Mind the Gap Collective Impact Initiative Aims to Make Mental Health Disorders During Pregnancy a National Priority

It's hard being a new mom. You're tired from getting up at night to feed your newborn. Your hormones are wonky. Perhaps you're juggling the baby and other children. As a new mom, you may not want to complain. Maybe you feel like you won't be taken seriously. Or you don't have the words to describe the mood swings, racing thoughts or other uncomfortable emotions you're feeling. Maybe you feel like people will judge you when you have been given the gift of life.

The perinatal period—which begins with pregnancy and can last up to a year after—can be tough. During this time, many women experience mental health disorders that go way beyond the "baby blues," including depression, anxiety, obsessive compulsive disorder and posttraumatic stress disorder. But too often they don't talk to anyone about it—not their partner, their family or their health care provider due to stigma associated with it.

"If you are a woman suffering from postpartum depression, anxiety or mood disorders, you are not to blame, you are not alone, and help is available," said Dr. Wendy Davis, executive director of Postpartum Support International (PSI).

Data show that perinatal mental health problems affect one in seven pregnant and postpartum women, according to a study in Obstetrics & Gynecology. Between 15 percent and 20 percent of women giving birth annually (estimated at 4 million in the United States) will experience a mental health disorder sometime during pregnancy or postpartum. About 30 percent of women with depression during pregnancy will continue to have depression 12 months after delivery if not treated. Perinatal depression and anxiety are highly treatable conditions but remain undiagnosed and untreated.

Perinatal mental health does more than just affect moms. The whole family feels it. Up to 25 percent of new dads can have perinatal depression, and having a partner with perinatal depression is a risk factor for dads developing depression. Furthermore, a woman suffering from a perinatal mental health disorder can have trouble bonding with her baby, doubt her ability to care for the newborn and may even think of harming herself. These issues pose a substantial risk to moms and their babies, potentially harming learning, behavior, development and overall functioning of infant and children. Perinatal mental health problems affect our families, society and future generations.

Recognizing the high prevalence and impact of perinatal mental health on our families and society, PSI, in partnership with The Reilly Group, recently launched the Mind the Gap Collective Impact Initiative. The goal is to acknowledge that perinatal mental health is a public health issue and make it a national priority . Public awareness along with other targeted policy changes are needed to improve the health of new moms and their families and minimize the current impact on our society.

Despite the prevalence of perinatal mental health disorders, research funding as measured by National Institutes of Health and Centers for Disease Control and Prevention grants ranks far below funding for other conditions that affect women.

Check out these numbers: Heart disease affect one in five women and receives $3.3 billion in federal funding. Breast cancer strikes one in eight women and gets $1.4 billion in federal funding. One out of 200 women have lupus, and it gets $197 million from the government. But perinatal mental health disorders, which one in seven women experience, only receives $54 million in federal funding, according to research presented at a Mind the Gap advisory workgroup meeting.

Screening for mental health disorders during pregnancy and postpartum have yet to be universally adopted or available. And if a woman does get screened showing a positive screen for depression, or other mental health disorders, referral and access to treatment aren't always available According to studies in Obstetrics & Gynecology and Journal of Women's Health, less than 30 percent of women who screened positive for depression and anxiety get treatment.

Over the past decade, a number of national, state and local organizations have made tremendous strides in addressing challenges related to screening, diagnosis and treatment of perinatal mental health.

Recently, key professional associations like the American Academy of Pediatrics, the American College of Obstetricians and Gynecologists, Postpartum Support International and the U.S. Preventive Services Task Force have issued guidelines to ensure that screening for mental health disorders is universal, routine and standard, with appropriate follow-up for diagnosis and treatment. But coordinated national efforts are needed to ensure that these guidelines are implemented and that barriers are eliminated to access and coverage of perinatal mental treatment for mothers. National public awareness can help lower the stigma, provide education and encourage women to seek help.

Mind the Gap Collective Impact Initiative

A landscape analysis of the issues, along with expert input from leading organizations at a September meeting in Washington, DC, led to development of consensus on a set of recommendations with specific actions to ensure that perinatal health is a national priority.

"Mom's mental health needs impact the whole family unit, and we can do so much when we work together in common purpose," says Colleen Reilly, president and CEO of The Reilly Group and co-leader of the initiative.

HealthyWomen was one of many national organizations that participated in this meeting and provided medical, educational and policy guidance. "This is an important national issue that a lot of people don't know about, and we look forward to educating women and their health care providers," says Beth Battaglino, RN-C, CEO of HealthyWomen.

"A lot of work needs to be done," says Battaglino. "Historically, the focus has been on the baby—not on mom's health. The OB/GYN and pediatrician and others involved in maternity and infant care need to be in a position to know how to screen and refer mom to get the help she needs."

Even though there are great models and programs, an overall gap remains for the appropriate detection, treatment and access to care for women with perinatal mental health disorders in the United States. The Mind the Gap Initiative seeks to bridge that gap by forming a diverse coalition of leaders and stakeholders, including federal agencies, researchers, provider associations and patient advocacy groups.

"At PSI, we understand women may feel alone and scared," "But they're not alone and they're not to blame. Help is available. We should never blame a mother. It's a medical condition, just like other medical conditions a woman may experience during pregnancy or postpartum. The good news is that there are effective treatments available that work, support services that help, and evidence-based interventions that we can provide to address mental health and well-being. We have to get the word out there. By working together we can close the gap in care for moms and families."

For more information on Mind the Gap, contact colleen@reillygroupinc.com or wdavis@postpartum.net.

For more information on perinatal mental health, visit Postpartum Support International.