In America’s growing maternal health crisis, more attention is being paid to mental health.
The Centers for Disease Control and Prevention released an alarming report last year estimating that 84% of maternal deaths can be prevented. While that takeaway deservedly garnered national headlines, the report shed new light on mental health and deaths tied to pregnancy. Mental health causes contributed to the largest number of deaths among white, Hispanic, and American Indian or Alaska Native mothers.
With that focus in mind, two digital health companies are tackling the issue. Brightside Health, a telehealth firm focused on mental health, and eLovu Health, a digital health firm serving women during and after pregnancy, have partnered to help pregnant patients get more access to mental health services.
Members of eLovu can be referred to Brightside for mental health services.
“What we have today is a mental health crisis among the pregnant population,” says Santosh Pandipati, chief medical officer and co-founder of eLovu Health. “We’ve got a situation that is worsening, especially with certain subgroups.”
Mimi Winsberg, chief medical officer and co-founder of Brightside Health, says a patient’s mental health is very much tied to their overall health during and after pregnancy.
“A patient’s mental health is also going to dictate the way that they’re taking care of themselves,” Winsberg says. “And there’s going to have a strong interplay between the way their physical health is managed.”
Pandipati and Winsberg spoke with Chief Healthcare Executive® about the partnership, the mental health challenges among pregnant and postpartum patients, and the role of telehealth in expanding access to patients.
(See part of our conversation in this video. The story continues below.)
Snowball on tip of the iceberg
Both Winsberg and Pandipati say the maternal health crisis doesn’t solely encompass the tragic number of patients who are dying. Tens of thousands of women suffer complications during and after pregnancy, according to the Commonwealth Fund.
“There’s a morbidity crisis as well,” says Pandipati, a maternal-fetal medicine physician. “And mortality is just the tip of the spear, right? It just represents the worst of the worst. But mortality doesn’t happen in a vacuum.”
Winsberg adds, “It’s not the tip of the iceberg. It’s the snowball that sits on top of the tip of the iceberg. And so we know that there’s a lot more underneath, from mild anxiety that’s experienced by so many women to severe illness that may not result in mortality, per se, but certainly contributes to morbidity and larger healthcare spend.”
With the eLovu platform, a number of mothers are being flagged for mental health issues, including depression, anxiety and suicidal ideation, Pandipati says.
When looking at other companies connecting patients to mental health services, he says Brightside was an obvious choice.
“It was very clear that Brightside had the capability, the footprint, the desire and dedication,” Pandipati says. “Every meeting we’ve had with Brightside has been passionate in terms of solving this problem.”
Brightside offers a network of clinicians and can be paid for with insurance in all 50 states and Washington, D.C. Last week, Brightside announced it was partnering with other healthcare organizations to make its virtual mental health services available to members of Medicare and Medicaid.
Part of the appeal of working with Brightside is getting patients connected to clinicians quickly, Pandipati says.
While patients often have to wait to get appointments with behavioral health clinicians, Brightside can typically get patients connected with a clinician in 48 hours, Winsberg says.
She says getting appointments quickly is critical for any patients with mental health needs, but it’s especially important for those who are pregnant and for postpartum patients.
“We need to have the access available, particularly for women struggling with postpartum depression, because time is of the essence,” Winsberg says. “It’s not just their lives that are at stake. It’s also the infant’s well-being that’s at stake, and that period of bonding with the baby and being able to provide care for the baby is so essential. We can’t delay treatment. Waiting four-to-six weeks for an appointment is a non-starter.”
Depression and anxiety are common among women in pregnancy, but sometimes, it’s not easy to see, Pandipati says.
While patients see doctors regularly during the course of their pregnancy, prenatal visits can be brief and clinicians don’t see that women are struggling.
“Often these issues are unaddressed,” Pandipati says. “They’re unaddressed for a number of reasons, time constraints, patients don’t bring these issues up, because they worry that they may not get a productive response from their clinician.”
They also stressed that offering better mental health services improves the chances of patients having healthy babies. Researchers have found depression is linked to preterm birth and low birth weight.
Postpartum patients are “especially vulnerable” when it comes to developing depression, and it goes unnoticed, Pandipati says.
“We have a significant care gap there,” he says. “Because if you have a vaginal delivery, you’re not typically seeing your prenatal care provider until six weeks, well past the time that postpartum depression may have set in, and potentially worse, psychosis and suicidal thinking.”
Earlier interventions to women suffering from postpartum depression could make a big difference, Winsberg says.
“The postpartum period is a key period in a woman’s life,” Winsberg says. “We can acutely address issues that may come up during that period. But we also know that it may have longer term implications for things like that woman’s risk for major depressive disorder down the road, or even bipolar disorder. And so it’s a key opportunity to intervene for acute issues, but it will have longer term health benefits down the road.”
Telehealth and access
More patients are utilizing telehealth for behavioral health services. Nearly two-thirds (62.8%) of telehealth visits in the fourth quarter of 2022 were for behavioral health appointments, according to an analysis by Trilliant Health.
Some patients are more comfortable talking about depression or their anxiety in the comfort of their home as opposed to going to an office, Winsberg says.
Beyond the comfort factor, telehealth is offering mental health services for patients that may not otherwise have any access, due to a shortage of clinicians.
“Patients in rural areas can access our services easily,” Winsberg says.
Many patients live in maternal care deserts, Pandipati notes. An analysis by the March of Dimes found that one in three counties has no obstetric services.
Similarly, some patients, and not just those in rural areas, have limited access to behavioral health. Over half of all U.S. counties are without a practicing psychiatrist, according to the University of Michigan.
“There are mental health care deserts as well,” Pandipati says.
Even for pregnant patients that have access to mental health services, telehealth makes it easier for some to actually use them. Some pregnant patients with other small children may have trouble finding child care, Winsberg says.
“Mothers who have children at home may not be able to get to clinics easily, or are fighting stigma issues around going to a mental health clinic,” she says. “These are all situations in which telemedicine does lower barriers to care.”
“We hope that telemedicine can reduce some of these barriers that exist for certain groups who may otherwise have poor access to care,” Winsberg says.
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