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National rates of maternal mortality have steadily increased over the last decade, particularly those related to mental health and substance use, indicating a critical need for national, state, and local efforts to improve both physical and behavioral health outcomes for pregnant and postpartum women. Perinatal mood, anxiety, and substance use disorders are among the most common complications of pregnancy and are preventable causes of maternal, fetal, and infant morbidity and mortality. Indeed, one in seven women in the U.S. suffer from a maternal mental health complication.
Women see a frontline healthcare provider (obstetrics, pediatrics, or primary care provider) 20 to 25 times during a routine pregnancy and during the first year of their baby's life, providing ample opportunity for these providers to discuss and screen for maternal mental health conditions. These frontline healthcare providers, however, do not always have the training, knowledge, or resources to address these conditions confidently and safely.
This challenge is magnified by the limited number of psychiatric specialists to provide care for these women. To address this challenge with increased clinical demand and limited access to mental health specialists, state and agency-funded perinatal telephonic access programs have emerged across the country as successful and scalable models of care. Currently there are a total of 21 programs in the United States.
In 2019, the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services funded programs in Florida, Kansas, Louisiana, Montana, North Carolina, Rhode Island, and Vermont.
The Arizona Perinatal Psychiatry Access Line is funded by the Arizona Cost Containment System and is the only resource of its kind in the state. The need in this state is great, as the rural, medically underserved areas are vast. Annually, approximately 70 women die during or within 365 days after pregnancy in Arizona, of which 15 to 20 deaths are pregnancy-related cases. This means these women would not have died if they had not been pregnant. At least 15,000 women per year in Arizona suffer from Perinatal Mood and Anxiety Disorders (PMAD) and up to 12,000 of those women are not diagnosed or treated despite PMADs being the #1 complication of pregnancy and childbirth.
AZ's Medically Underserved Areas, from the AZ Department of Health Services.
AZDHS
In Arizona, the numerous barriers to accessing high-quality and immediately responsive perinatal mental health services include:
- Provider pipeline
- Provider training
- Limited access to higher levels of treatment
- Reimbursement for consultation services, as many private practice psychiatrists do not participate with AHCCCS
- Geography and large swaths of medically underserved areas
APAL addresses these challenges by offering equitable access across the state, including to providers caring for residents living in border communities and tribal nations.
APAL also provides education through in-person and online trainings, along with clinical toolkits (that include clinical screeners, algorithmic guidance of care, community resources specific for different counties and communities) for providers and staff. These evidence-based guidelines are for screening, triage, and referral, guidance on risks and benefits of treatment, and discussion of screening results and treatment options for perinatal psychiatric disorders.
Last, but certainly not least, APAL is collecting data on trends of perinatal mental illness in the state in order to inform state and federal healthcare systems on best models of care delivery. The lack of data on maternal mental health is shocking and shameful and we are working to shift that paradigm.