Peaks programs work to address perinatal depression and improve maternal mental health
For many women, pregnancy is a time of immense joy, but it can also be challenging and filled with a lot of adjustments. It’s a period of increased vulnerability and emotional changes, and many pregnant women experience depression, anxiety or other mental health challenges. These conditions can contribute to an increased risk of suicidal thoughts or behaviors in some cases.
Perinatal mood and anxiety disorders are the single largest complications of pregnancy and childbirth. One in seven women in the U.S. will experience a perinatal mood or anxiety disorder and up to 85% of postpartum women will experience significant adjustment complications and emotional symptoms.
In 2017, legacy SCL Health, with a grant from the ZOMA Foundation, began a maternal mental health initiative designed to integrate behavioral health services into obstetric care. The goal is to promote the early identification and treatment of perinatal mood and anxiety disorders through universal education and screening and the provision of integrated behavioral health services in the OB setting. Today, this continues to be a top priority as identified by community needs analyses, and it’s one of the 10 key metrics Colorado care sites are tracking as part of the Hospital Transformation Program (HTP).
In Colorado, the Nourish & Bloom Perinatal Behavioral Health program is a behavioral health intervention for pregnant and postpartum mothers. It was piloted at Saint Joseph Hospital and now supports Intermountain’s four Front Range hospitals and 15 OB clinics. It is run by perinatal mental health experts with lots of specialty training to address the whole health of the patient.
In Montana, the Meadowlark program brings together a clinical team made up of prenatal care and behavioral health providers and coordinates community services to provide better care for pregnant women and their families and improve health outcomes. Both offer routine screenings and treatment for mental illness as part of prenatal and postpartum care.
“Women are screened for depression and anxiety at their first OB appointment and are screened three more times during pregnancy and after childbirth,” said Dr. Kathleen Rustici, medical director of Women’s Health for the Front Range and practicing OB/GYN at Central Park. “If they score a 10 or higher on the Edinburgh Perinatal Depression Scale (EPDS), a referral is made to the behavioral health program, and they are contacted by a mental health provider within 24 hours. A further assessment takes place, and a customized care plan is created to provide services within the patient’s OB setting. These services can include education, resource connection, care navigation, counseling and medication therapy.”
A Maternal Mental Health toolkit was created for the Peaks Region that includes information on how and when to screen, document, and refer based on EPDS scores, along with scripts for how to discuss the scores with patients.
Dr. Rustici is passionate about integrating behavioral health in our women’s health clinics and championed this work along with Heather Hagenson, director of Operations and Business Development for OB and women’s outpatient programs at Saint Joe’s. Heather oversees the Nourish & Bloom Program, the Birth Center of Denver and women’s health navigation programs.
“Through this process, a multidisciplinary team has access to the patient and access to each other to provide the highest level of care to pregnant women and new mothers up to one year postpartum,” Heather said. “All of our care providers monitor the patients throughout their pregnancy, monitor postpartum emotional symptoms and then offer counseling and workshops through the Bloom Program. In Colorado, 30% of all pregnancy-related deaths are by suicide and 89% of them are preventable. This intervention has successfully identified people at risk for maternal mental health concerns, including suicide, and connected them with the resources and support they need.”
Historically, women were screened only at the postpartum stage, but it was discovered that had these screenings been done earlier, women struggling with perinatal mood disorders could have gotten the help they desperately needed sooner.
“It used to be that OB providers didn’t have the resources or bandwidth to do anything when patients were struggling with mental health issues,” Dr. Rustici said. “What I love about the Bloom program is that it gives clinicians a toolkit and set of resources we can meaningfully offer our patients. We can offer a warm handoff to a behavioral health provider who can talk to the patient immediately, or get patients plugged into the system and someone will reach out to them within 24 hours.”
“It’s crucial that we meet patients where they are in their pregnancy or postpartum journey, in both inpatient and outpatient settings,” Heather said. “Key to the success of this program is the integration of OB care and mental health. We can take care of patients in a more comprehensive way when we integrate and don’t function in a silo. We have screened thousands of women for maternal mental health complications since this program started, and before all we could do was send them to the emergency department or provide them a potentially outdated list. Patients have been overwhelmingly grateful that we offer an integrated behavioral health program from preconception to postpartum.”