Blog Index
Washington, DC – In May, the Agency for Healthcare Research and Quality (AHRQ) announced that Joy Burkhard, MBA was selected to serve as an expert advisor for their Cross-Sectional Innovation to Improve Rural Postpartum Mental Health Challenge.
The challenge aims to drive both proposal and narrative submissions, allowing the initiative to highlight success stories in rural postpartum mental health and encourage future innovative approaches.
A new Center for Disease Control (CDC) study finds that around 1 in 8 women report experiencing symptoms of maternal depression. The analysis, which looked at 2018 Pregnancy Risk Assessment Monitoring Survey (PRAMS) data from 30 states and Puerto Rico, found that rates of “postpartum depression” symptoms ranged from a little under 10% in Illinois to almost 24% in Mississippi.
What I’m reading this month not surprisingly focuses on how the pandemic is affecting mood and also what we might be able to do about it. Interestingly, the Federal Agency AHRQ is also now more aggressively recommending a standardized depression screening/measurement approach to allow for more compatibility and quality improvement efforts. As a health systems quality improvement practitioner, I also believe this is critical and controversial.
By Joy Burkhard, MBA
Today, 2020 Mom, along with nearly 25 co-signers, submitted the following letter to the Governor of California and the states Health and Human Services (HHS) agency to address the fears mothers have about giving birth alone, the fear of hospitals having bed shortages and the potential doctor and nursing shortages, and the need for mothers to know their non-hospital birth options. The letter also urges the state to ensure all mothers who screen positive for an MMH disorder have access to treatment.
Following are two pertinent updates regarding California’s response to the COVID crisis.
1. California’s New Peer Support Service is Available
The state’s newly enacted mental health peer telephone line and web-chat service is available to any California resident experiencing increased levels of anxiety and interested in connecting with a peer.
What a week it’s been!
Let me divert your attention just a bit from the news story of the day by sharing the non-COVID stories that recently caught my eye (ok I’m sharing one!).
Regarding the third article below, as a mom of a sleepless infant (and child), I can attest to the emotional troubles he has had (and are only getting worse now that he’s 12).
The U.S. has the highest suicide rates among wealthy nations, according to a new report that looked at how health and care in the U.S. stacks up globally. In 2016, the suicide rate here was 13.9 suicide deaths per 100,000 people — while the U.K. had the lowest rate of the 11 high-income countries in the report, at 7.3 suicides per 100,000 people.
At the same time, another new report from the Well Being Trust highlights 4% of insurance payments went to mental health care in 2017 and that Americans continue to have to go out of network to find treatment.
Tonight, we are sharing a gift with all of you; a new report titled Maternal Mental Health The State of the State in California and Beyond, made possible through a grant from the California Health Care who is helping to pave the way for change in maternal mental health.
A Summary of State and National Maternal Mental Health Efforts
The report looks at all of the work implemented in both California and nationally to address maternal mental health since April 2017, when California’s state strategic plan was issued by the state’s Task Force on the Status of Maternal Mental Health.
Congrats Corie for an amazing year - you have accomplished so much:
Mason Jars for Moms – Raised $250
Hosted Forum webcast at Ball State – 20 attendees
Attended Mom Congress
Organized a Community Coalition: Muncie & Delaware County Maternal Mental Health Collaborative
Get to Know Corie
I am a Mama to an energetic two and a half-year-old rainbow baby boy and three precious angel babies in heaven. I am also a mental health professional and just about six months away from completing my Doctorate in Counseling Psychology.
On December 20, 2019, President Trump signed the Budget bill averting a government shut-down and funding a Maternal Mental Health interagency Task Force. The Health and Human Services (HHS) Agency is tasked with convening a task force of various federal agencies including:
The Office of Women's Health,
The Surgeon General,
The Health Resources and Services Administration Maternal Child Health Bureau (HRSA), and the
Substance Abuse and Mental Health Services Administration (SAMHSA) and more.
Here are the news articles covering clinical topics that caught my eye in the last two months. Note the focus on gut health and nutrition and the connection to depression. If you have had experiences as a patient or treating provider with any of these treatments please post your story in the comments below.
The Vagus Nerve May Carry Serotonin Along the Gut-Brain Axis
SSRIs may activate vagus nerve-dependent gut-to-brain serotonin signaling. Read more here.
I’m writing this post, 8 years to the day of when I convened our first call with stakeholders (learn more about why this first call was held, and why I raised my hand to lead it, on the video at the top of our About 2020 Mom page.)
Recalling Our Journey
I heard over and over again that providers needed more training, and universal screening was a must. This made sense, though what I wanted to understand was why women weren’t already being screened, diagnosed and treated.
I began my quest for knowledge. I combed through research (which was difficult to consolidate, and often contradictory) and struggled to find answers.
