A mental health provider was kind enough to leave the below comment on my blog. I found it so unsettling that I want to put it front and center as a post. I personally feel that this mental health provider is an absolute hero for standing up for her patient the way she did. If only every woman with depression or PPD had a patient advocate like her!!! Please read and let me know what you think. (I just wish I knew what insurance company this was.....)
Anonymous said:
I am a mental health provider and very interested in the topic of postpartum depression/perinatal mood disorders - I have two children and struggled w/ postpartum anxiety after my first child.
This topic struck me today specifically because I "had it out" with an insurance company and their "clinical review counselor" today....
I have a client who is a 35-year-old woman who is moderately depressed, and trying to get pregnant. She is responding nicely to psychotherapy and wishes not to start medications because of her desire to become pregnant, and I support this as do her physicians. The "clinical review counselor" from her insurance company disagreed with me because meds would make her treatment progress faster and therefore cost the insurance company less -- he cited this new literature that you cite here in your blog -- I hadn't read it yet but told him that it was ridiculous to medicate someone who is responding to psychotherapy and who wants to become pregnant just to speed things up. It's not worth the risk, no matter how small. His only response was that it was afterall the patient's decision.
What annoys me is that if I were not one to advocate for my clients or one who was up on the research, I may have been swayed by this and felt pressured to lead the patient in that direction. In this case, I totally feel like I won though, especially when he asked me for the expected length of treatment; I said "6 months and if she gets pregnant she'll need to be monitored throughout the pregnancy and the postpartum period because her risk of postpartum depression is increased." He said "ok" -- NEVER do they say "ok." Their job is to limit benefits to save money - he clearly had no clue about perinatal mood disorders.
May 17, 2008
May 12, 2008
Susan Dowd Stone comments on the Melanie Blocker Stokes MOTHERS Act
I know I've written before on The Melanie Blocker Stokes MOTHERS Act that is now before the US Senate, but really, there can't be enough said about this all-important legislation.
Susan Dowd Stone, President of Postpartum Support International, provided the below statement about the bill. She brilliantly covers the important aspects of the bill and why we desperately need it to be passed. Please feel free to comment or offer questions about the bill and I will get them to her to respond to you.
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While we await positive action from our nation’s legislators on The Melanie Blocker Stokes MOTHERS Act , questions arise. Some have wondered why we need a federal bill in place when we have so many well known organizations and individuals devoted to ending the ignorance of pregnancy related mood disorders. Hasn’t this issue received enough attention these past three years? With all the media, famous advocates and well respected leaders speaking out, the growing science and research substantiating the seriousness of untreated maternal depression – aren’t we done? Aren’t many thousands more people now aware of postpartum depression, thanks to the CBS Cares public service campaign, news stories on every major and local network, the power of the blogosphere, conferences, state’s responses and organizations like PSI, EmpowHer and many others? And aren’t there now more services and treatment options available as mothers face what is often the fight of their life?
NO. We are barely beyond the starting line.
It’s true we now have two states out of 50 with legislation on the books strongly encouraging screening, education for consumers and healthcare providers and services for new mothers. Many other states are in the process of developing programs thanks to the tireless efforts of grassroots organizations and advocates who have decided that lives will not be lost on their watch by the devastation of untreated maternal depression. But their sustainability is uncertain and often depends on the generosity of donors and foundations besieged with requests for funding. We now have one or maybe two hospitals in the whole country where women can seek treatment with their infants and avoid the damaging and often unnecessary separations when intense services are required.
We need a federal response because research and education .. not geography... should determine what services will be consistently available to all American mothers. And that is exactly the goal that The Melanie Blocker Stokes MOTHERS Act (TMBSMA) intends to initiate.
There is nothing in TMBSMA that suggests mandates for anything.. no conspiracy to medicate moms, take away children - its modest request for funding streamlines the focus of its initiatives - READ THE SUMMARY and see for yourself. This truly bipartisan effort is about research education and provision of services for long suffering moms who have not had such access in the past and disgracefully still don't. Currently only 15% of afflicted mothers will ever receive any treatment.
Treatment can take many forms including social support, consumer education, better nutrition and self care, therapy, and sometimes medication. No choice should ever be discouraged - each women's experience is as unique as her life, and her recovery plan should reflect all available options! To cast aspersions or imply weakness when medication is warranted for recovery is like telling a diabetic woman she should be ashamed of taking her insulin.
