“I had a pregnant patient who was homeless for a while and beginning to hear voices,” says Leizl Sapico, M.D. “She wanted to be under the care of a psychiatrist so she could better care for her child.”
Sapico, an OB-GYN at Franciscan Women’s Health Associates in Tacoma, didn’t know how best to help her patient, so she called UW Medicine’s Perinatal Psychiatry Consultation Line. A psychiatrist gave Sapico advice on medication and helped locate a clinic where her patient could get counseling and other help.
“Mental health disorders are very common during the perinatal period, the time from conception until one year after the baby’s birth,” says Amritha Bhat, MBBS, M.D., MPH, UW assistant professor in the Department of Psychiatry and Behavioral Sciences. “One in seven women battles depression during this time. But only 20 percent of the women who need help get the help they need.”
When Moms Need Help
Bhat has a few ideas on why so few women seek the help they need. Some are worried about being judged as a bad mother. Some think their feelings of exhaustion and disengagement are normal. There’s also a great deal of stigma around mental health.
Even when mothers do ask for help, the help may not be there; there’s a shortage of psychiatrists, especially in rural areas. Often, it’s left to a woman’s primary-care doctor or OB-GYN to field questions about mental health. That’s why the Perinatal Psychiatry Consultation Line was established.
Bhat, along with colleagues Deborah Cowley, M.D., and Carmen Croicu, M.D., provides consultations via the line, five days a week for two hours each day. The service, free to any healthcare provider in Washington state, takes calls from primary-care doctors, OB-GYNs, nurses, psychiatrists, nurse practitioners, social workers, counselors, midwives and pediatricians. They answer questions about diagnoses, medication safety during pregnancy and breastfeeding, and counseling. Thanks to state funding, the psychiatrists are looking forward to expanding the consultation line’s hours in January 2019.
“In an ideal world,” Bhat says, “I would hope that every mom who is struggling with emotional difficulty — not only those with a diagnosed mental health disorder — would get the support that she needs. That would be great, wouldn’t it?”
Moving Care Upstream
The Perinatal Psychiatry Consultation Line is just one part of a broader initiative for the UW Department of Psychiatry and Behavioral Sciences: diagnosing and providing effective behavioral health care as early as possible. The department’s shorthand for this effort is called moving mental health care upstream.
In Washington, approximately 10,000 women each year — specifically, women who are either experiencing or at high risk for mental health challenges or substance use — give birth. When it comes to pregnant women and new mothers, the need for moving care upstream is becoming increasingly clear. A mother’s mental health is deeply intertwined with that of her child.
“We know that the brains of babies who are born to depressed moms are wired differently,” says Bhat. “These babies are also at risk for being born prematurely and with a low birth weight. And after birth, there may be problems with attachment and bonding.”
“Caring for a pregnant or new mom with mental health or addiction problems is the closest we can come to immunizing a child against mental health and addiction problems downstream,” says Jürgen Unützer, M.D., MPH, M.A., UW professor and chair of the Department of Psychiatry and Behavioral Sciences.
Becca Graves, director of strategic investments at the Perigee Fund, emphasizes the importance of this initiative. The fund, dedicated to the healthy social and emotional development of babies and toddlers, made a gift to support the development of a statewide perinatal mental health resource. This resource will connect diverse providers with the UW Medicine network, providing more options for maternal support within Washington state.
“The bonds that babies form with their parents are essential to their brain development, well-being and future success. If we want to promote that bond, we also have to be mindful of the mothers’ and the parents’ well-being,” says Graves. “We need to make sure that supports for young parents are widely available prenatally and during the earliest months, so that parents can build the nurturing, responsive relationships critical to a baby’s development.”
What motivates psychiatry faculty like Bhat and contributors like Perigee is the realization that adequate
resources — resources like UW Medicine’s Perinatal Psychiatry Consultation Line — are key to keeping mothers healthy and well.
Sapico is proof of that. “This program is a tremendous help to me, and it’s a lifeline for my patients,” she says.
Perinatal Psychiatry Consultation Line
For healthcare staff in Washington state
Monday to Friday, 3 to 5 p.m.
(Extended hours expected starting January 2019)