Making Care for Women's Mental Health and Substance Use Issues a Priority

On her second day home after giving birth to her first child in 2012, Christina Jones* sat in a rocking chair, shook her head furiously and cried to her husband that she couldn't "do this." Instantly overwhelmed by the changes that came along with having a baby, Jones felt as though she was physically separated from her body. Where was she? How could she escape from this life as a mom? Would she ever feel "normal" again? "Even eating had become a chore," Jones recalls. "My hands would visibly shake at the dinner table."

In the months to come, Jones slowly acclimated to her family of three. But instead of feeling sad and depressed, she now felt anxious all the time. "When I woke in the mornings, my heart would race in fear as I waited for my daughter's first cry to start the day," Jones says. She would have near panic attacks when running errands with a fussy baby. And she would race from work to day care each evening in fear that running even a minute late would send her child into a tailspin, resulting in ruined bath- and bedtime. It was a vicious cycle that only subsided for a short time, until these issues recurred with the birth of her second child three years later.

But when Jones' second daughter was born, she was a little wiser and braver. "This time, soon after the baby was born, I didn't hesitate to call my doctor and cry to him on the phone," she says. "I knew I needed help, and I wasn't ashamed to ask for it."

*Not her real name

Meeting the Need

What about women who don't know how to get help? Should they simply call their OB-GYN? And what about new moms who don't fully understand what to call their issue—or even realize it's more than the "baby blues" — much like Jones felt with her first child? More importantly, what about those wives whose husbands and families don't offer support, so they feel embarrassed to admit they need help? The stigma surrounding these issues often causes them to suffer in silence.

Enter Kimberly Buckingham, PsyD, a behavioral health consultant with UM Upper Chesapeake Women's Care. Two years ago, Dr. Buckingham's position was created because of the high need for mental health and substance use support in Harford County, particularly for women. Three primary care sites under the UM Upper Chesapeake Health umbrella—UM Upper Chesapeake Women's Care, UM Upper Chesapeake Primary Care and UM Harford Primary Care—now have behavioral health consultants on-site and embedded within the practices, making this type of care more accessible.

At UM Upper Chesapeake Women's Care in particular, behavioral health issues related to postpartum depression (PPD) and postpartum anxiety (PPA) are frequent. PPD and PPA are defined as moderate to severe depression or anxiety experienced by a woman after giving birth. It may set in within the first few months after delivery or as long as a year later. Symptoms frequently include feeling scared or panicky, not enjoying things you used to look forward to, and feeling unusually sad, anxious or worried. In some cases, thoughts of harming yourself or your baby may occur.

"I see a lot of patients with peri-natal [during pregnancy] depression and postpartum depression," Dr. Buckingham says. "They account for nearly 30 percent of my caseload. Women have higher rates of depression than men for various reasons—hormonal, societal and emotional. So having access to care [within UC Women's Care] is really important."

"Access to behavioral health services is not always available, so integrating a service like this makes it easier for patients to get access to treatment," she continues. "Patients feel more comfort-able with their doctors that they've been working with for a long time. They are also more likely to keep an appointment if it's in the same office as their primary care doctor or OB-GYN."

In the United States alone, about 70 to 80 percent of women will experience, at a minimum, the "baby blues." Many of these women will develop the more severe conditions of PPD and PPA. One recent study found that 1 in 7 women may experience PPD in the year after giving birth. With approximately 4 million live births occurring each year in the United States, this equates to almost 600,000 PPD diagnoses.

Helping Women of all Ages

Dr. Buckingham and the Women's Care team have implemented a screening process for new patients that alerts providers to any red flags regarding self-care and mental health. This is given to all women, not just those who are newly pregnant. Another screening is provided to new moms in the weeks after giving birth.

If the answers from the original screenings bring up concerns, it allows for the start of an open conversation between the patient and her provider. The woman is then referred to Dr. Buckingham for an intake session where, together, they review the patient's history and her symptoms and stressors. Dr. Buckingham consults with a collaborative care psychiatrist on the consultation team to develop a treatment plan for the patient and then forwards these recommendations to the OB-GYN.

The OB-GYN can subsequently write a prescription, if needed, for the patient. Dr. Buckingham continues to provide monitoring and follow-up for these women, sometimes offering counseling on the phone depending on the situation. "It's a highly effective consultative model," she says.

"It's my job to determine if my patient's situation is really getting better," Dr. Buckingham says. "In some cases, I may refer her to other resources in the community, including longer-term counseling."

Providing prenatal and postpartum consultation isn't Dr. Buckingham's only role; she also sees older women going through menopause whose hormonal fluctuations may cause depression and anxiety. Sometimes she encounters women who are under a lot of stress and are experiencing anxiety or depression.

"There are so many pressures on women," she says. "They're juggling a lot of roles, like motherhood, taking care of older parents, having jobs and finding child care. It's a lot to manage. And most often these women put themselves in last place when it comes to caring for themselves."

Dr. Buckingham also doesn't want to overlook the substance use prevention and intervention aspect of her job. "We're in the midst of an opioid crisis, and it's impacting practices across the nation, including women's care. I can help connect addicted women and moms to treatment programs if that's something they need."

Looking back, Christina Jones says she wishes that there had been an initial screening at her OB-GYN when she became a new patient and that her practice had someone like Dr. Buckingham in-house during her pregnancy and after birth. "If so, I would've realized that my issues were quite common. And I wouldn't have hesitated to get help," she says. Hopefully, she adds, a mom-to-be, a new mom, a stressed-out working woman or a menopausal woman will read this article and know that help is available. And it's available right outside of the waiting area in the Upper Chesapeake Women's Care practice.

"Accepting help is a good thing," stresses Dr. Buckingham. "It doesn't mean you're not a good mom, wife, friend, sister, aunt or grandmother — you're just building up to becoming the best one you can be."