In an effort to connect women with sensitive mental health care during the weeks before and after pregnancy, the state health department and a collaborative virtual psychiatry practice partner to provide consultation to clinicians around the world. state.
For the past three months, the groups have been piloting a project called PRISM, which stands for Psychiatric Referrals, Intervention, and Support in Montana. The program consists of a phone line or free consultation website where doctors treating a woman during the perinatal period can call for psychiatric teleconsultation services from Frontier Psychiatry, a virtual practice based in Billings.
Montana lacks mental and behavioral health providers. All but one of the state’s counties are designed to not have enough mental health professionals, said Mary LeMieux, who works in the State Department of Health’s Office of Health Services.
This lack of health care that overlapped with increasing needs for mental health services during and after pregnancy affected the Department of Public Health and Human Services.
“Obviously there was a need for behavioral health to get into those powerful corners of rural border counties,” LeMieux said earlier this month. Citing data from the Federal Health Resources and Services Administration, LeMieux said nearly 20% of Montana women report depression before pregnancy, nearly double the national rate.
“When she was presented with this information about how many women are depressed in Montana, it became clear to the department that we needed to do something if we could,” LeMieux said.
The state project is funded with a five-year federal grant and the cost to support the line through 2023 is $ 490,000.
The pilot included maternity and women’s health FamilyBorn at Kalispell Regional Healthcare; Sisters of Charity of Leavenworth Health (SLC) – Billings Midwifery & Women Health; SCL Health Medical Group in Butte; SCL Health – Butte OB-GYN; and Holy Rosary OB-GYN in Miles City.
Dr. Eric Arzubi, CEO of Frontier Psychiatry, said psychiatrists are trained to think in three areas of need: psychological, social, and biological. These three factors can face additional stress during pregnancy.
This includes aspects such as the concern to relate to a first child or how a sibling fits into the family. There is also stress about the cost of joining a family and finding care for a baby. And women’s bodies and hormones change drastically during and after pregnancy. Pouring out the lack of sleep that a newborn brings makes things even harder.
“There are stressors in all three dimensions that make it a difficult time,” Arzubi told the Montana State News Bureau. “If a woman is vulnerable because of genetics, a family history or has had depression problems before, this time during pregnancy puts women at a particularly high risk of relapse or having a first episode.”
Christie Weseman, a certified midwife at FamilyBorn Maternity and Women Health in Kalispell, said she sees many perinatal mood disorders in her practice.
“When we have someone coming in the door for the first time who has something that is clearly a much more complicated case, we know we need psychiatric care for that person who is out of the reach of our practice,” Weseman said. . “What’s really hard is that it often takes months to get that person the right care.”
The new helpline, Weseman said, addresses this problem.
“It’s amazing for us to call someone, to get someone who specializes in perinatal mood disorders to really help these women,” Weseman said.
While things have improved in recent months, Weseman said the pandemic made things even harder due to increased isolation, which led to a lack of connection to social support networks.
Over the past few months, Weseman has used the service a handful of times when someone walks into his office with risk factors or a history of symptoms that require superior psychiatric care.
“What I did was get his story, and then I went ahead and called that line and here I was able to talk to Arzubi,” Weseman said. “We are able to review what I see and get their clinical experience and help to manage and talk about medications and talk about a care and follow-up plan. It’s been really nice to be able to walk around with someone who specializes in that. “
Being able to access services through telehealth can also address stigma issues around mental health care. There are also additional layers of expectations about pregnant women and mothers, Weseman said.
“It’s not necessarily rosy, easy and romantic. It can be really a challenge, “Weseman said.” I think I see people starting to be a little more honest about their experiences, which I think is incredibly important. “
At a pilot site, a provider called a patient who appeared to be in a manic episode. Arzubi said her consultation was able to work with the doctor to identify what was going on, what treatments had worked or not for the patient before and what approaches were safe during pregnancy.
Together, they implemented a medication plan. If the consultation had not been available, the other option would have been to send a referral to a local provider and wait weeks.
“With the collaboration we were able to address it quickly,” Arzubi said.
A mental health problem is a family problem, not just a mother’s, Arzubi said. Being able to approach and treat women in advance can help address other issues along the way.
“This has a very real and lasting impact. We can’t treat people who are part of a family system like little silos, “said Arzubi. “If the mother is fighting, the children are more likely to fight and the whole family system is fighting. There is research that shows that when you intervene earlier, especially with expectant mothers, they are less likely to expose children to stressful problems. “