Milken researcher grades states on maternal mental health policies, gives the District a D-plus

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Caitlin Murphy said her report was the first to grade states’ maternal mental health policies and that she plans to update the report cards every year.

Updated: May 26, 2023, at 11:11 a.m.

A researcher in the Milken Institute School of Public Health found D.C. lacks sufficient mental health care services for mothers in a report released earlier this month.

Caitlin Murphy, a research scientist and third-year doctoral student in health policy and management, created report cards grading each state on their maternal mental health policies and programming and gave 42 states a D or lower, which Murphy said reveals a national need for more maternal mental health services like specialized providers and treatment programs for disorders like postpartum depression. The report graded the District a D-plus because it fulfilled just seven of the report card’s 17 measures, a score that Murphy said could improve if D.C. begins requiring all OB-GYN to screen for maternal mental health disorders and requires insurance reimbursement for pregnancy and postpartum mental health screenings.

Murphy said she worked alongside the Policy Center for Maternal Mental Health — a nonprofit organization advocating to improve the detection and treatment of maternal mental health disorders — to develop the 17-measure report cards over the course of nearly a year using national data on policies like insurance coverage and requirements for perinatal mental health screenings. The report gave 16 states, including Texas, Connecticut and South Carolina, an F, while California received a B-minus on its report card, the highest grade in the country and the only state to receive higher than a C-plus.

“We, myself and the policy center, would really like people to understand not only the depth of maternal mental health need in the United States, but the fact that maternal mental health disorders impact one-in-five mothers, the fact that they’re the leading cause of maternal mortality in the U.S. and the fact that screening is really not occurring,” Murphy said.

One-in-five mothers suffer from postpartum depression, according to Postpartum Support International. Centers for Disease Control and Prevention data from May 2022 shows that more than half of pregnant women with depression go undiagnosed, and suicide accounts for up to 20 percent of maternal deaths, according to the policy center.

Murphy said her report was the first to grade states’ maternal mental health policies and that she plans to update the report cards every year. She said the report breaks down its areas for measurement into the three sections — providers and programs, screening and screening reimbursement, and insurance coverage and payment.

Murphy said she and researchers at the policy center gave the District an F for screening and screening reimbursement and a D for providers and programs because the city does not have specialized inpatient or outpatient treatment programs for maternal mental health disorders, the report shows. The report graded D.C. a C in insurance coverage and treatment payment because the District does not require insurance health plans to develop maternal mental health quality management processes, which ensure services meet a certain standard.

“Postpartum depression, anxiety, those show up very differently than generalized anxiety or generalized depression,” Murphy said. “Having a specialized provider is really the most beneficial to the individual receiving treatment. So us wanting to spotlight the fact that there are these specialized providers and specialized programs and just how limited they are right now.”

Murphy said she began working with the policy center about a year ago after requesting to join their team of six or seven researchers as a part of her GW doctoral practicum, which is required for her degree. She said her role in creating the report cards as the lead researcher involved assessing available data about current policies to determine the report’s metrics, deciding how much weight each measure had in determining the grade and collecting data on the various measures.

She said research for the report cards involved compiling data from the policy center and four organizations tracking maternal mental health care — Kaiser Family Foundation, FAIR Health Policy Center, the National Academy for State Health Policy and Postpartum Support International.

Murphy said the policy center released a roadmap along with the report cards with recommendations for states to follow as a guide for improvements to increase insurance coverage and requirements for providing maternal mental health. The roadmap asks state and federal governments to increase provisions for maternal mental health services and to develop state-specific plans that address the issues presented in their report cards.

She said she hopes researchers include data on whether states require providers to receive implicit bias training, insurance coverage for doulas — professionals who provide physical and emotional support during and after childbirth — and HEDIS and EPDS Perinatal Depression Screening — metrics that determine maternal mental health care — in future iterations of the report cards because more states are starting to record data through those metrics.

“We would really like to see these report cards spark action in terms of folks recognizing the breadth and depth of gaps,” Murphy said. “But also the recognition that there are very concrete actions that can be taken immediately by state and federal governments.”

Perinatal and reproductive experts said they were “excited” to see report cards that gathered maternal mental health data in each state and that states could improve report card grades by funding intensive outpatient programs that would directly bring nurses and practitioners into new parents’ homes to increase access to maternal mental health services.

Lynne McIntyre, a perinatal psychotherapist formerly based in D.C. and a GW alumna, said D.C. received a D-plus because the District does not require screening maternal mental health disorders, but states must provide accessible maternal mental health care for mandated screening to be effective. She said D.C. has a “foundation” to prepare for potential future mandated universal screening in part because she established a perinatal-health help program through Mary’s Center, a community health center in the District, and Children’s National Hospital in D.C. created commissions to improve mental health.

McIntyre said D.C. is fundraising to bring an intensive outpatient program to treat maternal mental health disorders to Georgetown University Hospital “very soon,” making it the 28th program in the country, which would improve D.C.’s grade in the report cards.

“D.C. has been doing it the right way in that we have been building up the system’s ability to take in, hold, treat women appropriately and effectively in the language they need,” McIntyre said.

Adrienne Griffen, the executive director at the Maternal Mental Health Leadership Alliance in D.C., said the report is helpful because it demonstrates the priorities states should place on mental health policy but that the report cards did not account for statewide nonprofits or community programs in states like Utah, New York and Virginia that provide services requested in the report cards.

Griffen said she thinks D.C. residents will be surprised to see the District’s low score because Children’s National Hospital and support groups have made efforts to provide counseling and psychiatric services to new mothers.

“No matter what measurements you’ve come up with, they’re never going to get the full picture,” Griffen said. “The challenge with any kind of analysis is you’re never going to get all the pieces of the puzzle.”

This post has been updated to correct the following:
The Hatchet incorrectly reported McIntyre is a psychiatrist. She is a psychotherapist.

The Hatchet also updated this story to specify that McIntyre and Griffen were referring to Children’s National Hospital instead of children’s hospitals in D.C., as there is only one children’s hospital in the District.

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