Postpartum Depression Plan a Good Start, but More Needed

In Texas, one out of seven mothers experiences postpartum depression, and maternal mental health challenges can affect their child’s development. 

The Texas Health and Human Services Commission has released its Draft 5-Year Postpartum Depression Strategic Plan, which was required by the Legislature when it passed HB 253 in 2019.

Texans Care for Children, a nonprofit, nonpartisan, multi-issue children’s policy organization, was pleased with the draft, as it includes a number of the recommendations it provided to HHSC after the nonprofit conducted a survey and other research on maternal mental health. 

The recommendations include adding mental health counseling as a covered benefit in the Healthy Texas Women’s postpartum package; leveraging formal and informal peer support to help more moms; establishing a referral network of community-based mental health providers, including certified mental health peer specialists, community health workers, and group prenatal care. 

The nonprofit also recommends increasing awareness of maternal mental health challenges by training more professionals serving moms and families and extending Medicaid coverage for a full year after birth, instead of the current 60 days. 

Overall, TCC believes the plan is a good start but sees more work ahead.

This set of issues should not be ignored at this time, said Adriana Kohler, policy director for Texans Care for Children.

“Given everything that families are dealing with right now, it’s more important than ever that our state health policies support moms and the infants and toddlers who rely on them. Many moms are losing jobs, health insurance, child care, and ways to connect with the friends and family who normally help them when they’re feeling overwhelmed. This is a critical time for state leaders to support moms’ mental health by extending their Medicaid health insurance to cover a full year after childbirth and implementing other smart policies,” she said in a statement Monday.

TCCC’s press release in response to the HHSC draft states the greatest challenge women face is the inability to afford mental health services after birth because of a lack of insurance. Last year, the Texas House passed HB 744 for this very issue, although it fell short in the Senate.

TCC suggests that along with increasing Medicaid rates to cover the costs of peer specialists, the plan needs to encourage more health settings to aid mental health needs, especially in settings where moms already go for their or their baby’s care, women’s health practices, and pediatric practices.

Along with these mental health screenings done at 1, 2, 4, and 6-month well-baby visits and promoting maternal mental health screenings in NICU settings and reimbursing facilities for these screenings under a baby’s  CHIP insurance or Medicaid.

“Postpartum depression has a huge impact on our community. Though it is more common than almost any other mental illness as well as any medical complications from pregnancy, it remains relatively underdiagnosed. Mothers are suffering, as are their communities and their children,” said Dr. Jessica Rohr, assistant professor of psychiatry and behavioral sciences at Baylor College of Medicine and Dr. Elisabeth Netherton, assistant professor of psychiatry and behavioral sciences at Baylor. Both are experts in maternal mental health.

 “We know that postpartum depression impacts a mother’s quality of life, risk for suicide, and ability to engage in important roles,” they said in joint statement Monday. 

“It also impacts her ability to bond with her child, create important attachment relationships, and can lead to emotional concerns in children later in life,” Rohr and Netherton said. “There is a stigma attached to the experience of postpartum depression that reduces our ability to accurately screen, diagnose, and treat issues when they come up. A lack of mental health providers limits medical providers’ ability to make appropriate referrals. A plan that includes proper education, increasing awareness, reducing stigma, identifying and streamlining referrals is critical for finding ways of decreasing the incredible impact this issue has on our mothers, families, and our communities.”

Also, TCC referred to its survey results which showed the need for formal, informal and home visiting options for mental health care postpartum, and urges the HHSC to expand the Child Psychiatry Access Network, which is implemented in 14 other states, to include perinatal psychiatric access. 

As some pediatric and women’s health facilities can struggle to locate a mental health professional, TCC suggests creating a network as a referral tool in the coming years.