Perinatal e-News
Issue 51 | December 23, 2009

Perinatal Depression Policy Roundtable
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Dear friends,

In this holiday season, we would like to thank you for your commitment and partnership in helping to increase healthy births in Los Angeles County and elsewhere. We wish you continued success and rewards in the coming year.

Your friends at LA Best Babies Network
Perinatal Depression Roundtable

Perinatal roundtable
LA Best Babies Network, in partnership with the Los Angeles County Perinatal Mental Health Task Force, recently hosted the first Perinatal Depression Policy Roundtable. The Roundtable was convened as a call to action to improve and increase screening and treatment resources for perinatal mood disorders in Los Angeles County. More than 30 committed perinatal stakeholders gathered to identify perinatal mental health policy solutions and thereby begin to develop a policy agenda for L.A. County. The Roundtable and the policy agenda are funded by a five-year Community Opportunities Fund policy and advocacy grant from First 5 LA.

Maternal depression is a significant public health concern affecting countless women, infants, and their families in the County. It is associated with substance abuse, premature delivery, low-birthweight babies, shorter duration of breastfeeding, and disruption of the mother-infant bond. In its most extreme form, it can be life-threatening to mothers and children.

Community clinic directors and county and state mental health agency members were welcomed by Dr. Lynn Yonekura, LA Best Babies Network's executive director. She was followed by a powerful video presentation of Kimberly Wong, Esq., Chair of the Perinatal Mental Health Task Force of Los Angeles County, testifying earlier this year before the California State Assembly, about her personal struggle with postpartum depression.

Speakers included Cynthia Harding, MPH, Director of Maternal Child and Adolescent Health Program of the Los Angeles County Department of Mental Health, Dr. Penny Knapp, Medical Director of the California Department of Mental Health, and Katie Monarch, Project Therapist for St. Joseph Hospital.

Harding cited some alarming statistics from the Network's recently published Landscape Report on Maternal Depression in Los Angeles County. Sadly, half of the women suffering from perinatal depression in the County are never diagnosed. And low-income women, Latinas, and African American mothers are at greatest risk for maternal depression. Harding emphasized that perinatal depression is highly treatable, and that all women should be screened.

"There are a lot of missed opportunities," said Harding, adding that, all too often, new mothers don't ask for help, because they are afraid or ashamed to admit they are not enjoying their new baby, or because cultural stigma prevents them from acknowledging mental health issues. Some women might even be afraid that their child will be taken from them.
Another recurring theme was the general reluctance on the part of providers to screen for maternal depression. Barriers to screening include lack of reimbursement by Medi-Cal, self-reported lack of qualifications, and in particular, the worry that should a woman screen positive for depression, there would be nowhere to refer her, and the provider would then become responsible for her care.

Harding cited the "great work" of the Network's Care Quality Collaborative, which, through training in evidence-based practices and diligent measuring of improvement, has dramatically increased its depression screening rates.

Participants later broke into smaller work-groups to brainstorm policy solutions in four areas:
  • Access, Financing, and Standards of Care
  • Education and Training of Providers
  • Public Awareness, Education, and Social Support
  • The Mental Health Workforce
Janice French, CNN, MS, the Network's director of programs, said of the Care Quality Collaborative, "When we asked providers to make it a goal to screen every woman in every trimester, some were aghast. But we started small and slowly, so that no one was going to be over-burdened by referrals."

The work has paid off in both measurable and incalculable ways. She told the story of two separate Care Quality clinics that, through screening, both identified a patient who was depressed to the point of having made a suicide plan. Were it not for the depression screening these clinics had in place, both of these women would have gone undiagnosed, and lives may have been lost. "This is a very powerful reinforcement," said French.

Additional funding for the Roundtable and the policy agenda come from The California Endowment, The California Wellness Foundation and the California Community Foundation.

See additional photographs from the Roundtable here.
Reflections 2009