Joy Burkhard’s Remarks on Behalf of 2020 Mom

Addressing Maternal Mental Health at the Federal Level Joy Burkhard, MBA

By Joy Burkhard, MBA
Founder and Executive Director, 2020 Mom

On June 8, 2022, several organizations, including 2020 Mom, were invited to join the Maternal Mental Health Leadership Alliance (MMHLA) in sharing their work. Participants learned more about the pandemic-driven rise in maternal mental health conditions, the effects of the infant formula crisis on moms’ mental health, and federal approaches to improve maternal mental health through systemic change, prevention, intervention, and treatment at the national, state, and local levels.

Here are Joy Burkhard’s remarks:

We are a 10+-year-old organization whose mission is to close gaps in maternal mental health care.

Our core project work includes convening thought leaders, Issuing reports and briefs, and providing technical assistance on policy and health care systems change.

I wanted to re-emphasize that there is a range of maternal mental health disorders and share that the new onset of these disorders happens nearly as frequently during pregnancy as in the postpartum period. And we need to be very concerned about the high numbers of young childbearing-aged women with pre-existing and untreated anxiety and depression.

As we heard, the formula crisis is adding fuel to the fire.

I wanted to point out that the suffering is extremely profound in some cities - most notably Houston and Phoenix. Mothers there have been severely impacted by both the formula shortage and the highest rates of maternal depression.

The field of maternal mental health is complex. There are many multi-faced barriers that both patients and health care providers face. There is certainly no one-size-fits-all nor simple solutions.

Why is this? Our research has shown there are 4 Ps- or Primary barriers and opportunities.

Prevention

In the U.S. we fail to provide young families with basic social services like paid family leave, childcare, addressing social determinants of health including food and formula insecurity and racism, and providing health care coverage & community-based supports.

Payment & Payors

The separate payment system for mental health care in America, called “carve-outs” complicate access for providers and patients alike.

Providers 

Most perinatal providers lack formal MMH education, we are facing significant OB/midwife shortages (what we call the maternal medical home), there are severe mental health provider shortages, and finally, there is misaligned reimbursement to incentivize detection and treatment of these disorders.

Performance Measurement 

In a fragmented health system like ours in America, a framework for quality measurement and national reporting that helps implement a standard of care and hold payors accountable is a must.

As we know health systems change in the U.S. largely lies with the states, and states are beginning to take action from declaring May as maternal mental health awareness month to forming task forces and mandating provider action.

Several states have formed task forces, including California. What did that process look like?

The Task Force Was Formed at the Urging of the Legislature

And included multiple public and private players and called for a report to be issued back to the legislature and to the public.

It Studied the Research, Landscape, Identified Multi-Faceted Barriers, and Opportunities

Similar to the 4 Ps I shared.

It Issued Recommendations to Cross-Sector Players

Including payors, hospitals, community-based organizations, provider associations, and government agencies.

You might be asking, “What has the federal government done?” Many of you may remember the reports issued in late 2020 under the prior administration, by HHS and the Surgeon General. What did those reports say about maternal mental health? A little….

Extend Medicaid twelve months postpartum for substance use disorder.
Called for the creation of provider maternal safety guidelines for the postpartum period, not specific to MMH.
Suggested postpartum depression be addressed for those with access to home visiting programs.
The report also called on SAMHSA to run a challenge to identify programs with promising outcomes addressing postpartum depression in rural communities.
Finally, it called for an awareness campaign to ask women to tell their providers when they are suffering.

While these steps are small steps in the right direction, they focus only on the postpartum period, and in one case, is ill-informed, by asking women to speak up, rather than recognizing when women do speak up most aren’t getting the help they need.

Lastly, I want to emphasize that extending Medicaid is absolutely foundational *and* yet we know the health system is still not positioned to diagnose and treat these disorders.

So what is the solution? The TRIUMPH for new Moms Act calls for the formation of a task force that would work similarly to CA’s to study and understand the complexities of the problem, develop a national strategic plan that includes actions each federal agency can take and that would issue recommendations to the states. This is a foundational step for mothers, communities, and providers across the country.

Thank you.

Question:

We know HHS has a couple of workgroups addressing maternal health, shouldn't they just address maternal mental health?

My answer:

I mentioned the complexities in my presentation, which help warrant the deep and undivided attention that's needed to solve this crisis. Further the Government and Accountability Office, the GAO found in a report issued last year that workgroup members reported competing priorities and that agencies struggle to coordinate. This temporary task force will prioritize maternal mental health and provide these critical structures.

Watch the webinar recording for all of the speaker's comments and view the slides below.
Webinar link
Webinar slides