‘Like Going to the Dentist’: The Business Case for Maternal Mental Health

This is an exclusive BHB+ story

Maternal mental health and well-being have been on the clinical back burner for years. That is compounded by the U.S. having some of the worst maternal mortality rates and poor maternal health outcomes of any industrially developed nation.

Against this backdrop, practitioners increasingly say maternal mental health should be separately treated instead of lumped in with general population mental wellness because of the unique needs this period of life has for mothers.

“There’s this misperception that a one-size-fits-all approach is enough, whether it is a broad women’s health solution or a broad mental health solution,” Emma Sugerman, co-founder and chief operating officer at Mavida Health, told Behavioral Health Business. “There are a lot of nuances as to why that’s why that’s not true – not least of which is the uniqueness of this life stage that makes it a very common entry point for a lot of folks into mental health care.”

Mavida Health is an online therapy and mental health service that specializes in maternal mental health.

“What we’ve seen is that a specialized maternal mental health offering is going to be quite a bit stickier than a broad solution, because they feel that their unique needs are understood and reflected,” Sugerman said.

Systemic and reimbursement barriers

Between 50-75% of birthing people are impacted by prolonged periods of depression and anxiety after giving birth – and sometimes leading up to it. Only in 2023 was the first oral medication to treat postpartum depression approved by the Food and Drug Administration.

Still, many women aren’t even aware of the pill’s existence, and even fewer are aware of specific mental health service lines for mothers. Meanwhile, postpartum maternal deaths are still on the rise.

“As women and as a society, we tend to think of pregnancy and the postpartum period as all about the baby,” Dr. Rachel Dalthorp, executive medical director of specialty services at LifeStance Health (Nasdaq: LFST), told BHB. “It’s an exciting time, and we want to ensure the baby gets the best start in life. Unfortunately, this can lead to less attention being paid to caring for mom, and supporting her mental and emotional health. Sometimes, mom’s mental health needs are dismissed as a ‘normal part of pregnancy or childbirth,’ because the physical and emotional symptoms associated with depression and pregnancy postpartum can overlap.”

LifeStance Health is one of the nation’s largest providers of virtual and in-person outpatient mental health care, with more than 550 centers across 33 states.

There are also few specialized experts in the space, adding to existing barriers.

“There’s a limited number of reproductive or perinatal psychiatrists with specialized expertise and experience caring for women during pregnancy and postpartum,” Dalthorp said. “Some mental health providers are less familiar with prescribing medications in these periods.” 

The “baby blues” were recognized in some capacity as early as 700 BC by Greek physician and philosopher Hippocrates, but it wasn’t until 1994 that postpartum depression was formally medically defined as a condition.

“Where I have seen opportunity is in more awareness being spread about these conditions, more advocacy and more technological solutions for the space, like my company, in creating access,” Lauren Elliott, founder and CEO of Candlelit Care, told BHB. “I’ve loved seeing that evolution, but I know for the communities that I focus on, stigma is still a huge deal. … Trying to break barriers of getting solutions like mine into health systems, into health insurance companies, or funded at least by them, that’s been the barrier over the years.”

Candlelit Care is a digital mental health platform focused on providing care to Black mothers who are perinatal or postpartum.

Black mothers in particular are 3 times more likely than their white counterparts to experience postpartum depression. And around 40% of Black mothers experience a mental health condition.

“The barrier I’ve seen the most is in the reimbursement of solutions now that there’s a lot of research and evidence behind their effectiveness,” Elliott said. “The challenge still seems to be the reimbursement and the funding of these solutions.”

OBGYNs can, to an extent, provide some mental health services for maternal patients, but the focus of these visits tends to be on physical health. That limits the time that can be spent addressing other concerns, Dalthorp explained, and reimbursement for those services isn’t on par with other care either.

“While awareness is growing, there’s still room to expand OB involvement in addressing mom’s mental and emotional health,” Dalthorp said. “Simplified referral processes and collaborative care models can help reduce delays and improve timely access to mental health care. Payment models, including bundled payments for perinatal OB care, can make it difficult for OBs to be fairly reimbursed for the time they spend supporting moms’ mental health. Separate physical and behavioral health benefits add complexity for clinicians and patients.”

Maternal mental health leads to cost savings

Another barrier is U.S. policy, these practitioners resoundingly told BHB.

Lack of parity enforcement around mental health care, in addition to few employment benefits for maternal leave, contribute to its stigmatization.

To put this in perspective even further, most U.S. states have laws prohibiting the separation of puppies from their mothers before eight weeks, yet for human mothers, there is still no federal law mandating paid maternity leave – exacerbating health and mental health outcomes.

“Postpartum mental health, or maternal mental health in general, needs to be looked at like going to the dentist. It’s not a choice,” Neha Kumar, maternal mental health expert and owner at Prose and Psyche, a private practice in Orange County, California, told BHB. “You need to get your teeth cleaned or you’re going to lose your teeth.”

The conversation about maternal mental health needs to start sooner and be integrated into other areas of health care in order to move the needle, she explained.

“Once people are cognizant of the fact that this is what’s going to actually make society healthier: Healthier moms produce healthier babies, which produces healthier citizens, which produce a healthier country,” Kumar said. “Ultimately, there needs to be more buy-in. I think it could be financially lucrative as [a service line], absolutely, but the perception around it needs to be changed. People need to realize that this is a must, as opposed to an option.”

If conversations around maternal mental health start earlier so these conditions can be addressed head-on, it will result in better physical health outcomes both for the mother and the baby, she said.

Investing in maternal mental health interventions yields cost savings downstream, which can not only underscore the business case for building out these specific service lines, according to Sugerman, but also produces a better environment for the baby to grow.

The cost of untreated perinatal mood and anxiety disorders can be up to $32,000 per patient from pregnancy through the first five years postpartum, a 2020 study found. Yet half of perinatal mothers who have a diagnosis of conditions like depression do not get the treatment they need.

“It speaks to the need to continue to pound the pavement and educate folks about what’s needed and what’s supportive here,” Sugerman said. “When it comes to specialized care, if I wouldn’t accept a generalist to treat my cancer, to treat my heart disease, why would I accept that for my mental health? … We need to be responsive to the need, and we need to continue to educate folks and push for policy that reflects what we do know, that reflects evidence, that reflects research.”

Looking ahead, Elliott hopes the industry can begin to value maternal mental health akin to how it handles gestational diabetes. Demonstrating that more concretely will help these emerging maternal-focused solutions to scale, she said.

“If we build the infrastructure in a seamless way for providers and grow adoption, then that brings us closer to reimbursement,” Elliott said. “Tests for physical conditions, unlike behavioral health, which is not as tangible, are well funded. There’s a very seamless reimbursement pathway. … I’ve been trying to use our solution as a way to showcase both qualitative and quantitative measurements of, ‘What does quality of life look like when you’re bringing a solution like ours into the fold?’ That’s in addition to the physical conditions that all of the solutions in the maternal mental space could be supporting: reducing hemorrhages, reducing conditions of diabetes and trying to showcase the duality of what the cost savings could look like both prenatally and postnatally.”