Here are the articles that caught our founder Joy Burkhard’s eye in recent weeks. If you have had direct experience with the topic covered on any of these articles please share your insight by adding a comment below.
What It Feels Like To Be In Psychosis
I was diagnosed with bipolar I disorder with psychotic features when I was 25 years old. My mental health journey unraveled my life to the point where I nearly died. An entire year, spanning most of 2005, drove me entirely out of reality. It remains extremely difficult to explain how something called “psychosis” has affected my brain.
Most people understand psychosis to be seeing, hearing and believing things that are not real. Simple. However, it is not easy to explain what being in psychosis feels like...
In July 2019, the California Medicaid (Medi-Cal) Agency, Department of Health Care Services (DHCS) announced how it would support health plan compliance with the US Preventive Services Task Force assessment of sufficient evidence and recommendation to screen and treat to prevent maternal depression. Read more here.
Other states are likely developing similar positions to provide clarity to Medicaid health plans and screening and treating providers on how services should be billed and covered.
Common and Costly Expenditures Associated with the Birth of Children in 2017 Amount to More than $14 Billion
If you ask people what they think the most common medical complication is during and after childbirth, you probably won’t hear mental health issues. Yet maternal mental health (MMH) disorders — including prenatal and postpartum depression and anxiety — top the list, affecting at least one in seven women. In addition to the substantial human toll of these conditions, they come with a hefty price tag, especially because women who have them often go untreated.
Below are the news articles that caught my eye this month. Use the comments feature below to share you thoughts with me.
AHRQ Stats: Depression Screening
Though the US Preventive Service Task Force has recommended depression screening in adults since 2009, fewer than half of all Americans ages 35 and older were screened for depression in 2015, according to the federal Agency for Health Care Research and Quality. Read it here.
Here are my favorite articles since I last shared “What I’m Reading.” Note, I’m eager to get your thoughts on any of these articles, but particularly interested in your opinions about the three articles at the bottom; are you having problems with insurers? Let us know in the comments below.
Pregnancy Specific Anxiety Impacts How Long Women Breastfeed
New research published in June links anxiety and breastfeeding, a link moms have long been sharing concerns about. Read it here.
CDC’s Maternal Mortality Review Data Brief
The Federal agency, The Center for Disease Control (CDC) shared a new brief on Maternal Mortality Review (MMR) with updated 2008-2017 data on pregnancy-related deaths from 14 Maternal Mortality Review Committees (MMRCs). Arizona, Colorado, Delaware, Florida, Georgia, Hawaii, Illinois, Louisiana, Mississippi, North Carolina, Ohio, South Carolina, Tennessee and Utah voluntarily shared their data through the Maternal Mortality Review Information Application (MMRIA). MMRIA supports and standardizes record abstraction, documentation of committee decisions, and routine analyses.
The United States has the worst maternal death rates of any developed country, with Black women dying at 3-4 times the rates of white women, this rate remains unchanged when accounting for income, education and economic status. Maternal death rates for women overall in the U.S. doubled in the past 25 years, meaning that women today have a higher risk of dying at childbirth than their mothers, and the disparities that Black women face have been around for decades. For every maternal death in the country, 70 women face a life-threatening and too often, life-altering complication.
Nikki’s story:
BETHLEHEM, GA – I am a maternal mental health survivor and advocate! I spent years in the darkness of MMH disorders, but I am proud to say I have made my way into the light and am committed to helping other moms join me there. I now work with moms as a childbirth educator, birth doula, and peer support group leader.
Have you ever wished that someone would monitor how often screening for maternal depression is happening and to report that rate?
It’s been a dream of mine to have such a measurement in place so we can gauge how quickly change is occurring, determine states where rates are highest/lowest, and push for more aggressive action until screening rates are in the acceptable 90% range nationally.
Now, development of such a measure, referred to as a Healthcare Effectiveness Data and Information Set (“HEDIS”) measure, is underway thanks to The California Health Care Foundation and the ZOMA Foundation.
In addition to a measure of screening, there is also a measure being developed to address whether the screening provider followed-up. Here are the proposed measures - which include assessment for screening/follow-up during both pregnancy and the postpartum period.
Black History Future Month, What It’s Meant to Me
February is Black History Month. Now, many are calling February Black Future Month; a time to raise awareness about how to move forward as a nation and continue to heal from the past.
The month of February was officially recognized as Black History Month in 1976 by President Gerald Ford as a time to honor the rich history, culture, contributions, and importance of African Americans. It is also a time, to consider the adversity and inequities that African Americans still face in our country. We invited Kay Matthews, Executive Director of the Shades of Blue Project in Houston, Texas, to share what Black History Month means to her.
There is a pain that lingers deep inside of me that sometimes surfaces to make for very dark days. Tuesday is the day of this particular week that I feel quite out of place. It’s a day I ask myself if I made the right decision to expose my feelings to the world to pick apart at their leisure.
