Maternal Mental Health: Looking Back, Moving Forward, Staying Positive

Written By Mia Hemstad
 

Written by Adrienne Griffen, MPP, Executive Director of the Maternal Mental Health Leadership Alliance (MMHLA). Adrienne holds a Masters in Public Policy from Harvard’s Kennedy School of Government and has over two decades of experience working in the maternal mental health field. Her lived experience with postpartum depression fuels her work as a peer supporter, educator, and advocate.

It is our job as health care providers, public health professionals, and policy advocates to look for problems and to fix them. Most of us have a passion for helping others and an abundance of optimism, which fuels our work to make things better for mothers in our community and across our country. But, as in any profession, the day-to-day hard work can make it challenging to maintain a positive perspective.

Lately, I have been feeling a bit overwhelmed by bad news. Not only does our country continue to experience distressingly high rates of maternal mortality (with mental health being a leading cause of pregnancy-related deaths), but our federal government is also proposing to eliminate many initiatives that support the health and well-being of our nation’s pregnant and postpartum parents.

At the Maternal Mental Health Leadership Alliance (MMHLA), we are being asked day after day to uplift important programs, such as Medicaid, which provides health care for over 40% of pregnant women and more than half of children. And, we have been asking our network to support MMHLA’s advocacy work by attending Congressional meetings during Advocacy Day, sending emails to elected officials, and signing on to letters to Congress. With all the stressful news, requests, and additional work, it’s understandable that we all might be experiencing some burnout and fatigue, yet we have to find a way to stay positive so that we can keep showing up for this work.

One way I stay positive is to periodically pause and look back at the progress that we have collectively accomplished in the maternal mental health field. Over the last two decades, the field of maternal mental health has grown and flourished with a steady stream of advancements and breakthroughs that continue to move this field forward and improve outcomes for many.

If you also have been feeling overwhelmed or unmotivated, here’s a quick look at how the field has grown over the past 20 years to help you refocus on the bigger picture and remain positive in the good work you do (note: this is not meant to be an exhaustive list).

Books

The go-to book in the early 2000s for maternal mental health was This Isn’t What I Expected: Overcoming Postpartum Depression. I had to find this book. I went to my local library — no luck. I went to the nearby Barnes & Noble bookstore, and I burst into tears when the manager told me it was not in stock. I don’t recall where I finally found it, but it helped save my life (thank you, Karen Kleiman!). Today, I have several bookshelves filled with books on maternal mental health, and a recent search for “postpartum depression” in the books section of Amazon yielded an astounding 4,000 results.

Federal Legislation and Funding

Since 2018, four federal laws addressing maternal mental health have been enacted, and all were passed the first time they were introduced, which is a significant accomplishment since it takes on average seven years for a bill to become law. Although there was a small amount of funding for maternal mental health prior to these laws, the majority of federal funding (almost $90 million) has been provided in the last five years. Funding supports the National Maternal Mental Health Hotline and the Maternal Mental Health and Substance Use Disorder Program, which provides grants to 13 states.

Intensive Treatment Programs

The number of intensive treatment programs has grown from fewer than five in the early 2000s to almost 40 today (including four inpatient treatment programs and over 35 intensive outpatient programs and partial hospitalization programs). While this is not enough for all the moms who need help, we are moving in the right direction.

Medication

Twenty years ago, the general consensus was that women should not be on anti-depressant medication during pregnancy. Today, both mental health and obstetric providers agree that maintaining a woman’s mental health — including staying on medication — is absolutely necessary during the perinatal period (during pregnancy and up to one year postpartum). In addition, medications designed specifically to treat postpartum depression have come to market, giving providers additional tools to treat maternal mental health conditions.

National Maternal Mental Health Hotline

When I experienced postpartum depression almost 20 years ago, I felt trapped, isolated, and all alone as I fed my newborn baby in the middle of the night. I desperately needed to connect with someone right then and there. This is why, when I came to MMHLA in 2019, the first thing I did was advocate for federal funding for a maternal mental health hotline so that all mothers could find support anytime, anywhere.

