Oct. 10, 2023

Maternal Mental Health

Maternal Mental Health

Maternal mental health issues impact at least one in five of those pregnant or postpartum. This week, Adrienne Griffin, Executive Director of the Maternal Mental Health Leadership Alliance, discusses misconceptions about maternal mental health and...

Maternal mental health issues impact at least one in five of those pregnant or postpartum. This week, Adrienne Griffen, Executive Director of the Maternal Mental Health Leadership Alliance, discusses misconceptions about maternal mental health and resources available to pregnant and postpartum people. She also tells us what the Alliance is doing to transform the maternal mental health landscape. 

Plus, Dr. Bob breaks down a significant win for patients with copay accumulator policies.


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Adrienne Griffin  0:00  
It is incredibly important to me I experienced significant postpartum issues when my son was born, he is now 21. We all survived, but it really rocked my world. And, you know, I consider myself you know, I'm pretty well educated, I have every resource available to me, I have a husband, I speak English at the Internet, I insurance, all of that. And it took me about six months to get the help that I needed. And so during that dark period in my life, I decided I needed to do something about this and changed my career and you know, came into this work.

Bob Goldberg  0:32  
This week on the patient's rising podcast, the maternal mental health leadership alliance, is working to help all of us understand the subject a little bit better. Adrienne  Griffin with the Alliance tells us her personal story, and how the MM HLA is working to make policy changes as well. Welcome to the patient's rising podcasts. I'm Bob Goldberg, and today for your normal host, and she is much more normal than I am. Terry Wilcox, CEO of patients rising. And I must say today's interview is applicable to me, as a father and as a grandfather, you and pretty much everyone else out there, because it's all about motherhood and pregnancy. If you're listening to the show, you're either a mother, have a mother, no mother, or will be a mother one day. So no matter your situation, you're going to want to hear this. Now Adrienne  Griffin is the executive director of the maternal mental health leadership alliance, also known as the Alliance. So the first question we asked was, What exactly is maternal mental health.

Adrienne Griffin  1:45  
So maternal mental health, we refer to the period of time during pregnancy, and through the first year following pregnancy. So some people call it the perinatal timeframe, but it's basically a two year timeframe. And we really use that terminology because we want to move past postpartum depression. We know so much more about these illnesses. Postpartum depression has long been used as an umbrella term to refer to mental health challenges that women face typically following pregnancy. But we know that these mental health issues often start during pregnancy. In fact, there was a study that was done several years ago that show basically, of people who experience postpartum mental health challenges, about a third of them actually enter pregnancy with these underlying conditions. Another third, develop symptoms during pregnancy. And then that final third, develop the symptoms in the postpartum period.

Bob Goldberg  2:39  
Now, for so long, we've heard about postpartum depression. But Griffin says maternal mental health is so much more. Because women who are pregnant can experience so much more than just depression.

Adrienne Griffin  2:53  
It's not just depression. In fact, we know so many more people experiencing anxiety then depression. And so again, that postpartum depression was sort of an old term and people, a lot of people still use it. But we're trying to expand it with a, you know, it's not just postpartum it can actually start during pregnancy. And it's not just depression. It's his full range of illnesses, including anxiety, obsessive compulsive disorder, post traumatic stress disorder, and in very rare cases of psychosis. Now I can

Bob Goldberg  3:21  
Just, again, speaking as a husband and a father and a grandfather, and also having in my daughter's therapy specializes in not just postpartum depression, but in women that have just given birth and dealing with all the other related issues. That pregnancy is something that we focus on to the exclusion of what happens after and the postpartum period, the result of COVID and changes in our society is a part of the journey of being a mother and being a parent that often gets ignored in the excitement and in the fact that you're turning a new page and becoming responsible for another life. So Adrienne  also says some people are caught off guard, because of how pregnancy before, during and after is most often portrayed. And when not everything is picture perfect. It can be a big adjustment.

Adrienne Griffin  4:32  
Our society makes it seem like pregnancy is just this beautiful experience. I mean, you look at the pictures whenever I do presentations, I take all these pictures off the internet and like all of these pictures are beautiful. The mother looks happy the baby is sleeping. The house is clean are these beautiful tones. Those first few weeks and months in particular after the baby comes home. Nobody is sleeping, right. I mean, you're caring for this person. In that you've never met, and now you're expected to keep this person alive. And they can't tell you what's wrong, they can't tell you if they're hungry or tired or cold. And so there's just this huge adjustment. And oftentimes, we do this without support from our family of origin.

Bob Goldberg  5:18  
So that doesn't mean pregnancy isn't amazing. For many people, it's just that it's different for everyone.

Adrienne Griffin  5:24  
Some people really love being pregnant, some people hate it, some people have their babies born, and they have this instant love and connection with the baby. And with motherhood, or fatherhood. And other people, it can be really challenging. And so I don't want to make it sound like you know, everybody has a horrible experience. But there are some people we know, mental health issues impact at least one in five pregnant or postpartum people, and one in three, and in certain higher risk communities. We know that women of color, women who live in low economic situations are at increased risk for experiencing these illnesses. And there are other certain subgroups, like immigrant women, military mothers, parents who have a baby in the NICU, you know, they're at increased risk for experiencing anxiety, in particular, during this timeframe.

