MTPR

State, Foundation Prioritizing Pregnant Women's Mental Health

Nov 20, 2018

Pregnant women in Montana should have a lot easier time getting help for addiction and mental health problems if $5 million in grant funding announced Monday works as intended.

Most of the money is coming from the federal government, but at least $1.2 million has been pledged by the Montana Healthcare Foundation.

Aaron Wernham, the foundation's CEO, says that when the foundation was getting started four years ago he visited clinics and hospitals across the state that treat pregnant women, and he learned, "Addiction in pregnancy and depression and other mental illness in pregnancy are very prevalent problems - problems that a lot of these practices were really struggling with."

Wernham says some hospitals told him babies exposed to street drugs make up 15 to more than 50 percent of their deliveries. Statewide the number of drug-positive newborns grew by three times between 2012 and 2016. And the number of kids being taken from parents and put into foster care because of drugs continues to grow rapidly.

Until very recently, Montana only had two state-approved chemical dependency centers that would take pregnant women.

"So you pair a big public health issue happening out in communities with very little treatment available and it was a pretty serious problem," Wernham says.

The solution that Wernham's foundation and the federal grant are funding is to help clinics and hospitals that see pregnant women hire mental health professionals themselves.

"They'll really end up with a team that is capable of not only just screening, but also providing some initial steps of treatment for these women."

The goal is to within five years have a licensed professional with mental health training in all 28 places in Montana where there's a hospital that delivers babies. They don't have to be top-level clinicians like psychiatrists, but mid-level pros like social workers, psychologists or licensed addiction counselors.

Now, it's not common for prenatal clinics to have providers like that on staff, Wernham says.

"Prenatal care providers – they have a busy job, and they're not used to even thinking that there is necessarily anything helpful they can do for some of these really challenging problems, like drug addiction."

But Wernham says there's evidence from Oregon, California, New Hampshire and overseas that adding some basic mental health services to prenatal clinics can have a big impact.

"I think it's really about helping providers out there understand there are resources, it's not that hard to take this on, and you can see a huge improvement in your patient outcomes."

Having counselors or social workers on staff in prenatal clinics means women who are depressed, addicted or struggling with behavioral health challenges are more likely to get diagnosed, says the Montana Healthcare Foundation's Tressie White. White says it's also more likely that women who are diagnosed actually get help.

"If you have a behavioral health provider at the time the woman is there for services, and you can just pull in the behavioral health provider and have that warm handoff, she's much more likely to actually take advantage of that service than to say, 'here's a phone number, you really need to call this provider.' Generally, for the most part, she's never going to make it for that referral."

White says the foundation recognizes that some women are going to need more help than a pregnancy clinic can provide, even after it brings an addiction or behavioral health pro on staff.

Foundation CEO Aaron Wernham says the grant also aims to help the clinics plug into outside help, too, some of which has only recently become available.

"In the last two years, we've seen a near doubling of the number of the number of state-approved chemical dependency treatment providers in the state, and that's a direct result of Medicaid expansion. So assuming that Medicaid expansion continues, we've seen a huge increase in the state's capacity to handle those referrals for more specialized, more intensive care."

Not everyone assumes Medicaid expansion will continue in Montana. When state lawmakers approved it in the 2015 legislative session, it was as a pilot project that will expire next June unless they vote to reauthorize it this year. Governor Steve Bullock and his fellow Democrats in the legislative minority will be pushing hard for that. Some Republican lawmakers say they'd like to see expansion continue, but with some pretty major changes.