Improving Mental Health Care for Women in Underserved Communities
In an interview with guest expert Sipra Laddha, MD, she discusses the pressing issues facing women's mental health during pregnancy and postpartum, highlighting the lack of resources and the need for enhanced screening by OB-GYNs to support vulnerable populations and improve outcomes.
Please share your name, title, and a brief overview of your professional history.
Sipra Laddha, MD: My name is Sipra Laddha, MD, and I’ve worked in psychiatry for nearly 15 years studying the profession and practicng in communities across the country. My residency took me to Emory Healthcare, where I’ve been embedded in the Atlanta and rural Georgia communities for nearly a decade. It’s been rewarding work and I’ve started my own family and private practice here.
After working as a staff psychiatrist for the local United States Department of Veterans Affairs (VA) center treating a variety of trauma-related injuries and mental health symptoms for veterans, I doubled down on focusing on vulnerable populations by creating Intown Psychiatry and Psychotherapy to focus on maternal health.
In 2021, my co-founder Shama Rathi, MD, and I started LunaJoy. LunaJoy is a refined approach to women’s mental health that expands traditional brick-and-mortar care settings and aligns mental health clinicians with the specialized needs of this population.
What are the core issues contributing to the mental health crisis for women in the US?
Dr Laddha: There are several addressable problems for the industry to tackle right now. We need to reach the communities that are most vulnerable – where cultural and social stigma prevents women from proactively seeking the help they need. I have found that these communities have persistent access problems that compound the issue. Examples of access problems include patients who may be living in an urban care desert with a lack of specialized mental health professionals who know how to treat symptoms like postpartum depression, or patients who may struggle to secure appointments that take weeks to schedule.
Something we often talk about is a group of patients that are ‘Medicaid moms.’ These patients make up 41% of all births in the US. They are not getting the proper screening or benefits in a system that has historically short-changed them. In other countries, it is common to measure symptoms like anxiety and depression during the 3 trimesters of pregnancy and during postpartum for up to 1 year. This baseline can help improve outcomes, but many OB-GYNs are resource-strapped and their time too constrained to commit to holistic care best practices.
The government is trying to incentivize more programs and stakeholder alignment across the industry, but it’s still moving slowly. It may take a decade to recruit and train the specialized professionals we need to reverse this crisis.
How do you think the lack of resources dedicated to supporting women in underserved communities affect their mental health during pregnancy and postpartum?
Dr Laddha: For patients, there is a feeling of helplessness and being left behind by the system. While not everyone recognizes a condition like perinatal or postpartum mood disorders, there are also times when patients try to mask or ignore their symptoms. This only compounds the problem, and my training and experience tell me that suppressed symptoms will often manifest in other ways and harm the health of the family unit.
Nearly 20% of pregnancy-related deaths are attributed to suicide and self harm. This sobering statistic is something we can collectively change with the right support system and financial incentives. It’s my mission to make sure payers are working with providers to reimburse badly needed behavioral health care and services. Additionally, a top priority is ensuring that providers are equipped to handle this rise in demand.
When I was pregnant with twins, I was among this cohort of women who suffered from postpartum depression. The more its talked about, the easier sharing becomes. Finding the right help takes time and persistence. The more vocal we are about this issue, the better. I do believe that technology serves a purpose in that it can shorten wait times and provide immediate assistance to someone going through a mental health crisis. If you’re pregnant and alone – or don’t have a partner or caregiver – sometimes it can be your only lifeline.
In what ways do OB-GYNs in particular play a role in addressing women's mental health needs during pregnancy, and what more can be done to support women in this area?
Dr Laddha: The OB-GYN is the first line of defense for any mental health issues that crop up during pregnancy. I have always been an advocate of enhanced screening. It is mandatory to screen for gestational diabetes, a condition that impacts roughly 8% of pregnant mothers. But it is far more likely for patients to have moderate-to-severe mental health symptoms during pregnancy, even though there is usually an absence of screening.
OB-GYNs can be that conduit to help initiate screening, check vitals, and refer specialists who can handle a higher volume of cases. By having a standard measurement system in place, which can be administered by and with technology, we can collect more data and take a more population-based approach to care. This is a big ask – but it's manageable and something that more clinical professionals are pushing for. Data analysis can create a baseline that is monitored over the term of the pregnancy. We’re getting better at spotting the expecting mothers who will be most at-risk, so the demand to screen every mother will not be a burden.
What strategies can health care providers adopt to build a better future for women’s mental health care?
Dr Laddha: We must make technology more available across the spectrum of care. From rural and community health providers (like Federally Qualified Health Centers (FQHCs) to OB-GYNs and primary care facilities, we need the data now to make better clinical decisions in the future.
Some of the poorest health systems and providers are in the Southeast region of the US where I am based. We need more financial assistance to establish programs and embed technology that connects with the hardest-to-reach patients. It is a financial issue as much as it is a systemic issue.
The women who seek help and come to my office are often traveling a great distance or have been turned down by another provider due to bandwidth constraints. This can’t continue to happen. It is going to take a coalition of payers, providers, and academic resources to combat this problem. We can’t afford to let it linger for another generation of women and families.
