for Moms) has been filling since its inception last year.
By offering training, toolkits, expert consultations, and referral support to providers statewide, the program has shown that an answer to the perinatal mental health epidemic is:
- less expensive,
- easier, and
- more achievable than we imagined.
To realize results nationwide, we must collectively advocate for this centralized model of care and stand together to demand help for millions of women, children, and families.
The Barriers to Care
Jamie’s story provides an example of the challenges women may face when trying to access mental health care during the perinatal period.
No one told Jamie she could develop depression. When she did, she didn’t know where to turn. Her physician did not have the training, skills, or resources to offer Jamie the assistance she needed. Jamie desperately wanted the best for herself and her baby, but instead she suffered immensely because help was not there.
There are barriers at the patient, provider, and systems levels. Women are often ashamed due to stigma and may fear losing parental rights. Others may not be aware they’re depressed. As discussed in an earlier blog post, OBs and pediatricians don’t have unlimited capacity to help women — despite their desire to do so.
Socioeconomic status is also a factor. Depression is far more common among women in underserved communities (it can affect up to 40% of these moms) and they face even greater barriers than their more affluent counterparts.
MCPAP for Moms
In response to countless cases like Jamie’s that happen every day across Massachusetts, we’ve created MCPAP for Moms, a program designed to overcome these multi-level barriers to care.
MCPAP for Moms launched in July 2014 and is well on its way to transforming care for pregnant and postpartum women in Massachusetts by ensuring that their obstetric, pediatric, and psychiatric providers are fully equipped to help. Here’s how it works:
- We help medical providers address depression and other mental health concerns during pregnancy and after birth.
- Our team trains obstetric practices in how to detect, assess, and manage depression, providing them with a toolkit and screening algorithm. Providers are eager to participate when we present them with the program and 35 percent of OBs across the state are already on board. We also work with pediatricians and offer a specialized toolkit for pediatric providers.
- Providers can call our helpline to consult with a perinatal psychiatrist and manage mental health concerns. We help providers link women with mental health care through our statewide database of qualified behavioral health providers.
- If a provider is still uncomfortable treating a patient, face-to-face consultations between a mental health care provider and the patient are also an option.
- In addition, MCPAP for Moms provides funding for Massachusetts-based MotherWoman to implement its Community-based Perinatal Support ModelTM (CPSM), an intervention that supports communities in creating a “comprehensive safety net for mothers at risk for/or experiencing perinatal depression.” The goal of the CPSM is to support community capacity by expanding resources, increasing provider competence, and promoting mothers’ inherent resilience at all points of provider contact from the first prenatal visit through the one-year well-child check. Through the CPSM, MotherWoman provides communities with professional training, resources, technical assistance, and toolkits.
- So far, this program has helped us provide treatment for more than 1,000 women and implement the CPSM to build community-readiness in 10 diverse communities across the state serving over 25,000 births annually. This includes the development of 15 new MotherWoman support groups that provide an easily-accessible resource for new moms.
At the minimum, we recommend women be screened during their first contact with an OB, at week 28 of their pregnancy, and at the postpartum visit. And as with any illness, depression needs to be monitored and followed to ensure the patient recovers.
What Good Care Looks Like: Amanda’s Story
In contrast to Jamie’s story, Amanda’s represents how a strong system of support can change a mother’s life. Amanda had suffered from anxiety and depression her entire life. She was on medication for her anxiety, but during pregnancy her anxiety lessened and she was able to stop taking her meds.
After delivery, everything changed. Amanda became increasingly depressed and anxious, and even questioned her decision to become a mom. Bawling her eyes out, she eventually called her OB.
Because MCPAP for Moms has been actively outreaching to engage and educate providers, Amanda’s OB was familiar with the program and immediately took steps to get her the care she needed. Within a week, Amanda was able to sit down with a psychiatrist, who connected her with a therapist who accepted her insurance. Thanks to her OB and MCPAP for Moms doing much of the legwork for her, Amanda was able to find the right combination of treatments that allowed her to recover.
Amanda felt supported and cared for throughout the duration of her need. Soon, she began feeling like herself again.
Cost-Effective and Affordable
MCPAP for Moms isn’t just effective, it’s also affordable and it offers a cost and care delivery model that can be easily replicated.