We routinely screen - without any public outcry - for many other pregnancy related conditions whose incidence is less than the up to 20% of mothers (that's 800,000 without counting women who miscarry or whose babies are stillborn) who may develop a serious mood disorder this year!
There is a long list of other illnesses - including breast cancer - which appear less frequently among American women, but which generate appropriate and unquestioned societal, legislative and healthcare response. But we do not consistently and routinely ask the right questions of pregnant and postpartum women. The difference is the stigma of mental illness.
Research continues to point to early brain development in the neonate as exquisitely sensitive to its environment – an environment whose quality largely depends on the health and abilities of its mother. In no other illness is the fate and future health of one innocent so closely tied to the present health and abilities of another. So we can pretty much double the number of those directly affected by pregnancy related mood disorders without argument. The statistics of those afflicated will continue to rise in numbers completely disproportionate to our abysmal response.
Perhaps when further research on long term societal, family and psychological effects finally translates into economic loss, this destroyer of our motherhood's expected joy will finally receive the attention needed to end truly needless suffering. The irony is that here's one condition where PRIMARY PREVENTION, i.e. methods to reduce the incidence and effects...is entirely possible. By our avoidance and refusal to implement a national, prosocial and adequate response we pay many times over for such ignorance... and those who pay the most are our most vulnerable citizens.
One can only incredulously wonder why on earth there would be any objection to federal encouragement and support for the research, education and services needed to end the loss of lives and incalculable suffering. Federal support means everyone is on notice to get up to speed. Federal support means the services are available to the many, not just the few. And federal support and acknowledgement means the beginning of the end of stigma.
The reality of maternal mental illness is a fact which cannot be challenged. The battle could go on another ten years depending on our demands of our elected officials to end a public health crisis. But while constituents remain inert about taking action, while we split hairs over definitions,form camps about what treatment is best, allow our legislators to politicize the problem and take aim at each other instead of the issue, suffering is prolonged for those too ill to participate in the calls for help.
Bills are passed for new roads while mothers experience unfathomable despair. Bills are passed for bicycle helmets while the partners of such mothers initiate a desperate search for help. Bills are passed for mortgage relief and campaign finance reform while babies cry alone.
Women are the majority of voters and our children are held up as the future of our country yet we are often silent for ourselves and our children - unused to the direct solicitation of our opinion as one that deeply matters and which can shape future policy. We are often too quickly grateful for any consideration received instead of demanding what is truly needed. The transformative magnificence of the internet is that it offers busy mothers and those who love them - a path to power, an internet megaphone, a virtual march on Washington, and the facilitation of unity despite the distracted isolation of daily demands.
------------------------------------------------------------------------------
Here is a summary of the bill. Please check it out and let everyone you know about this important legislation that we need to work together to make sure it's passed.
Susan Dowd Stone, President of Postpartum Support International, provided the below statement about the bill. She brilliantly covers the important aspects of the bill and why we desperately need it to be passed. Please feel free to comment or offer questions about the bill and I will get them to her to respond to you.
------------------------------------------------------------------------------
While we await positive action from our nation’s legislators on The Melanie Blocker Stokes MOTHERS Act , questions arise. Some have wondered why we need a federal bill in place when we have so many well known organizations and individuals devoted to ending the ignorance of pregnancy related mood disorders. Hasn’t this issue received enough attention these past three years? With all the media, famous advocates and well respected leaders speaking out, the growing science and research substantiating the seriousness of untreated maternal depression – aren’t we done? Aren’t many thousands more people now aware of postpartum depression, thanks to the CBS Cares public service campaign, news stories on every major and local network, the power of the blogosphere, conferences, state’s responses and organizations like PSI, EmpowHer and many others? And aren’t there now more services and treatment options available as mothers face what is often the fight of their life?
NO. We are barely beyond the starting line.
It’s true we now have two states out of 50 with legislation on the books strongly encouraging screening, education for consumers and healthcare providers and services for new mothers. Many other states are in the process of developing programs thanks to the tireless efforts of grassroots organizations and advocates who have decided that lives will not be lost on their watch by the devastation of untreated maternal depression. But their sustainability is uncertain and often depends on the generosity of donors and foundations besieged with requests for funding. We now have one or maybe two hospitals in the whole country where women can seek treatment with their infants and avoid the damaging and often unnecessary separations when intense services are required.
We need a federal response because research and education .. not geography... should determine what services will be consistently available to all American mothers. And that is exactly the goal that The Melanie Blocker Stokes MOTHERS Act (TMBSMA) intends to initiate.