Bob Goldberg  6:16  
So I mean, a lot of respects, just like with weddings or romances, the media portrays pregnancy with a sort of aura of uniqueness and beauty and completeness. And just because life is messy, and complex, that's not always the case. And feeling that you have to rise to the standard, you know, can be wearing on your mental health, especially in a time when everyone posts only the good stuff, only the beautiful, only the staged on social media. So we asked what work is the Alliance doing to help with these issues? And here's Adrian answering that question.

Adrienne Griffin  7:05  
You know, we have successfully advocated for federal funding for two important programs. The first is the national maternal mental health hotline, which launched on Mother's Day in 2022. And this was run through the Health Resources and Services Administration. So it's run through a government agency. And it has a 24/7 voice and text hotline, where people can get in touch anytime, day or night, because we know often new parents are up in the middle of the night, you know, feeding the baby walking the baby, whatever scrolling on their phone, and I remember being there thinking, I cannot do this, I need to talk to somebody now. And so we now have this great resource available to all moms, dads, grandparents, anybody who's really, you know, worried about mental health, pregnant and postpartum people. So that's our first really big win. Second is we've advocated for federal grants to states to create programs in their state to address these issues. And the first advocated for funding in 2018, and then successfully advocated for a reauthorization of that legislation last year, and we're actually waiting any day now to hear this announcement about what states are going to receive those grants.

Bob Goldberg  8:17  
They also want to incorporate maternal mental health into the entire pregnancy medical process.

Adrienne Griffin  8:25  
So one of the things that we're really focused on, is making sure that pregnant and postpartum people are not only educated about these illnesses, but our screening for them routinely, recognizing again, that they're the most common complication of pregnancy and childbirth, you've been working hard with obstetric providers, whether obstetricians or nurse practitioners or midwives, to start talking about these conditions, as soon as somebody is pregnant, right, that first prenatal visit, you know, you go through a whole lot of intake, you get history, they should do a screening and get a baseline for the person's mental health conditions, and then check in every time they see them, how's it going, you know, this can be stressful, we know this can be challenging, it can be wonderful. But you know, it also can be stressful. And so, you know, acknowledging that upfront, taking the burden off the pregnant person, and putting on the provider to start these conversations is really, really important.

Bob Goldberg  9:20  
So I was at a UN General Assembly, off site meeting, sort of an informal group of people who were attending the General Assembly, focusing on public health around the world. And there was a lot of discussion about expanding access to maternal mental health, globally, not just in New York City, but in Nigeria, and other places around the world. So the importance is there. And of course, the actual act of incorporating some of these practices. And these understandings is easier said than done. Figuring out who does the screening? What question to ask. Those are difficult. I think that's why there's an explosion of what is called femtech. Where technology, whether it's telehealth or other remote sensors, and so on, are being used to capture the lived experience of parents that expectant parents around the world. So, in a perfect world, mental health is addressed, just like every other part of pregnancy and new parenting. And thanks to people like Adrienne  Griffin, we're moving in that direction. So again, thanks to Adrian. And you can learn more about the maternal mental health leadership alliance by going to the link in the show notes.

This episode of the patient's rising podcast is brought to you by the patient helpline. This free service is just one of the many ways we try to help our patient community, patients oftentimes have trouble finding medical transportation, or trying to understand their insurance. And that's where we jump in. We have navigated hundreds of individual situations with patients. So if you or someone you know, has a health care question, a challenge or an issue, we are here ready to help to get in touch, leave us a voicemail, or send us an email using the link in the show notes.

Now before we go today, there are some other healthcare issues in the headlines this week that we thought our audience would want to hear about. The first is what many are calling, quote, a major victory for patients unquote. As a district court in Washington DC, struck down a Trump administration federal rule that allowed copay accumulator policies. Now, just to remind everybody, copay accumulators are basically organizations that are hired by the insurance companies or the PBMs. to intercept the copay assistance that pharmaceutical companies make available to lower out of pocket costs. They take that money, which is your money, they apply it to the cost of the drug, and then they still force you to pay the full out of pocket maximum that a plan might apply to their drugs, or to the total cost of care. As I've said before, on the show, it's legalized theft, and it puts patients in a deeper hole than they should be, given the fact that the money reducing codebase is for them, is to reduce their out of pocket costs, not the cost of the PBM. So while many PBMs are moving away from copay, accumulators to another iteration, which we'll have to fight, this is a significant victory. It establishes a legal precedent for pursuing, you know, a greater sense of justice and access for patients in the future. So finally, today, I want to mention that the Nobel Prize in Medicine was just awarded to two scientists for the discoveries that enabled the creation of the micro RNA vaccines against COVID-19. And those two people are the Hungarian American Katalin Kariko  and American Drew Weissman. Both were awarded the highly coveted prize. And it's just important to point out, first of all, just how many lives were saved, because of these discoveries, and because of these research, and also to point out that, to turn these insights into reality, required billions of dollars of funding that didn't come from the NIH, it didn't come from the federal government. It came from private investment, and from the biomedical enterprise here in the United States. So we congratulate the Nobel Prize winners in medicine. And we're thankful that we live in a in a world where the incentives to invest in these kinds of insights still exist. So we'll have a link to these stories in the show notes as well. Now we'll have another episode right here next Monday. Hopefully, Terry will be feeling better. So you can we can get back to our normal broadcasting structure, and every Monday after that, so make sure to follow the podcast on your favorite podcast player. And that way you can be notified as soon as a new episode is live. Until next week for everyone had patience rising I'm Bob Goldberg stay healthy