Minnesota has taken steps to address post-partum mental health, but more needs to be done

In 2003, Mine Ener struggled with her mental health following the birth of her baby and returned to St. Paul to be close to family. Unbeknownst to the family, Mine developed psychotic thinking that led her to kill her 6-month-old daughter, Raya, who was born with Down syndrome and several health conditions. Ener died by suicide a few weeks later in the Ramsey County jail. The Ener family was saddened and shocked; they knew little about postpartum depression, anxiety and even psychosis that can accompany it, broadly known as perinatal mood and anxiety disorders, or PMAD.

Depression, anxiety and psychosis are serious mental health conditions that affect nearly 20% of people before, during and after pregnancy. It’s more than just the “baby blues.” Mothers report feeling isolated, severely depressed, overcome with intrusive thoughts, panic attacks, insomnia and a state of numbness. Those experiencing psychosis will have hallucinations, delusional thoughts and paranoia. Many are ashamed to share what they are experiencing since the expectation is that having a new baby is a joyous time. Left untreated, it can lead to poor outcomes for both the birthing parent and the child. 

While high-profile cases involving infanticide are extremely rare, mental health and substance use disorders are the leading cause of pregnancy-associated deaths in Minnesota;  nationally 20% of maternal deaths are due to suicide.

The more the Ener family learned about this issue, the more they wanted to do something. They took their grief and vowed to create change.

With the help of social workers, psychiatrists, friends, NAMI Minnesota and mothers who had experienced PMAD, they successfully passed a law in 2005 requiring education on PMAD. The Minnesota Department of Health — working with families and health and mental health care facilities and providers — were tasked with developing materials and information on postpartum depression, including treatment resources. Physicians, midwives and other health care professionals providing prenatal care to women were required to make this information available to women and their families. Hospitals and other health care facilities were to provide departing new mothers and fathers and other family members with the information.

An annual conference (“Beyond the Baby Blues”) developed out of these efforts and recently held its 20th year educating thousands of mental health and birthing professionals and students on perinatal screenings, assessments, treatments, supports and much more. The Minnesota Chapter of Postpartum Support International created an impressive list of resources along with contact information of providers trained on this issue.

A lot has been done in the past 20  years to raise awareness, improve screening rates, and increase access to appropriate treatment.

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So where are we today?

Nationwide, the mental health of women pre-, during and post-pregnancy has worsened. An article in the Journal of the American Medical Association found a nearly 65% increase of mothers reporting “fair to poor mental health.” Dr. Uruj Kamal Haider shared in a recent column in Time that she is seeing an increase in psychosis among postpartum women.

While we need to support awareness campaigns and conduct screenings during — not just after — pregnancy, we also need to make sure we have effective programs to treat mothers.

For the past few months, I have volunteered at the Redleaf Center for Family Healing housed at Hennepin Healthcare. This clinic offers a 20-hour a week mother-baby partial hospitalization program for parents during pregnancy and parenting of children ages birth-5 years, who are experiencing symptoms of depression, anxiety, bipolar disorder or other emotional distress. Parents are encouraged to bring their babies. Treatment includes therapy, support for mother-baby bonding, parent education,  mindfulness, medication  management, and individual appointments with a lactation consultant or infant feeding and growth specialist. It’s the type of intensive program that should be available to any parent who needs it. 

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Once a week I sit in on one of the daily group therapy sessions. At various times during the session, I am asked to hold or play with a  baby. It’s incredibly satisfying to rock babies or get down on the floor to play with them and to give the parent a needed break. During this time, I also hear their struggles and coping strategies. While the incredibly competent therapist is there to help them, what I have also seen is the importance of peer support. Other moms comment on what someone has shared, offering acknowledgement, advice and support. They learn they are not alone. I witness how much they love their babies and it’s gratifying to watch them heal and graduate from the program.

Like so many parts of our mental health system, the payment rate is not sufficient to cover the costs of providing all the components of this robust program and other mother-baby programs in the state. They operate on a tenuous basis, especially those that serve a high percentage of people on Medicaid.

Investing in these types of programs is an investment in our future — for healthy babies and parents.  Minnesota received barely a passing grade from the Policy Center for Maternal Mental Health. They recommend fully funding these important programs, tracking screening and quality, creating inpatient programs, forming a task force, funding a perinatal psychiatry consultation program for obstetricians, and funding group prenatal care, among other things. 

Early identification is critically important, so I urge you to take time to learn about maternal mental health and reach in to support new parents who are struggling — bring food, clean their house, give them time to sleep, share resources. Let them know they are not alone. Legislators should pass bills that address the shortcomings in our own state. 

If you are struggling with your mental health call or text 988, the National Suicide and Crisis Lifeline or the National Maternal Mental Health Hotline at 1-833-TLC-MAMA (1-833-852-6262) for free, confidential support.