In an effort to connect women in the weeks before and after pregnancy with responsive mental health care, the state health department and a collaborative virtual psychiatry practice are partnering up to provide consultation with clinicians statewide.
For the last three months, the groups have been piloting a project called PRISM, which stands for Psychiatric Referrals, Intervention, and Support in Montana. The program is made up of a free consultation phone line or website where clinicians treating a woman in the perinatal period can call to get psychiatric teleconsultation services from Frontier Psychiatry, a virtual practice based in Billings.
Montana has a lack of mental and behavioral health providers. All but one of the state’s counties are designed as not having sufficient mental health professionals, said Mary LeMieux, who works in the Member Health Services Bureau of the state health department.
That lack of health care overlapping with increased needs for mental health services during and after pregnancy concerned the Department of Public Health and Human Services.
“There was obviously the need for behavioral health to get into those far-reaching corners of the rural frontier counties,” LeMieux said Monday. Citing data from the federal Health Resources and Services Administration, LeMieux said nearly 20% of Montana women report depression before pregnancy, nearly double the national rate.
“When presented with that information about how many women are depressed in Montana, it became apparent for the department that we needed to do something if we could,” LeMieux said.
The statewide project is funded with a five-year federal grant and the cost to support the line through 2023 is $490,000.
The pilot included FamilyBorn Maternity and Women’s Health at Kalispell Regional Healthcare; Sisters of Charity of Leavenworth Health (SLC) – Billings Midwifery & Women’s Health; SCL Health Medical Group in Butte; SCL Health - Butte OB-GYN; and Holy Rosary OB-GYN in Miles City.
Dr. Eric Arzubi, chief executive officer of Frontier Psychiatry, said psychiatrists are trained to think about three areas of need —psychological, social and biological. All three of those factors can face additional stress during pregnancy.
That includes things like concerns about bonding with a first child or how a sibling will fit into the family. There are also stresses from the cost of adding to a family and finding care for a baby. And women’s bodies and hormones change dramatically both during and after pregnancy. Throwing in the lack of sleep that comes with a newborn makes things even more challenging.
“There are stressors in all three dimensions that make it a difficult time,” Arzubi said. “If a woman is vulnerable because of genetics, family history or has struggled with depression before, that time during pregnancy puts women at particularly high risk for relapsing or having a first episode.”
Christie Weseman, a certified nurse midwife at FamilyBorn Maternity and Women’s Health in Kalispell, said she sees a lot of perinatal mood disorders in her practice.
“When we have somebody walk in the door for the first time that has something that is clearly a much more complicated case, we know that we need psychiatric care for this person that’s beyond the scope of our practice,” Weseman said. “What is really challenging was often it would take months to get this person into the appropriate care.”
The new helpline, Weseman said, addresses that problem.
“To be able to call somebody, get somebody that specializes in perinatal mood disorders to really help these women on the spot, is just amazing for us,” Weseman said.
Though things are improving over the last few months, Weseman said the pandemic made things even more challenging because of the increased isolation, leading to lack of connection to social support networks.
Over the last few months Weseman has used the service a handful of times when someone comes into her office with risk factors or a history of symptoms that require higher psychiatric care.
“What I’ve done is get their history, and then I’ve gone ahead and called this line and that’s where I’ve been able to talk to Arzubi,” Weseman said. “We’re able to go through what I’m seeing and get his clinical expertise and help in managing and talking about medications and talking about a plan of care and follow-up. That has really been nice to be able to walk through things with someone who specializes in this.”
Being able to access services through telehealth can also address issues of the stigma around mental health care. There are also additional layers of expectations put on pregnant women and mothers, Weseman said.
“It’s not necessarily rosy and easy and romantic. It can be really challenging,” Weseman said. “I think I see people starting to be a little bit more honest about their experiences, which I think is incredibly important.”
At one pilot site, a provider called with a patient that appeared to be in a manic episode. Arzubi said his practice was able to work with the clinician to identify what was happening, what treatments had worked or failed for the patient before and what approaches were safe during pregnancy.
Together, they implemented a medication plan. If the consultation hadn’t been available, the other option would have been to submit a referral to a local provider and wait weeks.
“With collaboration we were able to address it quickly,” Arzubi said.
A mental health problem is a family problem, not just a mom’s, Arzubi said. Being able to address and treat women early can help head off other problems down the road.
“This has a very real, long-lasting impact. We can’t be treating individuals who are part of a family system as little silos,” Arzubi said. “If mom’s struggling, it’s more likely kids will struggle and the whole family system is struggling. There’s research to show the earlier you intervene, especially with expecting moms, they are less likely to expose children to problematic stressors.”
To request a consultation, clinicians are encouraged to call 1-833-83-PRISM (1-833-837-7476) or submit a HIPAA-compliant online e-consult form at prismconsult.org. The line is not for patients to call directly.