The Importance of Perinatal Care Clinicians Delivering Mental Health Care

(Part 2 of 2)

In this video, Nancy Byatt, DO, MS, MBA, FACLP discusses the importance of treating perinatal individuals’ mental health and substance abuse disorders for the welfare of both themselves and their infant, and how recent research can impact policy in the field. Dr. Byatt gives a preview of her upcoming session at the American Psychiatric Association virtual meeting titled “Population-Based Approaches for Patients in Medical Settings: Delivering More Equitable Care?”

In part 1 of this series, Dr. Byatt discussed the key takeaway points from her upcoming session and challenges facing integrated perinatal psychiatric care.

Q: What do perinatal care providers in the field need to know?

A: When it comes to thinking about what do perinatal care providers in the community need to know, there's a couple of things. One is that these illnesses are common and there they have deleterious effects.

The other thing is that there's increasing recommendations for perinatal care providers—including obstetric providers and also pediatric providers who are seeing perinatal individuals at well-child visits—to be able to provide a mental health treatment, both for anxiety and mood disorders and also for substance use disorders.

The standards of care for frontline clinicians seeing pregnant and postpartum individuals are changing. One way that providers in the community can keep up with this changing standard is to start to provide care themselves, start to detect this, and to be able to access one of these types of access programs across the country.

Q: Are there any misconceptions on this topic that you would like to clear up?

A: One of the most pervasive misconceptions in the field of perinatal psychiatry specifically is that people, women themselves, individuals themselves, and also the clinicians serving them often think, "Well, I'm pregnant or I'm lactating, so I need to focus on the baby, because it's best for the baby."

We know that this is a total fallacy. The best thing that a perinatal individual and the clinicians who are serving them can do is to help that perinatal individual get the mental health care that they need. We know that untreated perinatal mental health and substance use disorders have a negative impact.

As a practicing psychiatrist, I'm often far more concerned about the risks of no treatment than I am about treatment. Generally speaking, it's not a time to try to switch medications or change medications. If something's working, it's often best to continue that medication, of course, with a few exceptions.

It's important that all of us serving pregnant and postpartum individuals and also for those individuals themselves that we serve to know that often, the best thing a woman and her family can do for themselves and their baby is to get the treatment that they need. Sometimes, that does include pharmacotherapy.

Q: How do you hope the current research, and topics from your session, can impact policy?

A: When it comes to what research is out there that needs to impact policy, I would say that it's very clear that we can do the best by perinatal individuals by helping them get mental health treatment.

It's very clear that if we don't do that, that outcomes are worse. In fact, mental health and substance use disorders are the leading preventable cause of death in America. That has major policy implications.

One of the most important policy implications is that we need to find ways to incentivize frontline clinicians who serve pregnant and postpartum individuals to be providing mental health care.

For example, obstetric care is a bundled payment, and so that creates some challenges. We need to find ways that when individuals are providing mental health care, both in perinatal settings and in medical settings that that care is reimbursed and that there's a financial incentive to do so.

That will be a really important policy change and there's clear research that backs up the need for that.

Nancy Byatt, DO, MS, MBA, FACLP, is a perinatal psychiatrist and physician-scientist focused on improving health care systems to promote maternal mental health. She is an Associate Professor of Psychiatry, OB/GYN, and Population and Quantitative Health Sciences at University of Massachusetts Medical School, Worcester. Dr. Byatt founded and is the Medical Director of the Massachusetts Child Psychiatry Access Program (MCPAP) for Moms, Boston. She is the Founding Director of the Division of Women’s Mental Health within the Department of Psychiatry at the University of Massachusetts Medical School. She also founded and is the Executive Director of Lifeline4Moms, a center focused on helping the health care community optimize perinatal mental health. Dr. Byatt has had continued federal funding for research focused on developing and testing scalable interventions for addressing perinatal mental health and substance use disorders in medical settings. She frequently serves on national advisory boards and expert work groups focused on improving perinatal mental health.