We had the opportunity to pull leaders in the field together to review the draft USPSTF recommendation. To learn what was discussed read more here.
It has now become more well known that maternal mental health disorders are the most common complication of pregnancy and childbirth.
In 2017, after the American College of Obstetrics and Gynecology (ACOG) overturned its position to recommend screening for maternal depression, the United States Preventive Service Task Force (USPSTF) changed its position to now recommend maternal depression screening.
Now, in 2019, the USPSTF released one of the firsts of its kind, a recommendation for a clinical intervention to prevent a potential disorder, not just screen for it retrospectively. The disorder? Maternal depression. The recommendation was published in on the USPSTF website and in the Journal of American Medical Association (JAMA) Network.
SO, I just posted a “What We’re Reading” blog post a week ago, but I have more to share. Here are some of the highlights: More about the gut-biome brain connection, the latest article by our favorite journalist, April Dembosky. April calls out that America is lacking adequate inpatient treatment facilities for mothers and their babies, that reimbursement is an issue, and how lack of sleep is a public health emergency.
Kaiser Health News: Postpartum Psychosis is Rare, Real, and Dangerous
There had been no crime after all — Lisa Abramson’s destination that day wasn’t a jail cell, but rather the general psychiatric ward at Sutter Health’s California Pacific Medical Center in San Francisco. The other patients were there for drug overdoses or alcohol withdrawal. People were screaming. Read it here.
Janessa's story:
SPRINGFIELD, NJ –
Q: How are you involved with 2020 Mom?
A: Ambassador, Completed the MMH Certification class
Q: 2020 Mom’s mission is to close gaps in maternal mental health care. What’s your big hope for how 2020 Mom can fulfill this bold mission?
A: The diagnosis gap seems so large, but with 2020 Mom advocating for the OBGYNs to be the primary physician in Maternal Mental Healthcare, and also asking Pediatricians to be on the lookout during a woman’s entrance into motherhood, I think they will be able to catch more people who are struggling. I remember just wanting someone to ask me or to notice that I was not operating at my full capacity. I was not finding the joy of motherhood that everyone talked about and I didn’t want to admit it. I hope that as 2020 Mom works with healthcare teams, policy makers, insurance companies, and individuals the barriers of stigma surrounding Maternal Mental Health will break down and more women will speak up and not suffer in silence.
Here are articles that caught Joy’s eye this month:
One of my favorite things to do is comb through articles that come across my desk (more like kitchen counter, where I work) from various sources. Here are the articles that I picked to share with you this month.
Wired: Virtual Reality’s Latest Use: Diagnosing Mental Illness?
Diagnosing psychiatric and neurological conditions is tricky. Physicians have long reported that diagnoses are fraught with complications and subtleties. Anywhere from 35 percent to 85 percent of mental health conditions go undetected and undiagnosed, according to the World Health Organization, depending on where you live on the planet. Needless to say, to treat depression, Alzheimer's, or autism, it must first be detected. Now clinicians and researchers are trying a new tool: virtual reality. Read it here.
This week, I head to Washington DC to meet with members of Congress about maternity care.
I will be joined by several colleagues from non-profit organizations, including leaders from groups like Every Mother Counts, The Preeclampsia Foundation, Improving Birth and March for Moms. With more women ever serving in congress, it’s a particularly exciting time to address women’s health and maternity issues.
We have been asked to share what we believe should be the highest priorities in improving maternity care. This includes maternal mental health.
If I were in position to write two federal laws, this is what I’d write.
Wow, 2018!
I'm pleased to share our 2018 Impact Report infographic and some of our 2018 highlights below.
If you have followed our work, you know our most celebrated accomplishment was our sponsorship and the passage of three pieces of key maternal mental health legislation. These bills made up the most comprehensive MMH legislative package ever.
Cassandra’s story:
GURNEE, IL – I’m that person who will be awake the earliest in the house, regardless if I had enough sleep or not, to welcome and conquer the day. I like challenges and I would travel at length to get to where I need to be, to connect with people and explore other cities. I’m a daughter, a sister, a friend, and a single mom who is currently in recovery from the aggressive downward slope of postpartum depression (PPD).
2020 Mom is proud to support the ‘‘Military Moms’ Mental Health Assessment Act’’ (“The Act”) which was introduced last week by Senators Richard Blumenthal (D-CT) and Tim Kaine (D-VA).
The Act will require the Comptroller General of the United States to conduct a study of prenatal and postpartum mental health conditions among members of the Armed Forces and their dependents.
The Bill Recognizes:
The bill cites 2018 birth stats within the Armed Forces - where over 50,000 members and their dependents gave birth at a combination of military medical treatment facilities and civilian hospitals, funded by the Department of Defense.