HHS Task Force Launches Roadmap for Improving Maternal Mental Health

One in five women experience mental health and substance use problems during pregnancy and the postpartum period, a member of the Task Force on Maternal Mental Health, said during a briefing hosted by HHS on Tuesday to mark the launch of the National Strategy to Improve Maternal Mental Health Care.

Sharing her own story, Nicole Barnett, MSW, a member of the Task Force, said something felt different after the birth of her third and youngest child. When she described her symptoms to a nurse at her obstetrician’s office and was told she might have postpartum depression, she said that she could not accept it.

“I did not want to hear the phrase ‘postpartum depression,'” she said, noting that, for her, it meant failing at motherhood.

Barnett refused to seek help or take medication, and her symptoms worsened. Washing her face became a chore. Decisions as immaterial as what color folder to send her kindergartener to school with could trigger a full-blown panic attack.

At her worst, Barnett said she would fence herself off with her children behind a baby gate in a back room. “I’d give my older two something to play with, and just hold my baby in the rocking chair and just pray for my husband to get home.”

Ultimately, the fear that she might be neglecting her children drove Barnett to seek help. Within weeks of starting on medication, she began to feel more like herself. She connected with a therapist and joined a support group for mothers, which she credits as most important to her recovery.

For the last 20 years, Barnett has worked in maternal mental health education and advocacy, including serving as a counselor for the Health Resources and Services Administration’s National Maternal Mental Health Hotline.

“Every day I get to help women just like me,” she noted.

The Task Force on Maternal Mental Health, which is co-chaired by Admiral Rachel Levine, MD, the HHS Assistant Secretary for Health, and Miriam Delphin-Rittmon, PhD, the HHS Assistant Secretary for Mental Health and Substance Use, is a product of the TRIUMPH for New Moms Act.

During the briefing, Levine said that maternal mental health issues and substance use disorders (SUDs) are the leading causes of pregnancy-related deaths in the U.S. Furthermore, pregnant women with mental health conditions are 50% more likely to experience severe maternal morbidity.

To address this crisis, the Task Force conducted a literature review, held listening sessions to gain input from stakeholders, and gathered public comments through a request for information. Five working groups met online dozens of times from November 2023 through April to gather their findings and develop the following five core recommendations:

• Build a national infrastructure that prioritizes perinatal mental health and well-being: Develop and strengthen federal policies to promote perinatal mental health and well-being by reducing disparities and expanding care models in which perinatal care, mental health care, and SUD care are integrated.
• Make care and services accessible, affordable, and equitable: Establish federal mechanisms to fund infrastructure to support new delivery models for mental health conditions, SUDs, and gender-based violence. Implement “culturally relevant and trauma-informed clinical screening” and focus on training, growing, and diversifying the perinatal mental health workforce.
• Use data and research to improve outcomes and accountability: Fund and expand support for perinatal quality collaboratives (PQCs) in all 50 states, the District of Columbia, and U.S. territories. (The CDC currently supports PQCs in 36 states.) Establish a central clearinghouse of information to make it easier for providers and other stakeholders to locate resources for perinatal health data.
• Promote prevention, and engage, educate, and partner with communities: Fund evidence-based best practices to support “person-centered, culturally relevant, and community-level detection and prevention of perinatal mental health conditions and SUDs,” particularly in under-resourced communities.
• Lift up lived experiences: Listen to the perspectives of people with lived experiences of maternal mental health problems and respond to their needs.

The Task Force’s report explains how the lack of national infrastructure for maternal mental health care and other systemic barriers place unnecessary stress on pregnant and postpartum women. A shortage and “geographic maldistribution” of mental health and SUD providers compounds these problems.

Those most vulnerable to mental health problems and SUDs include those from under-resourced racial and ethnic groups; incarcerated persons; parents of children in the neonatal intensive care unit; those who have experienced pregnancy loss, forcible displacement, trafficking, and gender-based violence; veterans; and those with pre-existing mental or behavioral health conditions.

During interviews, women with lived experiences shared the changes that would have improved their situation during pregnancy, including opportunities to connect with experienced mothers, access to high-quality care, sleep strategies and support, information about available medications, and specialty training in perinatal mental health support for members of the workforce from under-resourced communities.

A key recommendation of the report was the call to enact paid family leave, specifically to support the House Bipartisan Paid Family Leave Working Group, which launched in January 2023 and calls for at least 6 months of guaranteed leave in every state, U.S. territory, and the District of Columbia.

In interviews, many mothers reported having to return to work after only a few weeks when their babies were still vulnerable and they were still healing, said Task Force member Maya Mechenbier, JD.

“The mental health impact of having to leave your baby and return to work before you’re ready cannot be overstated,” she said.

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