To cover the program, we have one Full Time Equivalent (FTE) perinatal psychiatrist position (which is staffed by several doctors who alternate shifts) and only four full-time positions altogether. In total, this costs $8.32 per perinatal woman per year, or 70 cents per month. That’s a total operating budget of $600,000 for the 72,000 perinatal women that Massachusetts has annually. With these nominal resources, we help pregnant and postpartum women across the entire state get help for depression.
Due to the support of Massachusetts legislators, 50% of the program is funded by surcharges from health insurance companies (based on the percentage of woman who carry commercial insurance); thus, the Commonwealth pays only 50%.
A Systematic Solution
Moving past Massachusetts and onto the national level, the Bringing Postpartum Depression Out of the Shadows Act (H.R. 3235/S. 2311) was recently introduced by Congresswoman Katherine Clark (D-MA) and Congressman Ryan Costello (R-PA) [(and in the Senate by Senators Dean Heller (R-NV), Kirsten Gillibrand (D-NY), Kelly Ayotte (R-NH), and Ed Markey (D-MA)]. The legislation, which envisions other states implementing programs similar to MCPAP for Moms, would increase and improve screening and treatment for women with perinatal depression nationwide.
We’re also very excited to have been awarded a five-year grant from the Centers for Disease Control and Prevention (CDC)* to conduct a clinical trial that will test our approaches to addressing depression among pregnant and postpartum women. Our preliminary data from a recently conducted pilot trial is very positive and we hope the results from our new grant will help inform the creation of a national model of care.
Imagine the impact it could have on moms, babies, families, and future generations if we continued to expand this program throughout the rest of the United States.
A future post in this series addresses the importance of this legislation. This bipartisan bill needs the support of citizens, providers, and stakeholders nationwide.
Above all, we need to show women that the best thing they can do for themselves, their babies, and our society is to get the support they need and deserve.
*Centers for Disease Control and Prevention Grant Number: 1U01 DP006093
*Research reported in this publication was supported by the National Center for Advancing Translational Sciences of the National Institutes of Health under award numbers KL2TR000160 and KL2TR001455.
Your Turn
- What programs in your state support the expansion of mental health care for pregnant or postpartum women?
- What kinds of programs do you think are needed?
- If you or someone you know has been treated for perinatal depression, who provided the psychiatric care? Was the provider sensitive to and specially trained to treat perinatal depression?
Bios
Dr. Byatt is a perinatal psychiatrist focused on improving health care systems to promote maternal mental health. She is an Associate Professor at UMass Medical School in the Departments of Psychiatry and Obstetrics and Gynecology. She is the Founding and Statewide Medical Director of MCPAP for Moms, a statewide program that addresses perinatal depression in Massachusetts by providing mental health consultation and care coordination for medical providers serving pregnant and postpartum women. Her research focuses on developing innovative ways to improve the implementation and adoption of evidence-based depression treatment for pregnant and postpartum women. She has received federal funding from the Center for Disease Control to test an intensive, low-cost program that aims to ensure that pregnant and postpartum women with depression receive optimal treatment. Her academic achievements have led to numerous peer-reviewed publications and national awards.
Amanda Martin is a 29-year-old paramedic with a bachelor’s degree in public health. She’s married to her best friend, Jonathan, and together they have a one-year-old daughter. Amanda has suffered from depression and anxiety throughout most of her life, and enjoys telling her story about PPD to help break the stigma and share information so other mothers can get the help they need.
Jamie Belsito was challenged with Postpartum Depression [PPD] during and post pregnancies with both of her children. It was during this time that she experienced difficulties finding quality mental health care to address PPD, as well as a lack of communication around the issue at the OB/GYN’s, primary health care, and pediatrics offices. In the fall of 2013, she became a member of the North Shore Postpartum Taskforce (NSPPDT), with community based local groups and clinicians support Mom’s and families working through the temporary and treatable conditions of PPD. Partnering with Senator Joan Lovely, Senator Bruce Tarr, Representative Brad Hill, MCPAP for Mom’s and the Special Commission for PPD, Jamie helped educate the Statehouse and stakeholders on PPD, gaps in the system and what Mom’s may need to get better. Jaimie has partnered with grassroots groups and local legislators to help ensure passage of funding for MCPAP for Mom’s, PPD pilot program and implementation of universal PPD screening for Mom’s in the Commonwealth.
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