Improving Treatment of Maternal Mental Health

1 in 5 California Moms Suffers from Pregnancy-Related Depression

Why This Work Matters

One in five California women suffers from depression, anxiety, or both while pregnant or after giving birth, negatively impacting the mother and the child. Despite this high prevalence of mental health issues, few women receive treatment. CHCF is working with partners to better understand this issue and to explore innovative, practical solutions for delivering mental health care to California’s mothers and expectant mothers in need.

Perinatal mood and anxiety disorders are the most common medical complication affecting women during pregnancy and after childbirth. They include prenatal and postpartum depression and/or anxiety, and, in extreme cases, postpartum psychosis. According to the Maternal and Infant Health Assessment (MIHA) conducted by the California Department of Public Health (CDPH), 21.2% of pregnant and postpartum women in California are affected. The prevalence is estimated to be even higher in some populations. For example, one in four African American and Latina mothers in the state reports depressive symptoms, and so do as many as half of all mothers living in poverty.

Left undetected and untreated, these conditions can lead to negative health outcomes for the mother, and can negatively affect the mother-child bond and the child’s long-term physical, emotional, and developmental health. Additionally, the financial cost of untreated maternal mental health conditions can be significant (for example, more use of emergency care services, higher rates of absenteeism at work).

Our Goal

Fortunately, these conditions are treatable, and early detection can make a significant, positive impact. CHCF is currently funding projects to better understand maternal mental health care in California and to explore ways that it can be improved. A summary of the projects that are part of CHCF’s current maternal mental health portfolio is provided below.

Background and Landscape

  • A CHCF Almanac report describes the status of maternity care in the state, including available statewide data that relates to maternal mental health. (June 2016)
  • CHCF and The California Endowment supported the convening of a statewide task force on maternal mental health in California, which produced a report with statewide recommendations. (April 2017)
  • The Listening to Mothers in California survey is an effort to collect the opinions and experiences of mothers about maternity care. Co-funded with the Yellow Chair Foundation, and conducted by a team led by the National Partnership for Women and Families, the survey is being fielded in English and Spanish. It is based on the widely cited Listening to Mothers survey that has been conducted multiple times nationally, but never before at the state level or in Spanish. (In process, with findings expected Q2 2018.)
  • CHCF is partnering with University of Southern California’s Hollywood, Health and Society to incorporate more accurate depictions of maternity care into TV programming, including stories about maternal mental health. (In process)

Delivery System Improvement

  • The Institute for Medicaid Innovation is identifying and summarizing promising approaches used by Medicaid managed care plans for addressing maternal depression and anxiety during the perinatal period (i.e. pregnancy and up to one-year post birth), with a specific focus on Medi-Cal managed care plans in California. (In process)
  • The National Committee for Quality Assurance (NCQA) is developping three clinical quality measures for perinatal depression that will be proposed for inclusion in the national Healthcare Effectiveness Data and Information Set (HEDIS). (In process)
  • Maternal Mental Health (MMH) Now implemented a pilot program to test collaborative maternal mental health care in three Los Angeles community clinics: Harbor Community Clinic, Eisner Pediatric and Family Medical Center, and Martin Luther King Outpatient Center.
  • With the Los Angeles County Health Agency and the University of Southern California, a pilot program is testing use of secure emails in electronic consultations, or “eConsults,” between reproductive psychiatrists and general psychiatrists to improve the management of pregnant and postpartum women with severe, persistent mental illness (SPMI). (In process)
  • Researchers from the University of Washington and the Advancing Integrated Mental Health Solutions (AIMS) Center, in collaboration with OCHIN and the University of Pennsylvania, are assessing the impact and cost-effectiveness of the provision of longitudinal remote consultation (LRC) provider-to-provider. The goal of LRC in this project is to support the collaborative care model of perinatal depression management in community health centers. Approximately 20 community health centers from across the country — all members of the OCHIN community health information network — will be participating in this dissemination and implementation effort. Four California sites are participating so far: ChapCare Medical Health Center, Central Neighborhood Health Foundation, Alliance Medical Center, and Open Door Community Health Center. The National Institute of Mental Health is the main funder; CHCF is supporting the California sites. (In process)

Other CHCF maternity care-related work includes a statewide effort to lower the rates of unnecessary cesarean sections.

CHCF’s maternal mental health work is part of a CHCF-wide focus on behavioral health: building integration essentials (data transparency and data sharing, new financing models, and policy solutions) and supporting care transformation, including complex care integration and integration initiatives in the Medi-Cal program. CHCF is also participating in a statewide effort to address the opioid epidemic, a component of which focuses on increasing access to integrated addiction treatment.

Learn More

For more information, contact CHCF’s Stephanie Teleki.