Consensus Bundle on Maternal Mental Health: Perinatal Depression and Anxiety

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Kendig et al's article describing the Consensus Bundle on Maternal Mental Health1 is timely and excellent. As the authors point out, in clinical settings where screening is implemented, there also must be systems in place to implement interventions and monitor outcomes for women who screen positive. Some women will need to be referred to and treated by specialty mental health care providers, but most women can be treated within the setting where they were screened and in fact prefer this model.2 The authors mention “initiation of treatment incorporated into perinatal care settings” but cite an example of referral to behavioral health in an integrated health care delivery system.3 Many clinical settings do not have the luxury of expedited access to behavioral health. In addition, rates of follow-up on mental health referral are as low as 23%.2
A study describing mental health treatment in perinatal care settings is incomplete without a description of collaborative care, especially with the growing emphasis on integration of behavioral health into primary care. This is an unfortunate omission, given that collaborative care leads to better outcomes than usual care,4 even in obstetrics and gynecology settings5 and perinatal populations in primary care settings.6
All aspects of treatment for perinatal depression that the authors discuss—psychotherapy, antidepressants, and coordination of care—can be delivered by collaborative care teams that include a care manager, a psychiatric consultant, and obstetrician–gynecologists or other perinatal care providers. The care manager serves as a bridge between the patient, the perinatal providers, and the behavioral health provider, addressing challenges with access and transitions in care.
Table 2 in Kendig et al1 lists “Useful Resources,” but these resources, taken in isolation, do not achieve a maternal mental health safety bundle. Creating a collaborative care team within a perinatal clinic can provide integrated mental health care while achieving the triple aim of high-quality, low-cost care and improved patient outcomes. Collaborative care is achievable, even in resource-sparse settings, and accomplishes the maternal mental health safety domains outlined in Box 1 in the article.
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