There is nothing in TMBSMA that suggests mandates for anything.. no conspiracy to medicate moms, take away children - its modest request for funding streamlines the focus of its initiatives - READ THE SUMMARY and see for yourself. This truly bipartisan effort is about research education and provision of services for long suffering moms who have not had such access in the past and disgracefully still don't. Currently only 15% of afflicted mothers will ever receive any treatment.
Treatment can take many forms including social support, consumer education, better nutrition and self care, therapy, and sometimes medication. No choice should ever be discouraged - each women's experience is as unique as her life, and her recovery plan should reflect all available options! To cast aspersions or imply weakness when medication is warranted for recovery is like telling a diabetic woman she should be ashamed of taking her insulin.
We routinely screen - without any public outcry - for many other pregnancy related conditions whose incidence is less than the up to 20% of mothers (that's 800,000 without counting women who miscarry or whose babies are stillborn) who may develop a serious mood disorder this year!
There is a long list of other illnesses - including breast cancer - which appear less frequently among American women, but which generate appropriate and unquestioned societal, legislative and healthcare response. But we do not consistently and routinely ask the right questions of pregnant and postpartum women. The difference is the stigma of mental illness.
Research continues to point to early brain development in the neonate as exquisitely sensitive to its environment – an environment whose quality largely depends on the health and abilities of its mother. In no other illness is the fate and future health of one innocent so closely tied to the present health and abilities of another. So we can pretty much double the number of those directly affected by pregnancy related mood disorders without argument. The statistics of those afflicated will continue to rise in numbers completely disproportionate to our abysmal response.
Perhaps when further research on long term societal, family and psychological effects finally translates into economic loss, this destroyer of our motherhood's expected joy will finally receive the attention needed to end truly needless suffering. The irony is that here's one condition where PRIMARY PREVENTION, i.e. methods to reduce the incidence and effects...is entirely possible. By our avoidance and refusal to implement a national, prosocial and adequate response we pay many times over for such ignorance... and those who pay the most are our most vulnerable citizens.
One can only incredulously wonder why on earth there would be any objection to federal encouragement and support for the research, education and services needed to end the loss of lives and incalculable suffering. Federal support means everyone is on notice to get up to speed. Federal support means the services are available to the many, not just the few. And federal support and acknowledgement means the beginning of the end of stigma.
The reality of maternal mental illness is a fact which cannot be challenged. The battle could go on another ten years depending on our demands of our elected officials to end a public health crisis. But while constituents remain inert about taking action, while we split hairs over definitions,form camps about what treatment is best, allow our legislators to politicize the problem and take aim at each other instead of the issue, suffering is prolonged for those too ill to participate in the calls for help.
Bills are passed for new roads while mothers experience unfathomable despair. Bills are passed for bicycle helmets while the partners of such mothers initiate a desperate search for help. Bills are passed for mortgage relief and campaign finance reform while babies cry alone.
Women are the majority of voters and our children are held up as the future of our country yet we are often silent for ourselves and our children - unused to the direct solicitation of our opinion as one that deeply matters and which can shape future policy. We are often too quickly grateful for any consideration received instead of demanding what is truly needed. The transformative magnificence of the internet is that it offers busy mothers and those who love them - a path to power, an internet megaphone, a virtual march on Washington, and the facilitation of unity despite the distracted isolation of daily demands.
------------------------------------------------------------------------------
Here is a summary of the bill. Please check it out and let everyone you know about this important legislation that we need to work together to make sure it's passed.
May 6, 2008
Atlanta Mom asks me about how to prevent postpartum depression
Yesterday I heard from Atlanta Mom who also blogs about her PPD experience and tries to reach out to help new moms. She asked me how I overcame PPD with my subsequent pregnancy. Even though I've written about how I prevented experiencing PPD a second time, it's been a while, so I want to share what I wrote back to her.
Here's an excerpt from my e-mail to her:
I was determined not to go through PPD again at all costs, and began researching ways to avoid it. I came upwith a list of options/resources and spent much of the pregnancy planning on what I wanted my postpartum tobe like.
One thing I did was to hire a postpartum doula. That was absolutely the best money that I've ever spent!
I also enlisted my neighbors and close friends to help -- I told them my PPD story, if I hadn't already shared it with them, and asked if they would help with different areas that they felt like they could help with (ie: preparing meals, having my two older kids over for play dates, going to the grocery store for me, etc.). I got my friends to commit to certain things, and they were so happy to help out -- they were awesome. (It's so hard to ask for help,but once you do, you find that your close friends are so relieved to know what they can do that will truly help you.)
