Maternal Mental Health Coalition Meeting #3: Path to Wellness

Transcription

1 Maternal Mental Health Coalition Meeting #3: Path to Wellness Local / hospital logo

2 Goal of The Coalition COMPREHENSIVE MATERNAL MENTAL HEALTH CARE Conception to baby s 1 st birthday EDUCATION / SCREENING Childbearing women will receive information about PMADs and be screened for them TREATMENT PCPs will initiate care if possible FREE social support Therapy is accessible / affordable Medication management from many providers

3 Perinatal Mood & Anxiety Disorders It s not just postpartum. It s not just depression. PERINATAL Conception to baby s 1 st birthday MOOD ANXIETY Depression Bipolar Disorder Generalized Anxiety Panic Attacks Obsessive-Compulsive Disorder Post Traumatic Stress Disorder

4 Treatment Low Cost, Low Barrier SELF CARE SOCIAL SUPPORT TALK THERAPY High Cost, High Barrier MEDICATION 4

5 Path to Wellness SELF-CARE 1. Sleep 2. Nutrition Eat 3. Exercise 4. Time off Mother the mother SOCIAL SUPPORT Validate Normalize Offer Hope TALK THERAPY Learn coping skills, manage emotions MEDICATION Safe during medications pregnancy during and pregnancy breastfeeding and Always a breastfeeding risk-benefit analysis 5

6 Self Care Women need to recover from the physical and emotional effects of pregnancy and childbirth SLEEP 4-5 hours uninterrupted EAT Every time baby eats High protein Calories for breastfeeding EXERCISE Light exercise, Outdoors Vitamin D + fresh air + change of scenery + endorphins TIME OFF No other job is so challenging 24/7 Keeping another person alive Mothering the mother

7 Self Care How can we help new moms? Hold the baby so she can shower, take a nap, go for a walk, get a massage Take the baby out so she can be alone Stock a feeding station with water & healthy snacks Remind her she has been through a lot physically and emotionally Help her figure out what she needs Help her find a doula or babysitter

8 Social Support The perception and actuality that one is cared for, has assistance available from other people, and is part of a supportive social network. EMOTIONAL Let mom know she is valued Create warmth, nurturing, caring Show empathy, concern, acceptance Provide encouragement COMPANIONSHIP Provide a sense of social belonging You are not alone INFORMATIONAL Guidance and suggestions Information and resources Speak from experience TANGIBLE Preparing meals Watching children Tidying the house Running errands Doing laundry

9 Social Support BENEFITS Validate Normalize Offer hope Make connections FREE! OPTIONS In-Person Online Postpartum Progress Postpartum Support International 9

10 Social Support Groups The Gold Standard Timing Location Facilitators Why 2x/month for 1.5 hours Hospital: safe, accessible, plenty of parking well-lit, well-known, consistent 1 primary leader with 1 or more assistants 1 with lived experience 1 with mental health or medical experience Consistency, ease Partnership Hospital gains ownership

11 Talk Therapy GOALS Learn coping skills Regulate emotions Address underlying issues BENEFITS Problem-based Time-limited Pragmatic APPROACHES Cognitive Behavioral Therapy Interpersonal Therapy Mindfulness and mindbody techniques Other approaches 11

12 Talk Therapy This is the first time many women experience a mental health issue Why should I see a therapist? Objective third party Problem-solve Short-term solutions What can a therapist do? Create a safe space Meet moms where they are Model self-care Focus on symptom relief

13 Therapeutic Techniques Cognitive Behavioral Therapy Largest evidence base for depression 8-12 sessions Treatment is organized around cognitive restructuring Notice relationship among thoughts, feelings, behavior Develop constructive ways of thinking to help produce healthier behaviors & beliefs Interpersonal Therapy Only model with good evidence in pregnancy and postpartum sessions Focus on relationships and relationship problems 4 problem areas: Grief and loss Interpersonal distress Role transitions Role Disputes

14 Therapeutic Techniques Mindfulness Developing an awareness, being present in your body Noticing / labeling thoughts, feelings, sensations without judging Suffering comes from response: resisting, struggling against, judging, fearing rejecting Goal: change how one relates to thoughts, feelings, sensations Other Approaches Attachment theory Mothering the mother Trauma-based therapy Couples counseling Internal Family Systems

15 Medication GOALS Limit risk of maternal illness Minimize risk of relapse Minimize fetal exposure RISKS Risks of MEDICATING Risks of NOT MEDICATING RISK-BENEFIT ANALYSIS The answer is different for each woman

16 Medication Which Medication? Do not experiment Stay on medication if it works Use medication that has worked in the past Use as few meds as possible TAKE-HOME MESSAGES There are safe & effective medications that women can take during pregnancy and while breastfeeding Treat to remission DO NOT abruptly cease medications Women do not have to suck it up

17 Medication Resources

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19 Research NIMH - Estrogen Skin patch of estradiol PPD ACT App Questionnaire Saliva sample -- DNA SAGE-547 Metabolite of progesterone 60-hour infusion Symptom relief in hours Fast-tracking through FDA

20 EXAMPLES / CASE STUDIES

21 Example 1: Alice SITUATION No history of anxiety / depression Very traumatic birth Breastfeeding issues SYMPTOMS Sense of failure Physical symptoms Nightmares, flashbacks TREATMENT Support group Lots of therapy Medication

22 Example 2: Becky SITUATION Twins History of fertility treatments Family history of depression Recent cross-country move Lack of social support Recent parental illness SYMPTOMS I used to be able to do anything Overwhelmed / anxious Focus on baby s eczema TREATMENT Self-care -- sleep Help at home nanny Medication

23 Example 3: Carla SITUATION From El Salvador Children at home History of sexual assault No insurance SYMPTOMS Shutting down Extreme guilt Ignoring pregnancy TREATMENT Intervention at clinic Tex4Baby Healthy Families Home-based CBT