Improving Mental Health Services to Pregnant Women in an Urban Community Health Center

BACKGROUND: Depression is common in primary care settings. Rates of depression appear to be even higher during the perinatal period and are significantly higher than other common conditions in pregnancy. Prevalence rates for preeclampsia have been reported to be 3% and 4%- 8% for gestational diabetes compared to 15% for depression. Yet depression is overlooked in many pregnant women, often because many health care providers feel unprepared to detect or manage mental health (MH) conditions. Further compounding this problem is a paucity of available resources. Wait times for psychiatric referrals in inner city communities can be 3 months or longer. METHODS: A coordinated system of care was developed by a team of MH specialists and primary care providers at a community health center to address the unmet mental health needs of pregnant women in the South Bronx. This included implementing a standardized screening and referral process, incorporating a “meet and greet” strategy during intake, co-location of MH and primary care services, and offering on-going provider training and support. RESULTS: In the first 6 months of implementation, 89.5% of pregnant women enrolled in care were screened for depression; of these, 31.7% screened positive for depressive symptoms and needed more in-depth evaluation. Twenty-six percent were referred to a MH specialist; 100% of these women received care. CONCLUSION: Using a coordinated system of care increases screening and facilitates entry to MH care. Improving management of MH issues in pregnant mothers may also improve maternal-child bonding and future infant development.