No More Excuses: Providers Are Accountable for Their Lack of Knowledge About Moms’ Mental Health
When it comes to maternal mental health, there’s always an excuse as to why moms get bad treatment. It may be that screening takes too long. There is a duty to report if a mom is thought to be a danger to her child. Psychiatrists are the best professionals to handle mental illness. OBs don’t know enough about mental health. Providers lack knowledge about the risks and benefits of medication. Whatever the reason, these are all excuses and we’ve heard enough.
Over the weekend the story of Jessica Porten, a Sacramento, California mom who reached out for help with her postpartum depression, went viral and for good reason. During a visit to her OB’s office, Jessica talked to the nurse practitioner who was conducting the appointment about her struggle with her mental health since giving birth. She told her that she wanted to know more about medication and therapy. Jessica was after more information about treatment options and to come up with a plan to get better. She talked about her thoughts and feelings, describing her intrusive thoughts about violent, scary things happening to her baby. It was a brave and courageous decision that should have put Jessica on her road to recovery.
Instead, Jessica’s day turned into a nightmare. The nurse practitioner told Jessica that she was going to talk to the OB about her depression. What happened next should be unbelievable – but we know it’s repeated time and time again. The police were called and arrived at the OB’s office. Jessica, who had her baby with her, then had to drive herself in her car, with a police escort to local hospital. She was admitted to the hospital, unable to leave her room until she’d been assessed to determine that she wasn’t a risk to herself or her baby. Not once during this entire ordeal did Jessica see or talk to a doctor, including the OB she was scheduled to see in the first place.
Lack of Knowledge and Plain Old Ignorance
It’s unfathomable that despite maternal mental health issues being the most common complication of pregnancy, health care providers are still this clueless. Yes, completely and totally CLUELESS. Stronger words are justified but I won’t use them. How can a nurse practitioner in an obstetrician’s office, exclusively working with women who are pregnant or postpartum, not have any idea about mood disorders and anxiety?
Nurse practitioners are nurses who have completed graduate degrees and undergone additional training in their practice area. Many of them have the ability to prescribe medication and complete medical assessments in a way similar to a doctor. In other words, they’re not stupid. These are highly trained professionals.
And yet here we are, shocked and outraged by the treatment Jessica received from this nurse practitioner. We’re left wondering how this could happen. How could an entire health system be so cold, cruel and uncaring? Jessica’s experience is an example of how mental health is viewed and treated by the medical system. It’s misunderstood, maligned and deviant. Mental illnesses are suspect, even criminal, and those who are sick and in need of care are treated no differently than someone whose committed a crime. This lack of knowledge and ignorance is inexcusable; there is no justification.
Holding Health Care Providers Accountable
Any health care provider that works with women should be paying attention to what follows. For far too long now moms have taken it on themselves to advocate for improved awareness about maternal mental illnesses. We’ve been fighting to improve education for providers so that we can get better help. Or any help for that matter. But what moms haven’t been demanding is accountability. We put our trust in the hands of our health care providers and are under the assumption that they’re equipped to help us.
Taking the step to admit that we’re struggling and need help is terrifying. Any of you who have gone down this road can attest to the stomach churning fear that clutches at you you try to describe how you’re feeling. Or go into detail about your intrusive thoughts. It’s an act of true bravery at a time when you’re feeling your absolute worst.
But the onus should not be on moms to know the ins and outs of mental illnesses. Health care providers are the ones that must ensure their skills and knowledge are adequate to meet the needs of their patients. Professional and regulatory bodies also have a role to play to ensure their members are held to the highest standards. They set the criteria and guide each profession in terms of expectations around clinical competencies and required knowledge in order for members to remain in good standing.
While perinatal mental health is considered a specialty, there is no excuse for a health care provider that works with women who are having children to know so little about mental health. Absolutely no excuse. And it’s time that we as moms and as patients demand better and hold our providers accountable.
What Moms Can Do to Affect Change
A big part of the problem is that doctors can’t agree who is responsible for moms’ mental health. Does it fall to OBs or should it be something pediatricians are better trained in? Do we let maternal mental health fall to general practitioners or rely solely on psychiatrists? Because of this ambiguity, none of these professionals receive adequate training and ongoing professional development in maternal mental health unless they choose to do so. Each doctor’s office is responsible for hiring their support staff, like nurse practitioners, and they ultimately decide on the skills and knowledge needed.
Most doctors will look to large national regulatory bodies and professional associations for standards of practice. If you’re in the United States, start by contacting the American College of Obstetricians and Gynecologists (ACOG). OBs are likely to be the main provider that follows a woman through her pregnancy and into the postpartum period. There should be mandatory training in maternal mental health for these professionals along with everyone working in their office. We’re not talking about intensive specialization, but enough understanding of perinatal mood and anxiety disorders that when a mom talks about her mental health, the first thought isn’t to call the police. Send ACOG’s Clinical Practice area an email at clinical@acog.org.
Look at your health system and the local hospitals that you might access. Ask questions of labor and delivery units about their knowledge of mental health. Can they support a mom who’s struggling before she’s sent home with her new baby? Also look at hospital mental health services. Is there knowledge of maternal mental health issues among psychiatrists, psychologists and other support staff? If not, ask why.
Take the New Mom Checklist from Postpartum Progress and share it with your friends. Take it to your OB, your therapist and any other health care provider you see and ask that they start to use it in their practice. This tool has already saved countless lives because it makes postpartum depression and anxiety easier to understand. It can spark conversation and give you the confidence you need to get help.
Jessica is one of us. And we are a community of women and moms that take care of our own. We must demand accountability. We must insist on no more excuses. Get loud on social media. Share this blog. Share Jessica’s story. Maternal mental health isn’t just a health issue, it’s a women’s rights issue and the time for change is now. #nomoreexcuses
Shannon Hennig is Program Director of the Maternal Mental Health Research Collaborative.