Governor Inslee Proclaims May 2024 Maternal Mental Health Awareness Month
Governor Jay Inslee has proclaimed May 2024 as Maternal Mental Health Month in Washington State. This proclamation highlights the critical importance of maternal mental health and the need for increased awareness, education, and support for parents before, during, and after pregnancy.
The proclamation recognizes that over 83,000 babies are born in Washington State each year and emphasizes the prevalence of perinatal depression and related mood disorders, affecting approximately 20% of new and expectant parents. It also acknowledges the challenges faced by parents in seeking help due to lack of information, screening tools, and awareness of available services.
During Maternal Mental Health month, HCA aims to:
- raise awareness about perinatal depression and related mood disorders,
- educate on the importance of early detection of maternal mental health, and
- promote access to treatment and supportive services.
This proclamation is a step forward to begin destigmatizing maternal mental health and starting the conversation about treatment and supports needed to address the needs of the perinatal population. We encourage all providers and state partners to participate in this special observance and help spread the word about maternal mental health.
What is maternal mental health?
Maternal mental health refers to overall mental health and well-being any time during pregnancy and the year after birth.
Why it matters?
Maternal mental health is one of the leading causes of complication for new and expectant parents in the United States. Maternal mental health impacts nearly 20% of the birthing population and according to the CDC is the leading cause of preventable death for the perinatal population.
Who it affects?
Maternal mental health can impact anyone, regardless of ethnicity, financial stability, or physical ability. Mental health during the perinatal period and early parenting can impact birthing people and their co-parents, foster and adoptive parents, and other family caregivers. Caregivers who experience loss (including miscarriage, stillbirth and abortion) can also be affected.
Many terms, the same issue
Maternal mental health, most commonly referred to as Perinatal Mental Health, has many historical terms used as knowledge and understanding of mental and behavioral health have changed over time.
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Mid 1800’s: In the 1850’s Dr. Marce published the first paper devoted on perinatal mental health issues. As a founder in the study of postpartum depression (PPD) throughout the world, his work opened the door to understanding and recognizing perinatal mental health. His work initially referenced perinatal mental health conditions as “Puerperal Insanity” reflecting the gender bias and misunderstanding of mental health during pregnancy and postpartum.. Further exploration of symptoms and increased understanding resulted in a change to a less stigmatizing term to reflect the spectrum of mental health needs.
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Late 1900’s: Postpartum Depression (PPD) was first coined by Brice Pitt after a perinatal mental health community study. When described as a ‘less severe’ depression than psychosis, he unknowingly furthered the belief that perinatal depression was something different than non-postpartum depression. Use of the term Postpartum depression was widely used to identify any postpartum onset of depression or symptoms.
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Early(?) With more research, there was a greater understanding that needs encompassed more than the postpartum period, including mental health needs with during pregnancy. There was also a new understanding of anxiety as a common occurrence for the perinatal population. This understanding resulted in the use of new terminology, Perinatal mood and anxiety disorders (PMAD).
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Current day: As continued awareness spread across the globe, more exploration of symptoms confirmed perinatal mental health encompasses the whole of the perinatal period and full scope of mental health conditions (e.g. Post Traumatic Stress Disorder (PTSD), eating disorders, bipolar disorder) that can impact perinatal people. Thus, Perinatal mental health has become an umbrella term to recognize and identify any mental health need during pregnancy and the year after birth.
Perinatal Mental Health at Health Care Authority
2024 Legislative Session
This legislative session included new directives and resources for HCA to continue to strengthen its policies and programs supporting perinatal well-being.
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Improving maternal health outcomes (2ESSB 5580): Recognizing the Apple Health’s (Medicaid) role in supporting perinatal people, 2ESSB 5580 included several components to improve maternal health outcomes:
- Increasing coverage for Washington residents through changing the eligibility criteria for pregnancy and 12 months of postpartum coverage. Change will increase the current 193% of Federal Poverty Level (FPL) increasing to 210% of FPL.
- Creating a hospital post-delivery and transitional care program for perinatal people with a substance use disorder at the time of delivery
- Investments in First Steps Maternity Support Services (MSS) program - updating current screening tools, increasing the allowable benefit and reimbursement, and collecting the results of each client’s MSS screening
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Apple Health Doula benefit: The supplemental operating budget included funding and directives for HCA to establish an Apple Health doula benefit which would allow Medicaid reimbursement for their services. HCA anticipates the benefit will be implemented in early 2025. HCA is also directed to contract for the design and implementation of a statewide “Doula Hub” to support doulas in navigating the Medicaid system and manage a doula referral system
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Caregiver depression screening rate: The supplemental operating budget included funding to increase reimbursement for screening during well-child visits to account for the coordination and support needed when a concern is identified. This includes caregiver depression screenings for the adult caregivers of children up to 1 year old.
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Distressed hospital grant: The supplemental operating budget included language to update the distressed hospital grant to allow for birth centers and low-volume labor and delivery hospitals to be eligible to participate.
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Substance Using Pregnant Person (SUPP) program rate: The supplemental operating budget included funding to increase current SUPP rates for qualifying hospitals.
Apple Health Policies and Programs
Apple Health includes whole-person benefits during pregnancy and for the year postpartum. The following list highlights several programs supporting perinatal behavioral health. Visit HCA’s Pregnancy care resources and Pregnancy services webpages to learn more about the other services and resources available for perinatal people enrolled in Apple Health.
