On May 14, the federal government issued a groundbreaking and comprehensive national strategy to address the prevalence and magnitude of the maternal mental health care crisis in the United States, the National Strategy to Improve Maternal Mental Health Care.
Key Goals
The National Strategy focuses on (see pages 2 and 16 of the report):
- Building a national infrastructure that prioritizes maternal mental health.
- Providing integrated and better coordinated services that are accessible, affordable, and equitable.
- Using data and research to improve maternal mental health outcomes.
- Improving health promotion and prevention strategies through community partnerships.
- Listening to the voices of people with lived experience and building trust.
The National Strategy also features several policy recommendations and regulatory changes, including enhancing and increasing funding for federal programs serving the perinatal population. The task force called for the federal government to increase funding for and include mandatory training around perinatal mental health care in federal workforce programs, such as the Minority Fellowship Program. According to the report, public and private health insurance systems should extend health insurance coverage for pregnancy care for up to 1 year postpartum.
The report also calls for specific considerations to achieve key goals including better education about screening for maternal mental health conditions and SUDs, and developing clear pathways to connect individuals with services that are holistic, trauma-informed, patient-centered, and culturally relevant.
Further information can be found in a companion report that was sent to Congress.
Resources for Counselors
The Task Force reports call for mental health providers to routinely screen for maternal mental health conditions, and use validated screening tools that measure and detect depression, anxiety, or thoughts of self-harm among pregnant and postpartum individuals, such as:
- The Perceived Prenatal Maternal Stress Scale -- or PPNMSS scale. https://pubmed.ncbi.nlm.nih.gov/31552850/
- The Perinatal Anxiety Screening Scale (PASS). https://postpartumhealthalliance.org/resources/screening/pass-assessment/
- The Edinburgh Postnatal Depression Scale. https://www.samhsa.gov/resource/dbhis/edinburgh-postnatal-depression-scale
- The Patient Health Questionnaire-9.
- The Task Force also identified selected validated screening tools for SUDs for pregnant and post-partum individuals:
- TWEAK Instrument (which stands for “tolerance, worried, eye-opener, amnesia, cut down”). https://oasas.ny.gov/system/files/documents/2019/11/tweak-pregnantwomen.pdf
- The 4P’s Plus (the four P’s are “parents,” “partners,” “past,” and “pregnancy”) Screening Instrument. https://www.ntiupstream.com/4psabout
- The Substance Use Risk Profile-Pregnancy (SURP-P) Scale. https://ilpqc.org/wp-content/docs/toolkits/MNO-OB/Substance-Use-Risk-Profile-Pregnancy-Scale.pdf
- T-ACE (which stands for “tolerance, annoyance, cut down, eye-opener”) Four-item Screening Tool. https://projectteachny.org/app/uploads/2022/07/T-ACE_alcohol_screen.pdf
For more information on the screening tools referenced in the reports, please visit the Policy Center for Maternal Mental Health.
The Task Force members highlighted Cognitive Behavioral Therapy (CBT) as an incredibly important evidence-based treatment to address maternal mental health conditions, such as depression. Interpersonal Therapy (IPT) was another evidence-based intervention identified for treating perinatal depression. According to the report, Dialectical Behavior Therapy (DBT) is an evidence-based therapy that addresses self-harm, suicidality, and substance use, and should be used during the peripartum period as needed.
Next Steps for the Task Force
The Task Force on Maternal Health is in the process of developing a report to all state governors that will describe opportunities for local- and state-level partnerships to address maternal mental health issues. NBCC will report on the release of those recommendations to the governors and identify opportunities for NCCs to participate in local community programs to address maternal mental health issues.
