Maternal Mental Health: A long and lonely road

I’ve often compared my ability to parent and have a relationship with my husband to the relationship between passengers in a row on a plane.  You can’t help your family if you can’t help yourself or help your partner when they need.  Adults have needs.  We need to meet them so we can be good parents.

Mental health care kind of falls in the “put your air mask on before helping others” category.  One of the main issues facing new parents is postpartum depression (PPD).  I was completely overwhelmed when I wandered onto the Postpartum Progress Blog and discovered that very imagery on its facts about PPD.  Studies on PPD, according to Postpartum Progress, show that PPD occurs in 11 to 25% of moms.  Symptoms may be difficult to assess but there are more diagnostics being made public.  My OB now requires this diagnostic at postpartum appointments since it is just that prevalent.  A lot of other OB’s, especially ones aware of new research, are beginning to see the utility in this as well.  After all, if you are too sick to meet your own needs – physically or emotionally – you can’t really mom your best.   Having had a mom who exhibited a number of these symptoms in the 90s with my sister but wasn’t diagnosed and a number of friends who wish they had reached out sooner, I can say it is a big problem even just in my social circle.

PPD isn’t the only thing facing moms, though.  Postpartum Support International argues that 6% of pregnant women and 10% of postpartum women exhibit anxiety.  Some women even have Postpartum Panic Disorder and a pregnancy or postpartum induced form of Obsessive Compulsive Disorder.  Having other conditions, such as hyperemesis gravidarum or gestational diabetes, makes these conditions all the more likely during or after pregnancy.

I knew all of this when I started to see really bad depressive symptoms about 2 months ago.  It was during the worst part of my HG.  I was vomiting every day too many times to count.  I loved food but suddenly couldn’t be around it.  I knew it was too much for me.  So, with my husband’s strong support, I asked for a referral.  I’ve recently moved away from student health practices after graduation so I didn’t have a current psychiatrist or therapist.  I knew there was no time like the present.

I had resources and an education to help me tell my doctor that I needed to see a new shrink and a new therapist.  She was actually really helpful and gave me a referral right away.  So then why do I still lack adequate mental health care?

The problem is a lack of providers.  The only doctor I could get a quick referral to was a quack who didn’t believe in therapy and thought my HG was basically just a binge eating disorder or bulimia.  She had no idea I was pregnant and neither did her staff despite the LOADS of paperwork my provider and I had faxed.  She was supposed to be good at taking care of patients dealing with prenatal depression but she had no empathy and wasn’t even sure what was safe to take while pregnant.  And, rather than consult with my OB, she basically said, “I don’t know, take it or don’t”. Very convincing.  She also blamed me for past trauma and said I had bulimia. All in 20 minutes.  And the entire time I was trying not to puke. She told me to “puke in my hands” rather than bring me a wastebasket.  Because, you know, that’s how you deal with patients.  I’ve been seeing a psychiatrist since I was 18.  This was a terrible experience.  I’m at least glad I have some other data to pull from because if my first experience was to get checked out by someone like this, I would run away screaming never to ask for help again.

So, I thought, I’m not going back to her.  My OB’s office concurred and will no longer refer to her.  But the problem didn’t end there.  I’d found a therapist, which helped.  He didn’t know about HG but he educated himself.  He was experienced with PPD/A.  So, I was lucky.  But I still to this day have not found another psychiatrist who could get me in before 3 weeks postpartum.  In a town littered with hospitals, I still cannot find someone.

I turned to the internet to two support groups I belong to and found, basically I was not alone in my predicament. Most psychiatrists, like all specialists, who are in private practice are affiliated with a hospital group.  There are almost never enough of them.  And they are all only taking in-group referrals.  And even those take months.  If you can’t get into a private practice, you get somewhat spotty community mental health resources.  These place can be either very good or very bad – it just depends on your provider and the area.  There is high turnover of providers and you will usually don’t get a typical 60 or 90 minute evaluation like you would at a private practice.  Here, these services are actually quite good but definitely over-taxed-especially in more rural areas.

This stark difference between community mental health and private practice is due to a lack of resources. Private practices only provide resources to paying clients or clients who have good insurance.  Community providers can’t really turn anyone in need away.  You don’t get a lot of input into the type of care you have there – not because the providers aren’t good or don’t care but because they are set up to meet the needs of as many people as possible.  In my experience, this meant a 30 minute intake consult a few one-on-one sessions with a therapist, a meeting with a psychiatrist, and then a lot of group therapy.  Since my agency works with community providers to provide services to at-risk people, this isn’t an option.  I could end up working in group with people who are in our database and who need our services.  It was a serious professional faux-pas I wasn’t willing to involve myself in and I would then have to warn my boss and see if this was even allowable.  I did not want to do that.  For some without professional issues, this system still doesn’t meet their needs.  For some, it does.  These places meet a great need for those who need substance abuse care or for unipolar depression.  Still, for other issues, they may not be enough.  And without insurance, women who do succeed here can still have trouble paying – even with a sliding scale setup.

So here I sit.  I know I need to be back on medication but I can’t find anyone to evaluate me. My doctor wants me to get the best care via an evaluation and agrees that because I have a history of OCD, PTSD, and a mood disorder, it is best I go to a private practice where I can get consistent care.  I have great insurance. I can afford care.  I am not a newb.  I knew to ask for help.  When I found myself let down, I knew it wasn’t the rule but the exception.  I know I will still find someone eventually so I try to stay positive.  Because, as a mom and stepmom, I have to.  I need to find a way.

But if I was new to this life, I am not sure I would press on to find another provider.  The worry for these women is to be let down again.  So, they go along in silence.  After all, mom takes care of everyone before herself.  And that’s the problem.

We need to take serious care of new parents and women dealing with depression.  So, even when screening shows it is needed, even when providers and patients are trying, it’s still not enough. There is a mental health provider shortage in this country.  According to the Washington Post about half of the counties in the U.S. lack a mental health provider.  Especially in rural areas.  Until we make mental health care attainable, these issues will still remain.  And the vulnerable time for most women – that time right after a baby is born – will continue to remain a high, lonely hill to climb.