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After pregnancy coverage (APC): APC is comprehensive health care coverage, including mental health services, for 12 months after pregnancy ends. APC is available for any end of pregnancy outcome, and those who were not on Apple Health during the pregnancy may also apply.
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Perinatal mental health screening: In 2024, HCA updated its screening policy clarifying that providers can be reimbursed for perinatal mental health screening during pregnancy. Additionally, HCA received approval from Centers for Medicare and Medicaid Services (CMS) to allow for screening of two caregivers during infant well-child visits ensuring multiple caregiver needs can be identified and supported.
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First Steps Enhanced Services: The First Steps program includes Maternity Support Services (MSS), Infant Case Management (ICM), and Childbirth Education (CBE). MSS includes a behavioral health specialist as a core member of the team addressing identified risks, sharing information, and supporting connection to community resources.
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Substance Using Pregnant People (SUPP) Program: SUPP is a 26-day inpatient hospital program for pregnant people who have a medical need, substance use history, and screening indicating risk. The program aims to reduce harm and improve the health of both the pregnant individual and their baby.
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Pregnant and Parenting Women (PPW) services: Pregnant and Parenting Women (PPW) services are designed to meet the needs of pregnant and parenting women seeking services. PPW are a priority population for Federal Substance Abuse Block Grant funding. PPW services include inpatient and outpatient SUD treatment. Residential substance use disorder treatment is available for women and their children under the age of six for up to six months. Structured clinical services are provided in a planned regimen of patient care in a 24-hour, live-in setting.
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Parent Child Assistance Program (PCAP): Offers evidence-informed, person-centered home visitation case-management to pregnant and parenting individuals (up to 24 months postpartum) with substance use disorders. The goals of the program are to help caregivers build healthy families and prevent subsequent prenatal substance exposures.
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Pregnant and Parenting Individuals (PPI): In partnership with the Department of Children, Youth, and Families (DCYF), HCA is overseeing the development of a new PPI facility specifically tailored for pregnant and parenting individuals, including fathers, implementing a family preservation model of care.
Learning Collaboratives
In an effort to continuously improve HCA’s policies and programs for perinatal people, HCA staff participate in national collaboratives to learn from other state’s approaches and receive technical assistance for implementing high quality care.
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Institute for Medicaid Innovation (IMI) Midwifery Led Care: Washington is one of five states exploring sustainable strategies to advance midwifery-led care models in Medicaid. Initial efforts have focused on gathering insights on how Apple Health (Medicaid) clients are currently learning about midwifery led care, and creating new messaging for Apple Health clients across HCA and our 5 managed care organizations (MCOs).
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Substance Abuse and Mental Health Services Administration (SAMHSA) Perinatal Mental Health: Washington has been selected as one of eight states to participate in the SAMHSA Perinatal Mental Health Collaborative. With the focus on identifying barriers and improving access to perinatal mental health care, Washington is eager to gather information from other states and implement practices to support the perinatal populations.
Dig into the research
Increasingly, researchers are also recognizing the importance of better understanding perinatal mental health conditions. Health Affairs, an open access health policy journal, has published two special issues on perinatal mental health in Oct 2021 and April 2024.
Health Equity
Research into perinatal mental health is a critical tool for addressing health equity. Studies from across the country highlight that people of color often do not receive equitable screening, referral, diagnosis, or treatment for perinatal mental health conditions. Most recently, researcher Sarah Haight and her colleagues looked at survey data from 4,500 postpartum people from across seven states. They found that only about half of those who reported postpartum depression symptoms received any mental health care. However, the percentage of people who received care was even lower for postpartum people of color (Haight et al., 2024).
Stories for Change
Qualitative research, or research that involves going deeper into to the stories and voices of individual people, has explored barriers to mental health care that postpartum people from historically marginalized racial and ethnic groups may experience. Researcher Esti Iturralde and her colleagues spoke with pregnant and postpartum people of color, who shared that key barriers include past trauma with medical care, as well as feelings that clinicians lacked the skills and cultural competency to establish trusting relationships and communicate, screen, and treat in different languages (Iturralde et al., 2021).
Healing-centered Approaches
Research doesn’t just reveal inequities, though; it also shows the power of collaborative, healing-centered approaches to supporting birthing people’s wellbeing. The recent Health Affairs issue highlighted several promising approaches to perinatal health equity, including building collective responsibility through upstream and multigenerational approaches (Stuebe et al., 2024), community-based asset mapping with Indigenous communities (Stiffarm et al., 2024), and culturally and linguistically specific services informed by lived experience (Lara-Cinisomo, et al., 2024).
It will take all of us to transform our perinatal mental health systems, using all the tools we have – including data and research.
Taking Action
What can you do to help spread maternal mental health awareness?
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Speak up. Share stories, information and educational resources to friends, community and have conversations with providers.
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Volunteer. Have you experienced a maternal mental health issue and would like to find out how you can support others on their journey to recovery? Visit Perinatal Support Washington’s webpage for available volunteer opportunities!
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Education is key in becoming an advocate and promoting awareness. There are many resources and opportunities to become involved, learn and educate yourself to ask for support. Learn more about relevant Events and Resources below.
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Know where to turn. Having a friend, family member or experiencing maternal mental health needs can feel scary and alone. Knowing where resources are can be literally lifesaving. Hang on to these resources to share and utilize if you or someone you care about needs support.
For perinatal people:
For providers:
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