1. Promoting Perinatal Mental Health: The Massachusetts Experience
Karin Downs, RN, MPH
HRSA/MCHB TA Panel Discussion
October 18th 2017

2. Perinatal Depression is one of the most common complications of pregnancy
Most of these slides have been developed by MCPAP for Moms, and, as will be discussed, and were generously shared with me by Nancy Byatt, Medical Director for MCPAP for Moms.
Perinatal depression is both underdiagnosed and under treated. Only about 50% of women with perinatal mood disorders are identified, and of those about 25% are treated.

3. System is broken and there are multiple points for improved engagement and intervention to influence outcomes.

4. MA PPD Legislation – passed in 2010 *
Established PPD Commission
Promulgated PPD screening reporting requirements
Annual PPD awareness day at state house
Funded PPD Community Health Center Projects
Advocated for reimbursement for screening in pediatric settings
Supported MCPAP for Moms with state funding channeled through DMH *

6. Education – Trainings and Toolkits
Once you’ve decided to prescribe, how do you decide what to prescribe? This algorithm helps you decide what to prescribe.

7. Telephone Consultation
Obstetric providers/ Midwives
Family Medicine
Psychiatric providers
Primary care providers
Pediatric providers
Patient consultations are for licenses independent practitioners. We do not prescribe for patients – the goal of the patient consult is to help triage the patient and decide whether this is a pt you can manage with our help, or if this is someone who needs to be seen by a psychiatric provider, or, if it’s unclear, but it seems that the patient is likely someone who will be able to be managed by the primary care provider, we can see the patient for a one time consultation.
If appropriate we can also help out with care coordination after a patient consultation.

8. Discuss potential management strategies
Recommend a Face to Face Evaluation
Similar to integrated care models but not quite as you are not contracted to provide a service through MCPAP
Refer to the community

9. Links to support groups and community resources
Care coordination either refers for treatment or links to community resources and support groups – this picture was taken at a support group run by Early Intervention Partnership Program – a nurse-led home-visiting program in which the original HRSA/MCHB funding supported groups for women experiencing perinatal depression and social isolation.

11. MCPAP for Moms has served many providers and parents in our first 26 months from July 2014 to October 2017
OB Practices Enrolled
135 (73%)
Trainings
130
Women Served
3,218
Doc-doc Telephone Encounters
2,273
Face to Face Evaluations
203
Care Coordination Encounters
3,958
Telephone Encounters with Ob/Gyns and MWs
992 (82%)
Telephone Encounters with Psychiatric Providers
242 (15%)
Telephone Encounters with Other Providers
361 (23%)
MCPAP for Moms is 2 years young.
But in that short time we have enrolled over half of the state’s Ob/Gyn practices, performed trainings, and served almost 1700 women through telephone encounters, face to face evaluation, and care coordination efforts.
Because only 10% of the telephone consultations result in face-to-face evaluations with a perinatal psychiatrist, the psychiatrists are standardly able to see our patients within 1 week.
This is a significantly shortened timeline compared to what providers describe experiencing previously.

12. Our model can result in significant savings
$22,000/yr
$192,400,000/yr
$11.81/yr
$0.98/month
$850,000/yr
It is of course reasonable to inquire about the costs of such a program.
Let’s first recognize the costs of untreated perinatal depression which is estimated to be $22,000 per woman.
If you apply this to the 72,000 perinatal women in MA, conservatively assuming that 1 in 7 are depressed and 85% do not receive care, then the cost to the state of untreated perinatal depression is almost 2 Million dollars.
Alternatively, the cost of the program, including administrative expenses, is $8.32 per perinatal women per year ($0.70 per month).
This totals to $600,000 for the 72,000 perinatal women Massachusetts has annually.
This is currently a line item in our state budget, funded through the Massachusetts Department of Mental Health, and supplemented by private insurance companies paying a surcharge that covers 50% of the costs.
Jose Y. Diaz and Richard Chase. Wilder Research, October 2010

13. MCPAP for Moms is spreading and being viewed as a national model
5 states starting a program modeled on MCPAP for Moms (unique funding mechanisms)
>17 states or
health plans
have contacted us
If you are interested in a program like this but are thinking to yourself, my state would never do this. . .
I should point out that 12 years ago there was one state with the child MCPAP program Now there are 32 states with some version of this child-focused program, funded in various ways, and connected through a network that shares best-practices.
This model of care for child psychiatric needs as been designated as an AHRQ innovation.
We are hopeful that in the near term the MCPAP for Moms program will have sister programs in other states and we too can collaborate and share best practices.

14. Bringing Postpartum Depression out of the Shadows Act of 2015
HR 3235
S 2311
Bipartisan bicameral federal legislative bills
Proposes appropriation of $5 M/ yr x 5 years
Support ≥ 3 state-based programs to improve access to screening and treatment
MCPAP for Moms is the model. Allows for flexibility to meet state needs.
21st Century Cures/Cancer/Mental Health/Opioid/Family Services legislation
As for the larger mental health package - Rumors are swirling that it will be rolled into another package addressing medical innovations, and that the PPD language may be included. 
- Was included in the Senate's comprehensive mental health package. 
-is the only women's health-specific provision in both House and Senate mental health packages. 

15. QUESTIONS? Thank you! karin.downs@state.ma.us (617) 624-5967
Please contact Nancy Byatt, DO, MS, MBA
My granddaughters!