I also hired a neighborhood teenager to come over to my house nearly every afternoon just for a couple of hours or so toplay actively with my older kids, to give them really solid attention. My husband saved up his vacation time andwas able to take a full 3 weeks off after the birth, and he was great around the house and supervising everything.
I also started on an anti-depressant within minutes after giving birth, and also had a psychologist on call in case I experienced any PPD symptoms so that I could quickly get in to see her or have a phone consultation if I needed it.
So, basically I was very focused on creating a really strong support system, not only helping me with just about everything but also helping me monitor any PPD symptoms should they arise. Happily, I never even experienced a single symptom!! It was a wonderful postpartum and I was relatively rested even after having had a C-section. The doula helped me immensely with getting the baby on a schedule while juggling my older kids. I only needed her help for the first three weeks. I stayed on the anti-depressant for about 9 months or so just to make sure I was doing okay, and then I gradually weaned off of it and did great. PPD is totally preventable. That's my big message. The big thing is overcoming the fear of going through it again, facing that fear and then preparing/educating yourself on how to avoid it. Everyone should be able to experience a happy postpartum!!
Here's an excerpt from my e-mail to her:
I was determined not to go through PPD again at all costs, and began researching ways to avoid it. I came upwith a list of options/resources and spent much of the pregnancy planning on what I wanted my postpartum tobe like.
One thing I did was to hire a postpartum doula. That was absolutely the best money that I've ever spent!
I also enlisted my neighbors and close friends to help -- I told them my PPD story, if I hadn't already shared it with them, and asked if they would help with different areas that they felt like they could help with (ie: preparing meals, having my two older kids over for play dates, going to the grocery store for me, etc.). I got my friends to commit to certain things, and they were so happy to help out -- they were awesome. (It's so hard to ask for help,but once you do, you find that your close friends are so relieved to know what they can do that will truly help you.)
I also hired a neighborhood teenager to come over to my house nearly every afternoon just for a couple of hours or so toplay actively with my older kids, to give them really solid attention. My husband saved up his vacation time andwas able to take a full 3 weeks off after the birth, and he was great around the house and supervising everything.
I also started on an anti-depressant within minutes after giving birth, and also had a psychologist on call in case I experienced any PPD symptoms so that I could quickly get in to see her or have a phone consultation if I needed it.
So, basically I was very focused on creating a really strong support system, not only helping me with just about everything but also helping me monitor any PPD symptoms should they arise. Happily, I never even experienced a single symptom!! It was a wonderful postpartum and I was relatively rested even after having had a C-section. The doula helped me immensely with getting the baby on a schedule while juggling my older kids. I only needed her help for the first three weeks. I stayed on the anti-depressant for about 9 months or so just to make sure I was doing okay, and then I gradually weaned off of it and did great. PPD is totally preventable. That's my big message. The big thing is overcoming the fear of going through it again, facing that fear and then preparing/educating yourself on how to avoid it. Everyone should be able to experience a happy postpartum!!
Toll-free warm line offers Spanish language PPD support!
Well, I haven't had much luck in my quest to find PPD resources for new, single moms, but I did find this helpful bit of info.....
Postpartum Support International offers Spanish-language support on its toll-free warmline, at 1-800-944-4PPD (press 1 for Spanish).
I think this is an incredibly helpful resource. I do believe that there are many hispanic women suffering not only from PPD, but also from the stigma of PPD, due to cultural and language barriers. I applaud PSI for offering this very important resource!
Andrea Zas Jimenez is the support coordinator for the Spanish Warmline, and Stephanie Morales will be coordinating PSI's national resource list for Spanish-speaking support.
Please help spread the word about this resource for Spanish-speaking new moms who may need PPD information and help.
Postpartum Support International offers Spanish-language support on its toll-free warmline, at 1-800-944-4PPD (press 1 for Spanish).
I think this is an incredibly helpful resource. I do believe that there are many hispanic women suffering not only from PPD, but also from the stigma of PPD, due to cultural and language barriers. I applaud PSI for offering this very important resource!
Andrea Zas Jimenez is the support coordinator for the Spanish Warmline, and Stephanie Morales will be coordinating PSI's national resource list for Spanish-speaking support.
Please help spread the word about this resource for Spanish-speaking new moms who may need PPD information and help.
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