Barriers to Perinatal Mental Health Care: Meeting Patients Where They Are

Following her session "Understanding and Addressing Perinatal Mood and Anxiety Disorders," presented at the 2024 Psych Congress NP Institute Meeting, Moushumi Mukerji, MSN, PMHNP-BC, CNM, psychiatric nurse practitioner at Hope Integrative Psychiatry, sat down with Psych Congress Network to examine the landscape of perinatal mental health care. Nurse Mukerji sheds light on the common mood and anxiety disorders experienced during pregnancy and postpartum, navigating stigma, addressing barriers to care, and how health care providers can meet patients where they are. 

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Read the Transcript:

Psych Congress Network: What are the common mood and anxiety disorders experienced by people during pregnancy and after birth? And what are the implications of untreated perinatal mental health conditions for both mother and child? 

Moushumi Mukerji, PMHNP-BC: Depressive disorders, including major depressive disorder, adjustment disorder, dysphoric disorder, any of those types of depressive disorders are common, as well as PTSD, childbirth-related PTSD, OCD is quite common, generalized anxiety disorder is common, and all of the bipolar spectrum disorders can also manifest during the perinatal period.

Implications of not treating psychiatric illness during the perinatal period really have to do with the transmission of these disorders intergenerationally, so there can be negative effects on offspring, a greater risk for psychopathology in offspring. There's data to show developmental delays, and potentially cognitive delays in children who have been exposed to maternal illness.

There can be risks to the pregnancy itself. Untreated mood and anxiety disorders are associated with a shorter duration of pregnancy, lower birth weight, and complications of pregnancy like preeclampsia. And another way that untreated psychiatric illness can exert its effect is on the behavioral aspects of mothering. So decreased bonding, less attunement, more unintended neglect of infant needs. And all of those have implications as well for child development later in life. 

Psych Congress Network: Can you discuss the barriers that prevent people from seeking treatment for perinatal mood and anxiety disorders and how can health care providers address these barriers to improve access to care? 

Nurse Mukerji: In addition to the barriers that are prevalent in our society generally for mental health care, for seeking mental health care, things like lack of access because of economic reasons, not having insurance or being under-insured or not being able to pay for high quality care or long wait times, the lack of providers, those are all well -known barriers. In addition for the perinatal population, I think the issue of stigma is a big barrier.

The idea that pregnancy is supposed to be a time of excitement and joy and happiness, and so often people will feel a lot of shame around not functioning well or not feeling particularly happy during that time. Other barriers are related to more functional issues like just lack of transportation, being more tired, having more other kinds of doctors' visits or health care visits, prenatal visits that then crowd out the seeking additional care. Moms who work might have a hard time. They might be nervous about taking time off work to attend a mental health visit because they are trying to save up their time for maternity leave.

These can all be considerations. Ways that we as health care providers can help address these barriers could be providing empathic and compassionate care to reduce self- judgment, blame, and stigma. Normalizing for people that it is okay to be struggling with difficult emotions and difficult feelings during the perinatal period.

Providing telehealth services is a wonderful way of reducing barriers. Moms, whether they're pregnant, later in their pregnancy or they're postpartum, it's harder to get out of the house, it's very difficult to get to appointments when you have a newborn. For instance, telehealth is a great boon for postpartum moms and also moms later in pregnancy.

And things like having later hours, office hours. I was seeing a patient recently who worked all day and the only time they could come in for a visit was after work hours, so providing those types of before-work or after-work visits can be very helpful. 

Moushumi Mukerji MSN, PMHNP-BC, CNM, is a psychiatric nurse practitioner in private practice with Hope Integrative Psychiatry and Wellpsyche Medical Group. She is also a certified nurse-midwife with 21 years of experience in midwifery, women’s health, and maternity care nursing in various settings around the country. In her clinical practice, she provides medication management and psychodynamic psychotherapy and specializes in perinatal mental health. She is also currently training in psychedelic-assisted psychotherapy and Hakomi. Moushumi is a graduate of Yale University and University of California San Francisco Schools of Nursing. She is an outspoken advocate for maternal mental health as well as an educator and recently joined the faculty of the University of California San Francisco as an Associate Clinical Professor.