Tag: severe depression

The Inexpensive Way to Lift New Moms Out of Postpartum Depression

Posted on by robbie

Judy’s first pregnancy was planned, and she was looking forward to having a baby. Yet, halfway through the pregnancy, something changed. She began to feel down and bad about herself. She had less energy and struggled to concentrate. Thinking this was a normal part of pregnancy, she ignored it.
After she delivered her son, it all got worse. She felt as if she was in a black hole of sadness. She often gave her son to her mother, thinking he was better off without her. It wasn’t until a year and a half later, when she came out of the depression on her own, that she realized that she had not been herself.
Judy is a composite figure, based on the thousands of women for whom we have cared for or met during our clinical work and research. Her story demonstrates the profound impact that depression can have on mothers and their children.
Having a baby can be extraordinarily challenging. Women are extremely vulnerable to emotional changes during pregnancy and the year after delivery. In fact, depression is the most common complication of pregnancy. But women often have absolutely no idea they have depression, nor do anyone in their circle of influence, including their medical providers.
We believe there’s a missed opportunity to address depression in obstetric and pediatric settings: settings in which women are seen often during pregnancy and the year after birth. Women like Judy often drown in their illness, without anyone ever speaking to them about the possibility of depression. How and why does the health care system let this happen?

THE COSTS OF UNTREATED DEPRESSION

One in seven women experience depression during pregnancy and after birth. Depression negatively impacts mothers, children and families. It can affect birth outcomes, the way moms bond with their baby and children’s mental health later in life.
When untreated, depression can also lead to tragic outcomes, including suicide or infanticide. In fact, suicide is the leading cause of death among postpartum women with depression.
This illness is also costly. One case of untreated depression is estimated to cost over $22,000 annually per mother and baby pair.
Despite being a common illness with profound negative effects, most depression among pregnant and postpartum women goes unrecognized and untreated. Of the 4 million women who give birth in the U.S. every year, about 14 percent will experience depression. At least 80 percent will not generally get treatment.
There’s historically been no system in place to detect depression or help women get care. But professional societies and policymakers are starting to recommend screenings, while medical practices are beginning to integrate depression into obstetric and pediatric care.
This is a great first step. However, screening is not enough. After screening, the health system must ensure women get appropriately diagnosed and treated. Unfortunately, many providers aren’t trained or equipped with the proper resources to help women with depression, or may be reluctant to do so.

HELPING PROVIDERS HELP MOMS

In response to this need, our team is working on integrating depression into obstetric care in our state.
Our Massachusetts Child Psychiatry Access Program for Moms, launched in July 2014, helps frontline medical providers screen for and treat depression and other mental health concerns among pregnant and postpartum women.
MCPAP for Moms provides training and toolkits for providers, as well as telephone and face-to-face psychiatric consultation. For example, Judy’s obstetric provider could call MCPAP for Moms and talk to a psychiatrist to get guidance on how to treat, and with consultation, decide on a treatment plan that would include therapy. MCPAP for Moms also offers resources directly to women with ongoing mental health care.
Every provider in Massachusetts can access our services free of charge. MCPAP for Moms is funded through the MA Department of Mental Health. It also offers access to mental health care to pregnant and postpartum women in Massachusetts for less than $1 per month per woman. We are now evaluating how the program has affected outcomes for the more than 4,000 patients directly served since launch.
The ConversationTwo other states, Washington and Wisconsin, are starting programs like MCPAP for Moms, and 17 others are seeking funding. Especially exciting, next year’s federal budget includes grant money for other states to establish such programs. We envision a health care system where all providers caring for pregnant and postpartum women are armed with the resources they need to support women with depression.

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Tiffany Moore Simas is an associate professor of obstetrics-gynecology and pediatrics, and Nancy Byatt is an associate professor of psychiatry and obstetrics-gynecology, both at the University of Massachusetts Medical School. This article was originally published on The Conversation. 

This Common Sense Program Could Be the Future of Mental Health Care Nationwide

Posted on by robbie

What would you do if your teenage son or daughter began expressing paranoid thoughts? Jumbling their sentences? Exhibiting bizarre behavior? Few parents know the warning signs of psychosis, but one joint effort in Connecticut is aiming to change that.
The state’s Department of Mental Health & Addiction Services and Yale University are pioneering MindMap, an outreach program designed to catch the early signs of a young person experiencing a psychotic episode, lessening the chance of self-harm or endangerment to others.
Mindmap’s creation is the result of university psychiatrists discovering that patients who received early treatment at community clinics reduced their risks of future psychotic breaks. Their findings also show that those who get help early on remain employed or in school 92 percent of time, compared to just 67 percent when receiving standard treatment. Even better? Three out of four avoided hospitalizations in the first year (as opposed to half), saving taxpayer dollars.
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Patients receiving treatment at Yale’s Specialized Treatment Early in Psychosis (STEP) clinic are set up with a team of caseworkers, which coordinates medication, counseling and social skills training for the patient and education for their family, whose guilt or frustration at the disease can often exacerbate symptoms. (The lack of vital long-term care has been identified as the reason why our mental health system has largely failed after state-run institutions shuttered in the 1960s.)
“Traditionally, people show up to psychiatric care after many years of suffering and poor functioning. Maybe they got psychiatrically committed in a hospital against their will, maybe they were picked up by the police or became homeless,” says STEP clinical director Jessica Pollard. “We try to catch people as soon as they have noticeable symptoms, whether it is full-blown and diagnosable psychosis or signs of something to come.”
Hallucinations, delusions, disorganized speech or excessive motor activity can be caused by, say, stress or substance abuse, but they can also be symptoms of schizophrenia, bipolar disorder or severe depression. And while diagnoses have improved, mental health centers still struggle with the stigmas associated with psychosis.
“People don’t tend to show up on their own for care,” Pollard says. “They’re really embarrassed. They don’t want anyone to know.”
As many as one in every 29 people will experience some form of psychosis — generally defined as losing contact with reality — within their lifetime, according to one study. Psychiatrists know that most people have their first psychotic episode in their late teens or early twenties and reaching people at this early age is key, Yale’s psychiatrists say. It’s when the risk of relapse into psychotic episodes is highest and when two-thirds of suicides triggered by the disease occur.
“The model is a pragmatic, effective and economically feasible,” Vinod Srihari, professor of psychiatry at Yale School of Medicine, says in a statement. “The message is simple,” he adds. “The earlier, the better.”
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