Since Mother’s Day 2022, the National Maternal Mental Health Hotline has helped over 60,000 mothers and and their families impacted by maternal mental health conditions. In addition, the Health Resources and Services Administration (HRSA) — the federal agency that oversees the Hotline — started a communications initiative with private-sector companies to promote the Hotline; they provide free promotional materials to anyone that requests them; and they launched a national public awareness campaign.

Postpartum Support International (PSI)

I attended my first Postpartum Support International (PSI) conference in 2007. At the time, PSI only had one paid employee, state chapters did not exist, and all the volunteers could fit in one small room. Fast forward almost twenty years later, and PSI has chapters and volunteers in all 50 states, almost 150 employees, and over 1,300 people attended the most recent PSI conference.

PSI now provides extensive resources, including:

Postpartum Psychosis

In 2001, Texas mother Andrea Yates tragically drowned all five of her children while in the throes of postpartum psychosis. This was a turning point in awareness about maternal mental health conditions and recognition of postpartum psychosis as a medical emergency. Today, mainstream media publications, such as The New Yorker and The New York Times, have published well-researched, accurate, and informative long-format articles that explain and illustrate the many nuances of this condition. A recent Amazon search for books on the topic yielded 94 results, including several memoirs about survivors’ lived experiences. In addition, Postpartum Support International hosts the Postpartum Psychosis Task Force, and there is an annual Pregnancy and Postpartum Psychosis Awareness Day.

Psychiatry Access Programs

The first perinatal psychiatry access program, MCPAP for Moms, launched in 2018 in Massachusetts. Today, almost half the states have similar programs. These programs provide outreach and education to frontline providers (obstetricians, pediatricians, psychiatrists, lactation consultants, etc.), real-time psychiatric consultation, resources and referrals, and technical assistance — thereby expanding our current health care system’s capacity to address maternal mental health conditions more effectively.

State Legislation, Programs, and Organizations

Action around maternal mental health most often happens at the state level. State governments have launched task forces and commissions; they have issued proclamations and resolutions; and they have passed legislation calling for screening and education. Several states — including California, New York, Ohio, Washington, and Virginia — have statewide nonprofit organizations that provide support, education, and resources to address maternal mental health.

Telehealth

Could we ever have imagined online support groups, virtual therapy sessions, or behavioral health technology platforms? Telehealth and digital behavioral platforms enable more moms and families to get the help they need by eliminating barriers such as lack of childcare and transportation.

And a few other important initiatives…

Imagine what we can accomplish together in the next 20 years.

When I started working in this field 20 years ago, I could not have envisioned the progress we have made to date, but I knew that all the people impacted by maternal mental health — providers, policymakers, and the perinatal population — would continue to innovate and move forward.

I hope this high-level overview is a reminder that we have made so much progress. Each of us is making a difference through serving patients and clients, implementing new programs in clinics, writing legislation that calls for universal screening, and so much more. Together, we are improving the landscape of maternal mental health and saving lives.

Thank you to mental health providers and people with lived experience for sharing your wisdom and insights in books, articles, podcasts, and social media posts. Thank you to survivors of maternal mental health conditions, especially of postpartum psychosis, whose stories are shaping programs and policies. Thank you to providers and practitioners who are launching innovative programs to identify, treat, and prevent maternal mental health conditions. And thank you to advocates and policymakers who are working towards long-term solutions.

All of these developments have been made in just 20 short years, so imagine what we can accomplish together in the next 20 years! Let’s keep going.

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Mia Hemstad

Mia is a mom of 2, a trauma-informed self-care coach, a speaker, and the creator of No Longer Last, which is a group coaching experience that empowers women to value themselves, advocate for what they wand and need, and live life on their own terms.

https://miahemstad.com
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