Perinatal mental health conditions are the leading cause of maternal mortality or pregnancy-related death in the United States. Yet, mental health conditions in pregnancy and the year following childbirth are often undetected and under- or untreated. Two UMass Chan Medical School researchers have spearheaded creation of new resources to help obstetric care clinicians identify and care for patients with mental health conditions.
Tiffany Moore Simas, MD, MPH, MEd, the Donna M. and Robert J. Manning Chair in Obstetrics and Gynecology and chair and professor of obstetrics & gynecology, led the charge on two clinical practice guidelines published May 18 by the American College of Obstetricians and Gynecologists (ACOG), with contributions from Nancy Byatt, DO, MS, MBA, professor of psychiatry, obstetrics & gynecology, and population & quantitative health sciences.
The guidelines augment resources in which Drs. Moore Simas and Byatt have played major roles in developing, including the Alliance For Innovation on Maternal Health’s (AIM) Perinatal Mental Health Conditions Patient Safety Bundle, released in February; UMass Chan’s Lifeline for Moms Center’s Perinatal Mental Health Tool Kit, e-modules, and implementation guide for integration of obstetric and mental health care; and state-based and national Perinatal Psychiatry Access Programs.
“The clinical practice guidelines and patient safety bundle basically changed the standard of care for obstetricians addressing perinatal mental health,” said Moore Simas. “They’re much more robust as it relates to when to screen, how to screen, what to screen for and makes it very clear that it is within our OB-GYN standard of care to be addressing perinatal mental health, which is a big change.”
Moore Simas said that the new guidelines and patient safety bundle were prompted by focus groups convened by ACOG, which reported clinicians were uncomfortable addressing perinatal mental health because they hadn’t been trained in it.
According to Byatt, a menu of resources has evolved from work done at UMass Chan that provides the “how to” implementation tools for “what” clinicians should do.
Byatt explained that on top of the clinical guidelines, the tools include online training videos, developed with funding from the National Institute of Mental Health, which provide guidelines for screening, assessment, treatment and follow-up; a toolkit with specific directions that accompanies the training, developed with funding from the Centers for Disease Control and Prevention; and an implementation protocol to guide obstetrics practices on integrating these things into their practice workflow—for example, at what point to screen for depression, who performs it, who responds, and what to do if a screen comes up positive.
Byatt and Moore Simas are also working with the Institute for Healthcare Improvement (IHI) on a soon-to-be released “change package,” which will include these resources to support perinatal mental health.
The new tools for clinicians build on experience and knowledge developed at UMass Chan dating back a decade to development of the statewide Massachusetts Child Psychiatric Access Program (MCPAP). Byatt developed the statewide program based on MCPAP, called MCPAP for Moms, which has increased access to mental health care for thousands of perinatal individuals, become a national model for perinatal mental health care, and impacted state and national policies and funding.
“So, along with these other tools, providers can call us, and we can help them manage the patients themselves,” said Byatt. “Because, unfortunately, it’s so hard to access psychiatrists. For example, for individuals with public health insurance, it can take probably three to six months to get an appointment with a psychiatrist.”
The resources shaped by Moore Simas and Byatt are being disseminated through ACOG and its partners, reaching 70,000 to 80,000 obstetricians across the United States.
