Boston Doctors Support Bill To Broaden Access To Perinatal Disorder Care

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BOSTON (State House News Service) — For Dr. Rose Molina, an obstetrician-gynecologist at The Dimock Center, the hardest part of her job is telling patients -- who are predominantly Spanish-speaking and identify as Black or brown -- that they cannot access treatment for perinatal or mental health challenges for several months.

Wait lists are "so long," especially to see the "very few" behavioral health clinicians who can provide services in Spanish, Molina told lawmakers as she advocated in support of the so-called Moms Matter Act. The proposals from Rep. Brandy Fluker Oakley and Sen. Liz Miranda (H 1984 / S 1261) aim to grow and diversify the state's perinatal mental health workforce, including by launching a grant program to support training and education initiatives for providers who specialize in postpartum depression and psychosis, among other perinatal mood and anxiety disorders.

While Molina is trained to screen and identify people who would benefit from therapy, she cannot provide that counseling. There needs to be more capacity in the perinatal mental health workforce to manage the volume of physician referrals, Molina told the Joint Committee on Mental Health, Substance Use and Recovery during a hearing Monday afternoon.

"I would like you all to focus on the importance of expanding our perinatal mental health workforce, and we need particular attention to racial, ethnic, cultural, social and linguistic diversity of the workforce so that we can better meet our patients where they are," Molina, an assistant professor at Harvard Medical School, told lawmakers. "Not a day goes by when I'm in clinic and don't actively need to address mental health concerns for patients who are navigating pregnancy and their transition to parenthood."

Grants provided through the legislation would be prioritized for recruiting and retaining students and faculty from underserved populations or perinatal health care deserts, defined as regions where people have "inadequate access" to care. Schools and programs would need to incorporate training on implicit bias and racism into their curriculum, according to the bills.

The bills also carve out a separate category of grants for community-based organizations that support perinatal individuals and families.

At least 20 percent of mothers and birthing people experience perinatal mood and anxiety disorders (PMADs), but cases are widely undiagnosed and untreated, said Miranda, who co-chairs the Ellen Story Commission on Postpartum Depression with Fluker Oakley.

Miranda said Black and Latino parents, as well parents who are low-income or live in rural areas, are more likely to experience PMADs but are "less likely to receive the necessary care they deserve."

Describing herself as a "resourced" person, Miranda said it's still been difficult to help family members experiencing PMADs and lamented that most Bay Staters live in maternal health care deserts.

"In areas with poor maternal health outcomes or that face higher rates of racial and ethnic disparities in those outcomes -- including that Black and brown women die in the Commonwealth of Massachusetts two times the rate of white women -- I would just like to end by sharing that untreated depression can result in poor adherence to health care, exacerbation of previous physical conditions, substance abuse and suicide, and other adverse outcomes, which impact families for the rest of their lives."

Four out five pregnancy-related deaths in the United States are preventable, Fluker Oakley said as she cited data from the Centers for Disease Control and Prevention. PMADs can be treated with medication, therapy, peer support and other social suppports, Fluker Oakley said.

"But the number of perinatal individuals needing support far exceeds the amount of qualified providers and community resources available," Fluker Oakley said at the hearing. "We must act swiftly to put these supports in place for Massachusetts families. Literally I know everyone says this often about their legislation, but lives truly are at stake."

Amanda Hollis recounted to lawmakers how symptoms of her disorder began immediately after the birth of her first child. Hollis said she would lie awake at night unable to sleep for hours despite feeling exhausted, for example, and she also had "out-of-body explosions" of rage over "trivial issues."

Still, she said it took four "dark" months to identify something was wrong, forging a traumatic experience that Hollis said almost caused her not to have the second child she "desperately" wanted. As a first-time parent, Hollis said she missed signs about her condition and struggled to determine what was abnormal behavior.

The bills would raise awareness of PMADs for families, said Hollis, a member of the Mind the Gap Coalition, which is part of a broader initiative from Postpartum Support International to bolster maternal health.

"This legislation would expand capacity for meaningful intervention. I so wish someone had intervened with me," said Hollis, who credited her eventual recovery to a specialized therapist who made home visits. "I felt so alone."

Written By Alison Kuznitz/SHNS

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