Improving Maternal Mental Health Care
Why This Work Matters
One in five California women suffers from depression, anxiety, or both while pregnant or after giving birth, negatively impacting the mother and the child. Despite this high prevalence of mental health issues, few women receive treatment. CHCF is working with partners to better understand this issue and to explore innovative, practical solutions for delivering mental health care to California’s mothers and expectant mothers in need.
Perinatal mood and anxiety disorders are the most common medical complication affecting women during pregnancy and after childbirth. They include prenatal and postpartum depression and/or anxiety, and, in extreme cases, postpartum psychosis. According to the Maternal and Infant Health Assessment (MIHA) conducted by the California Department of Public Health (CDPH), 21% of pregnant and postpartum women in California are affected. The prevalence is estimated to be even higher in some populations. For example, one in four African American and Latina mothers in the state reports depressive symptoms, and so do as many as half of all mothers living in poverty.
Left undetected and untreated, these conditions can lead to negative health outcomes for the mother, and can negatively affect the mother-child bond and the child’s long-term physical, emotional, and developmental health. Additionally, the financial cost of untreated maternal mental health conditions can be significant (for example, more use of emergency care services, higher rates of absenteeism at work).
Fortunately, these conditions are treatable, and early detection can make a significant, positive impact. CHCF is currently funding projects to better understand maternal mental health care in California and to explore ways that it can be improved. A summary of the projects that are part of CHCF’s current maternal mental health portfolio is provided below.
- University of California, San Francisco, and the California Department of Public Health are working to improve questions about perinatal mental health in the annually fielded Maternal and Infant Health Assessment (MIHA) survey. (In process)
- The National Committee for Quality Assurance is developing clinical quality measures for perinatal depression to be proposed for inclusion in the national Healthcare Effectiveness Data and Information Set (HEDIS). (In process)
- The CHCF Almanac report Maternity Care in California describes the state of maternity care in California, including available statewide data that relates to maternal mental health. (November 2019)
- The Listening to Mothers in California survey (cofunded with the Yellow Chair Foundation), fielded in English and Spanish by the National Partnership for Women & Families, highlights the attitudes and experiences of mothers around maternity care. (September 2018)
Delivery System Interventions
- The Hospital Quality Institute, in partnership with Maternal Mental Health Now, is leading an initiative to help hospital perinatal staff understand, recognize, and effectively respond to mental health issues in the perinatal period. This will help hospitals comply with Assembly Bill 3032, which, effective Jan. 1, 2020, requires education of perinatal employees about maternal mental health conditions and to inform postpartum women and families about signs and symptoms of maternal mental health disorders, local post-hospital treatment options, and community resources. (In process)
- Researchers from the University of Washington and the Advancing Integrated Mental Health Solutions Center, in collaboration with the Oregon Community Health Information Network and the University of Pennsylvania, are assessing the impact and cost-effectiveness of provider-to-provider longitudinal remote consultation for the management of perinatal depression in community health centers and other primary care practices. The National Institute of Mental Health is the main funder. CHCF is supporting four (of the approximately 20 participating) sites based in California: ChapCare, Central Neighborhood Health Foundation, Alliance Medical Center, and Open Door Community Health Centers. Related, CHCF is also supporting a planning grant to explore expanding this model in clinics in LA County, in collaboration with the Community Clinic Association of LA County. (In process)
- Funded by a program-related investment from the CHCF Health Innovation Fund, Docent Health is scaling and tailoring their technology-enabled maternity care coordination platform, which pairs local, culturally responsive navigators with digital engagement tools, to serve more birthing people enrolled in Medi-Cal. The investment builds on a growing partnership between Docent and CommonSpirit Health, the health system that delivers the most Medi-Cal births in California. Learn more about this project in this CHCF blog post (In process)
- The Pacific Business Group on Health has developed resources to promote access to and use of certified nurse midwives (CNMs), as well as tools to assist providers in integrating CNMs into their practices. (February 2020)
- A pilot program run by the Los Angeles County Health Agency and the University of Southern California tested use of secure emails in electronic consultations between reproductive psychiatrists and general psychiatrists to improve management of pregnant and postpartum women with severe and persistent mental illness. (December 2019)
- There is significant interest in California and nationally regarding provider-to-provider telephone consult programs to help improve the care of women with maternal mental health conditions. Lifeline4Moms, which supports Massachusetts’ program called MCPAP for Moms, a national model, held a webinar highlighting its program and other state-based programs like it. (November 2019)
- The Institute for Medicaid Innovation identified promising approaches to address maternal depression and anxiety during pregnancy and one year post birth, with a focus on the Medicaid population. (October 2018)
- Maternal Mental Health Now tested collaborative maternal mental health care in three Los Angeles community clinics: Harbor Community Clinic, Eisner Pediatric and Family Medical Center, and Martin Luther King, Jr. Outpatient Center. (February 2018)
- Along with ZOMA Foundation and the Perigee Fund, CHCF funded Mathematica to estimate the total societal cost of perinatal mood and anxiety disorders. A report sharing the national numbers as well as the findings for California, Colorado, and Washington State was produced. (April 2019)
- CHCF and The California Endowment supported the nonprofit 2020 Mom in spearheading a statewide task force on maternal mental health in California, which produced a report with recommendations. 2020 Mom is now working to implement the recommendations with stakeholders. (April 2017)
- CHCF is funding Hollywood, Health & Society, a program of the USC Annenberg Norman Lear Center, to provide materials that help screenwriters more accurately depict maternity care on television and in other entertainment programming. (In process)
For more information, contact CHCF’s Stephanie Teleki.