Lenore Jarvis, M.D., M.Ed., director of advocacy and health policy for the Division of Emergency Medicine and an affiliate faculty member of the Child Health Advocacy Institute at Children’s National Hospital, recently participated in a congressional briefing about maternal mental health. The goal of the briefing was to bring awareness to the devastating impact of untreated perinatal mood and anxiety disorders (PMADs) on moms, babies and families and to eliminate the pervasive stigma around seeking care, including in communities of color and military populations.
PMADs are one of the leading causes of maternal mortality and morbidity in the U.S., responsible for nearly one quarter of all maternal deaths. Evidence shows that 1 in 5 women experience a PMAD during pregnancy or the postpartum period. All maternal mental health conditions are treatable, yet over 75% go untreated.
Dr. Jarvis spoke about the importance of screening caregivers for PMADs not just in outpatient settings, but also in emergency departments and NICUs. She said that an emergency department can serve as a safety net for high-risk patient populations who may have limited access to primary or mental health care, or for those who use the emergency department at a time of increased stress, anxiety or depression. Similarly, the NICU population is comprised of caregivers coping with stressful scenarios like traumatic perinatal or birth experiences and life altering diagnoses.
“At Children’s National, our primary care clinics screen for PMADs, but we also provide universal screening by approaching caregivers with infants six months and younger in both the emergency department and the NICU. Our philosophy is that by offering this screening and education to families, we are providing a higher standard of care for the patients seen in these settings,” said Dr. Jarvis. If a caregiver screens positive, meaning they are exhibiting enough symptoms that they could be at risk for experiencing PMADs, a member of our social work team meets with that caregiver to complete an additional assessment and provide further support, including to understand if there are suicidal or infanticidal ideations and intent to act. Our social workers can then make referrals to connect them to more care and follow up with those caregivers to confirm they have connected with the appropriate resource.
Dr. Jarvis was asked how to make it easier to support caregivers and families regarding PMADs. “Caregivers need education regarding PMADs. We need them to know it’s common and it doesn’t make them bad parents. We also need to ensure that providers are screening and that they have increased time for visits that include addressing mental health concerns.” She also stressed that the healthcare system can be difficult to navigate. “We need to decrease barriers to care, like the long wait times to get into mental health care and insurance coverage issues.”