College of Medicine

The Florida Maternal Mental Health Collaborative (FLMMHC) and the Florida State University College of Medicine hosted Florida’s 8^th Annual Perinatal Mental Health Conference Dec. 8 and 9, the first time it has been held in Tallahassee since the inaugural event.

The theme, “Collaborating to Address our Maternal Mental Health Crisis,” was not hyperbole. Perinatal mental health, encompassing the period shortly before delivery as well as the post-partum time frame, is the No. 1 health problem related to pregnancy in Florida and a growing problem nationwide.

Heather Flynn, Ph.D., chair of the College of Medicine’s Department of Behavioral Sciences and Social Medicine, co-founded FLMMHC in 2015 with a vision that every woman in Florida and her family would receive the health and support they need for optimal maternal mental health and related conditions.

“It’s a holistic approach to mental health, and it really is a collaborative effort,” she said. “We seek solutions, and anyone is welcome to join.”

Flynn presented a conference session titled “Florida Behavioral Health Impact: Improving maternal and pediatric access to care and treatment.” An initiative of the Florida Department of Health, FSU College of Medicine and FLMMHC that provides educational materials and other resources to support practitioners who are addressing maternal and child health issues of their patients, BH Impact offers easy ways to incorporate mental health assessment into prenatal, post-partum and well-child appointments. Other partners are the University of Florida, Florida Association of Healthy Start Coalitions and Sunshine Health.

Research conducted at FSU and elsewhere has shown that many practitioners do not routinely screen mothers for depression during pregnancy or in post-partum follow-ups, which BH Impact lists as one of its five core components.
 
Neglect of maternal mental health is a common problem across the country.

A report released in May from the non-profit Policy Center for Maternal Mental Health, in partnership with researchers from George Washington University, showed 40 states and the District of Columbia received grades of D or F on several key issues including screening, access to therapists and access to treatment programs. One state scored a B-; three states scored a C; and no state where access to abortion has been severely curtailed received a grade higher than D+, further underscoring the lack of concern for maternal mental health and the impacts on society for failure to treat Perinatal Mood and Anxiety Disorders (PMADs).

Originally launched as a pilot in Alachua, Duval and Leon counties, the BH Impact program has been expanded to obstetrics providers in 16 counties and has served patients from 34 Florida counties and three in Georgia. There are 28 practices enrolled, with 326 providers, and 41 training events have been held, including behavioral health training events.

“It is about putting our families first, while centering on our mothers,” said College of Medicine’s Adam Baptiste, M.D., statewide coordinator of FLMMHC.

Post-partum depression and anxiety are common, and the long-term effects on the mother, the child and the rest of the family can be extreme if left untreated.

The BH Impact program costs $650,000 per year, which translates to $3 per birth using 2021 birth rates. This includes using the Reproductive Psychiatric Consultation and Referral at least once during pregnancy and once post-partum. Flynn said. With one in every seven or eight mothers experiencing PMADS, the costs of later dealing with problems not identified and treated perinatally jumps to more than $988 million.

“It was a crisis before the pandemic, but now it’s even worse,” said Robert “Bob” Ammerman, Ph.D., a staff psychologist in the Division of Behavioral Medicine and Clinical Psychology at the University of Cincinnati. One of two keynote speakers at the conference, Ammerman is also scientific director of Every Child Succeeds at Cincinnati Children’s Hospital Medical Center.

One in seven to 10 pregnant women and one in five to eight post-partum women exhibit symptoms of major depression. Men also can develop perinatal depression as the major changes to the family dynamic come with childbirth, including concerns about finances, the ability to be a good parent and partner and family safety. Untreated depression can lead to additional health problems, Ammerman said; some people will develop psychosis. An estimated 20% of post-partum deaths are suicide, but many other deaths result from failure to seek medical treatment for health problems related to depression.

Symptoms of depression include sadness, fatigue, depressed mood, weepiness and lack of interest in everyday life.

The lack of bonding between an infant and a depressed mother can make the infant fussy and delay development of motor and cognitive skills, including future risk of emotional and behavioral problems and academic underachieving.

“Half of all psychiatric disorders begin before age 14,” Ammerman said. “Age 6 is the median age of onset.”

Ammerman and colleague Frank Putnam, a child psychologist, developed a Strengths and Difficulties Questionnaire for screening children ages 2-6 to determine how likely they were to develop or have already developed a psychiatric disorder. They screened more than 15,000 children.  

Ten years ago, Ammerman helped launch “Moving Beyond Depression,” a train-the-trainers model that expanded counseling for new mothers to home visits – either in person or through telehealth visits – in an effort to reduce the stigma, embarrassment and shame of seeking mental health treatment. By piggybacking on home visits by social service workers, with whom the mothers form strong bonds, the program helps mothers become more comfortable with seeking help.

The conference’s other keynote speaker, Omari Maynard, shared details of how he lost his life partner, Shamony Gibson, shortly after the birth of their second child because practitioners dismissed her chest pains as overdoing it too soon, when in fact she had a pulmonary embolism.

The artist, activist and educator co-founded The ARIAH Foundation, which uses art, education and advocacy to mitigate the impact of systemic racism and oppression on the sexual and reproductive health and birth outcomes in communities of people of color.

“Aftershock” tells his and Shamony’s story as well as that of another couple with a similar outcome. It won the 2022 Sundance Award for best documentary.

“It’s time for the men to join this fight,” he said.

Contact Audrey Post at audrey.post@med.fsu.edu.

Photos by Colin Hackley for the FSU College of Medicine.

Spotlight photo on Home page: Stakeholders from across Florida gathered at the FSU Alumni Center for the 8th Annual Florida Perinatal Mental Health Conference.

Photo at top right: Heather Flynn, Ph.D., welcomes Robert Ammerman, Ph.D., to the conference.