More Help for More Moms: Increasing Access Through Innovation

When we think about innovation in psychiatric practice, our first thoughts are often about exciting new interventions and drug discoveries such as ketamine infusions and transcranial magnetic stimulation. Sometimes innovation in a field like psychiatry represents an advance in what is done, while other times innovation aims to enhance how things are done. In all the excitement about new therapeutic innovations—the what—it can be easy to forget that that even the most incredible interventions have limited benefit if they cannot be broadly accessed. Innovation design that is focused on the how of services delivery is a key component retooling health care so that gaps in access are addressed.

Take the problem of caring for pregnant women and new moms. As many as 21.9 percent of new moms experience depression in the first year of motherhood, which (taking the almost 4 million live births in 2015 as a reference point) amounts to 875,000 cases of postpartum depression each year. This is a problem in serious need of innovation for the mother, the family, and ultimately the next generation of children.

But where to begin?

Let’s use some of the tools of innovation to think about solutions to this problem. First, define the problem. A problem could be framed as how to get more people into a particular specialty clinic or hiring more physicians to see more patients, but that is not our problem. Our problem is untreated mental illness in peripartum women. Paradoxically, narrowing the problem enables us to come up with broader designs possibilities.

Now let’s take out a second innovations tool: analogous learning. Are there other analogous systems that have solved analogous problems successfully? For our current problem, can we learn from models in collaborative care, which creates access to stepped psychiatric treatment in primary care? Can we learn or adapt from models employed for general pediatrics whereby expert child psychiatry telephone consultation is made available to pediatricians regarding psychiatric and psychopharmacologic treatment of children? Is there something we can incorporate from low-resource countries that utilize paraprofessional community health workers to extend the reach of health care?

There are two innovative programs of which we are aware that have developed innovative solutions to our problem. The first is the MCPAP for Moms program in Boston (Psychiatric News, June 2, 2017). This program built upon the successful MCPAP, or Massachusetts Child Psychiatry Access Program, which has been successfully providing telephone consultation from child psychiatrists to general pediatricians for many years. Many states have emulated this program. MCPAP for Moms is a recent adaptation of MCPAP that aims to use the similar technique of telephone access to psychiatrists who provide consultation to frontline providers, the obstetricians. This innovation expands the number of providers who become equipped to identify and treat peripartum mood disorders. The developers of MCPAP for Moms, Program Director Marcy Ravech, M.S.W., and Medical Director Nancy Byatt, D.O., M.S., were recognized by APA with a Gold Achievement Award last fall.

In Connecticut, the New Haven Mental Health Outreach for Mothers (or MOMS Partnership) aims to explicitly foster collaboration between Yale academics, city officials, and community and health care supports for low-income mothers. It was awarded a Kresge Foundation grant in 2017 for its work. This program is designed in the style of modern local health departments “Public Health 3.0” model in that it convenes and supports a network of new public and private partners to focus on an identified problem: the impact of untreated mental illnesses in mothers. In this case, leaning on community supports allows mothers to get the care they need while connecting with their community.

In each case, a local group has designed a strategy that aims to solve the problem of access to care for women with peripartum mental health conditions. These are examples of innovative population health strategies that address how we solve the problem of good access to an appropriate level of care for a group of people. Realistically, our modern health care systems are complex and often based on traditional workflow designs that have been built to serve one patient at a time.

All of us—each one of us who cares for patients—can be innovators. Every time we streamline a clinical workflow and work with new partners to develop new ways to serve a new population, we are changing and improving our health care system. In fact, you’re probably already an innovator.

Yes, our patients depend on us to continue researching, developing, and promoting new therapies. But let’s not forget that we still need better systems to deliver those therapies. ■