Even though a lot of progress has been made in the last few years, we are far from making effective mental health care truly accessible. An example of this is the lack of mental health support for expecting women and new moms.
Perinatal mental health — mental health during pregnancy and after childbirth — has not been prioritized until very recently. Despite the fact that it is extremely common to struggle during this period, around 85% of moms who could benefit from support never get it.
We believe that in order to close the perinatal mental health care and treatment gap, we should make perinatal mental health care as standard as taking a prenatal vitamin.
- Mental health struggles, such as persistent symptoms of anxiety and depression, are the most common complications of pregnancy and childbirth. The official statistic for clinical levels is around 20%, but 70% of new mothers say they struggled more with their mental health during the perinatal period than any at other time in their lives. We should support moms for the sake of supporting moms, but we also know that it is much harder to take care of someone else — like a new baby — if you are struggling yourself.
- A lot of these cases are preventable. An estimated 50% of cases of depression in the postpartum period are preventable with cost-effective interventions, including cognitive behavioral therapeutic techniques delivered through digital interventions. Whenever we can, we need to prevent symptoms of depression and anxiety from getting to the point where people need complex, intensive treatment. Early and frequent support is critical. This is partly because there are shortages of perinatal mental health professionals, particularly in rural or under-resourced areas, where wait times for specialist appointments can be three months. Even when therapy is affordable or available, it is difficult for brand new parents to schedule appointments because of the unpredictability of their lives, let alone figure out childcare during a session. Prevention and early intervention can help us target more complex support for those who need it later.
- The stigma of a diagnosis will keep people from getting help. If we take a purely diagnostic approach, even if we create all the accessible tools in the world, perinatal mental health will continue to be stigmatized. Celebrities like Serena Williams, Chrissy Teigen, and Meghan Markle to name a few, have bravely helped normalize the struggle so many of us go through. We definitely aren’t going to meet the need if the first time that moms are thinking about their mental health is when they receive a diagnosis, which can be a very painful and difficult conversation and leave moms feeling worse.
- Untreated maternal depression exacerbates inequities and inequalities in our society and is a public health issue. Moms of color and moms with few resources are much more likely to be depressed and less likely to get support. Untreated depression is linked to poor child outcomes — including cognitive and behavioral issues, earlier school leaving, and depression as an adult. Untreated depression exacerbates cycles of inequities by setting children up for a more difficult life. Under-represented parents are affected by a lack of mental health support more than white moms and parents.
Access to tools and techniques that are cost-effective, scalable, and inclusive are part of the solution. But what also needs to happen is at every single clinical touch point and outside of any diagnosis, an expecting or new mother should be offered mental health care options and support. There are so many opportunities for this — from hospital visits, to OBGYN check-ups and pediatrician well-child visits. And with commitment and creativity, we can cost-effectively provide every new mother with support — that she can access on her own time — that is effective for alleviating difficult symptoms and managing the inevitable highs and lows of parenthood. It’s a public health matter. It just makes sense and we have to do it.
Another point to add here — maybe it’s time to get rid of the word “disorder” when describing mental health struggles. The point here is not one of clinical definition, it’s the fact that the word is stigmatizing. Much of what happens to us are unfortunate side effects of biology and society and many other circumstances that are not our fault. We struggle to varying degrees and at different times. The word “disorder” does not help with the stigma and it can contribute to people not getting help. We all need support to get through difficult times, and the physical and emotional transition from expecting to new parent (for example) is challenging.
Just as prenatal vitamins and nutrition interventions are designed to help set mothers and babies up for a good start, effective mental health interventions delivered as a preventive measure contribute to the same goal and should be prioritized.