Free Service Connects Clinicians With Perinatal Psychiatry Experts

As a community psychiatrist who travels between two rural clinics across southern South Carolina, Brittany Sauerborn, M.D., knows that the patients she sees have limited access to specialty health care. As such, she takes extra care when working with patients who may require additional health services beyond mental health, such as pregnant women. For example, she recently faced the difficult decision of whether to add a second medication for a pregnant patient taking an antipsychotic.

“She was over an hour away from the nearest high-risk OB-GYN, so I had to get this decision right,” said Sauerborn, who is just a few years out of residency and still learning the special considerations of treating pregnant women. While researching online for guidance, she happened upon a phone consultation service offered by Postpartum Support International (PSI), which proved an invaluable assistance.

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Two weeks later, she was discussing her patient with Jennifer Payne, M.D., director of the Women’s Mood Disorders Center at Johns Hopkins University. After consulting with Payne, who is one of the leading authorities in perinatal psychiatry, Sauerborn felt much more confident about her treatment plan.

On top of that, Sauerborn recalled, “It felt like I had called up a friend; she was friendly, down to earth, and didn’t make me feel unknowledgeable.”

“It always feels great to educate other health care professionals,” said Payne, who sets aside one hour each week to provide consultation services through PSI. “It may not seem like a big impact, but everyone I can empower becomes someone else who can share knowledge; it becomes a domino effect.”

Filling a Pregnancy Care Gap

Stories like the experience between Payne and Sauerborn fill PSI Board President Ann Smith, C.N.M., with a great sense of pride. “This initiative is a baby of mine,” she said of the consultation service, which launched in 2018.

“We know how difficult it is for women nationwide to access mental health care,” Smith explained to Psychiatric News. What she found equally distressing is that pregnant women fortunate enough to get to a mental health care professional often receive inadequate care. “Though perinatal depression falls under the aegis of depressive disorders, there are many differences in how you screen and treat this disorder,” she said.

Unfortunately, many mental health care professionals do not know how to treat pregnant women properly, Smith continued. “And I felt it was incumbent on us [PSI] to try and fix that.”

Smith wanted to provide a free service so that any frontline physician could reach out and have a conversation with a nationally recognized expert in perinatal psychiatry. Though an online forum was initially considered, Smith settled on a phone consultation service since live conversations can uncover nuances that might be overlooked in typed messages.

The process starts with an appointment call. The physician selects a time that works for him or her, and then an appointed expert calls the physician at that time. Anyone associated with the physician—an office manager or nurse—can make the initial appointment call, but the prescribing doctor has to take the consultation call personally.

Currently, 12 perinatal experts volunteer as PSI consultants, with several others who have indicated support once the call volume increases. “I have been thrilled with how energized the reproductive psychiatry community has been since we launched this service,” Smith said, but added, “We are always happy to take more since we know the demand is out there.”

There is no minimum time requirement expected of the volunteer experts. “Tell us what you can manage. If it’s one hour a month, we will take it,” said Smith. And though the work is pro bono, the consultants do receive “PSI Bucks,” which provide discounts to services like online courses or the PSI annual meeting.

Bridging Patients and Doctors

The key now is spreading the word to more people. Smith and other PSI leaders do their part by plugging the consultation service at meetings and events, but she said that mothers have been some of the biggest promoters to date.

“From what I hear, a lot of our consult calls start with the phrase, ‘My patient told me …,’” said Smith, which shows that patients often learn about the service first and then tell their doctors about it. She finds satisfaction in that patient initiative because it demonstrates PSI’s success in supporting both patients and physicians—and acting as a bridge between the two—key PSI missions since it was founded in 1987.

Smith is keen to point out that PSI offers more than just consultations to psychiatrists and other physicians. Last year the organization also initiated a certification program in perinatal mental health with specialty tracks for psychotherapists, prescribing physicians, and support staff like nurses, doulas, and lactation consultants. PSI’s current project is establishing a national directory of trained therapists and psychiatrists to help with referrals.

But the impact that the consultation service has made on patient lives cannot be understated. “In some situations, that one phone call can be a real game changer,” Smith said.

Though Sauerborn has used the service just once, it was a valuable resource. “I do feel more comfortable now, even just knowing it’s available,” she said. “If an unfamiliar situation arises, I would definitely use it again.”

“There is a lot of misinformation out there about pregnancy and mental illness,” Payne said. “If you’re not 100% sure about something, then call. That’s what we are here for.” ■