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.
Background and Landscape
- 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 and findings also for California, Colorado, and Washington state were produced. (April 2019)
- CHCF is funding Hollywood, Health and Society, a program of the USC Annenberg Norman Lear Center, to provide materials that help screenwriters more accurately depict maternity care on television and other entertainment programming. (In process)
- Fielded in English and Spanish by the National Partnership for Women & Families, the Listening to Mothers in California survey (co-funded with the Yellow Chair Foundation), highlights the attitudes and experiences of mothers around maternity care. (September 2018)
- CHCF and The California Endowment supported 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)
- This CHCF Almanac report describes the state of maternity care in the state, including available statewide data that relates to maternal mental health. (June 2016)
Delivery System Improvement
- With the Los Angeles County Health Agency and the University of Southern California, a pilot program is testing the use of secure emails in electronic consultations between reproductive psychiatrists and general psychiatrists to improve management of pregnant and postpartum women with severe, persistent mental illness (SPMI). (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)
- Researchers from the University of Washington and the Advancing Integrated Mental Health Solutions Center, in collaboration with OCHIN and the University of Pennsylvania, are assessing the impact and cost-effectiveness of provider-to-provider longitudinal remote consultation (LRC) 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 Medical Health Center, Central Neighborhood Health Foundation, Alliance Medical Center, and Open Door Community Health Center. (In process)
- 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 Outpatient Center. (February 2018)
Other CHCF maternity care-related work includes a statewide effort to lower the rates of unnecessary cesarean sections.
CHCF’s maternal mental health work is part of a CHCF-wide focus on behavioral health: building integration essentials (data transparency and data sharing, new financing models, and policy solutions) and supporting care transformation, including complex care integration and integration initiatives in the Medi-Cal program. CHCF is also participating in a statewide effort to address the opioid epidemic, a component of which focuses on increasing access to integrated addiction treatment.
For more information, contact CHCF’s Stephanie Teleki.