In November 2015, Congresswoman Katherine Clark of Massachusetts and Congressman Mr. Costello of Pennsylvania have introduced the following bill; Bringing Postpartum Depression Out of the Shadows Act of 2015 [H.R. 3235]. (Read the text here: Bringing Postpartum Depression Out of the Shadows Act of 2015) This bill would amend the Public Health Service Act to authorize the Secretary of Health and Human Services, acting through the Administrator of the Health Resources and Services Administration, to make grants to States for screening and treatment for maternal depression. The Bringing Postpartum Depression Out of the Shadows Act would build upon existing state and local efforts by providing targeted federal grants to assist states in developing programs to better screen and treat maternal depression. A companion bill, S. 2311, was introduced in the U.S. Senate by Senators Dean Heller (R-NV), Kirsten Gillibrand (D-NY), Kelly Ayotte (R-NH) and Ed Markey (D-MA)].
The Melanie Blocker Stokes MOTHERS Act, sponsored by Senators Menendez, Durbin and Snowe, was written to provide support services and education to women suffering from postpartum depression and psychosis, and to support research into the causes, diagnoses and treatments for postpartum depression and psychosis.
The MOTHERS ACT stands for “The Mom’s Opportunity to Access Health, Education, Research, and Support” for Postpartum Depression Act.
When the U.S. Patient Protection and Affordable Care Act passed in 2010, the MOTHERS Act was included in the text of the bill. The adoption of the Patient Protection and Affordable Care Act (ACA), Section 2952: Support, Education, and Research for Postpartum Depression mandated ongoing research to better understand the frequency and course of postpartum depression, address differences in treatment needs among racial and ethnic groups, and develop culturally competent evidence-based treatment approaches (U.S. Department of Labor, 2012). However, Congress has not appropriated funds to carry out the activities authorized in these provisions.
The MOTHERS Act was historically significant, introducing language of postpartum depression into the federal legislative record, and it garnered support and interest across the US and across political parties. However, none of the provisions of the Act were activated with funding. Subsequent legislative action has been state-based, until the introduction of the Bringing Depression Out of the Shadows Act in 2015, as mentioned above.
Although there are no US federal policies that require screening of new mothers for postpartum depression, at least 12 states have adopted either state legislation, developed awareness campaigns, or convened tasks forces. States that require screening include New Jersey (Findings, Declarations Relative to Postpartum Depression, 2006), Illinois (Perinatal Mental Health Disorders Prevention and Treatment Act, 2008), and West Virginia (Uniform Maternal Screening Act, 2009). Other states require education about postpartum depression including Texas (Relating to Information Provided to Parents of Newborn Children, 2005), Virginia (Certain Information Required for Maternity Patients, 2003), Minnesota (Postpartum Depression Education and Information, 2015), and Oregon (Relating to Perinatal Mental Health Disorders and Declaring an Emergency, 2011). Washington has passed statewide awareness campaigns, and California, Michigan, and Oregon have postpartum depression awareness months. Maine, Maryland, Massachusetts, and Oregon have appointed perinatal depression task forces. Read below for more details about the history of state laws and initiatives.
Reference: Rhodes, A. M., & Segre, L. S. (2013). Perinatal depression: A review of US legislation and law. Archives of Women’s Mental Health, 16(4), 259-270. doi: http://dx.doi.org/10.1007/s00737-013-0359-6
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2014: The California Legislative Women’s Caucus put forth Assembly Concurrent Resolution (ACR) 148 which was passed in 2014. ACR 148 requested that the California Maternal Mental Health Collaborative (now known as 2020 Mom), a nonprofit organization, establish a task force on the status of maternal mental health care. The California Endowment provided financial support for a research team at California State University – Fresno and 2020 Mom Executive Director, Joy Burkhard to convene the task force.
2010: California Assemblymember Pedro Nava announced that his Assembly Concurrent Resolution 105, sponsored by the Junior Leagues of California State Public Affairs Committee and supported by the Los Angeles County Board of Supervisors, passed the State Assembly on an overwhelming bipartisan vote of 72 to 0. Read Whole Resolution Text
“The State Assembly sent a resounding message today to women and their families—that Perinatal Mood and Anxiety Disorders (PMAD) are a serious health issue and need to be taken seriously. My resolution will raise awareness in California regarding PMAD for new mothers and their families,” said Nava. “These disorders impact 1 in 8 women. By naming the month of May as Perninatal Depression Awareness Month, I hope to facilitate public discussion, increased awareness, and access for women and their families to important healthcare services.”
ACR 105 proclaimed the month of May every year as Perinatal Depression Awareness Month and requested that the State Department of Health Care Services, the State Department of Public Health, the State Department of Mental Health, First 5 California, Postpartum Support International, and other stakeholders work together to explore ways to improve women’s access to mental health care at the state and local levels. Additionally, it encouraged the stakeholders to facilitate increased awareness and education about perinatal depression and to explore and encourage the use of prenatal screening tools in order to improve the availability of effective treatment and community support services.
Said Los Angeles County Supervisor and Chairwoman, Gloria Molina, “In Los Angeles County, statistics show that perinatal depression and related mood disorders affect almost 20 percent of new and expectant mothers. Assemblymember Nava’s measure is a step in the right direction to make sure that women and their families know that there are supportive healthcare services in Los Angeles County available to them.”
Senate Bill 15 in 2007 created the “Postpartum Mood Disorders Prevention Act.” It became law in 2008. It calls for early screening of postpartum depression by front-line health workers such as pediatricians, primary care doctors, nurse practitioners and obstetricians. Medicaid covers PPD screenings and treatment. Screening for perinatal depression using an approved instrument is reimbursable for women enrolled in health care and family services, from pregnancy through one year after delivery. If women are screened by a provider during their infant’s well-child and episodic visits, the screening can be reimbursed through the infant’s coverage. Infants and toddlers of mothers with mental health diagnoses (including depression) are automatically eligible for the early intervention program.
Through a contract with its managed care organizations and its primary care case management network, Illinois requires prenatal and postpartum depression screening using an approved validated, standardized tool, referral, and treatment, as well as ongoing monitoring and tracking for enrollees. A complementary state law requires that women and their families be educated about perinatal mental health disorders in prenatal and labor and delivery settings, and that women be invited to take an assessment questionnaire in prenatal, postnatal, and pediatric care settings.
The Perinatal Mental Health Consultation Service operated by the University of Illinois at Chicago, and the state, in partnership with the Illinois Chapter of the Academy of Pediatrics and the Academy of Family Physicians offers provider consultative services and education and training to clinicians across disciplines to develop competencies in assessment and treatment of maternal depression. The education and quality improvement initiatives also include a pilot to develop a stepped care model; it includes self-care kits to be disseminated statewide that provide information on when and where to access resources. The state is also piloting a tool to assess risk at the preconception and interconception stages. The initiative also includes support for postpartum depression crisis intervention through hotlines.
In Iowa, the Department of Public Health is working to improve provider knowledge and capacity as well as consumer knowledge and ease of access. The Iowa Perinatal Depression Project has expanded screening, early identification, and effective treatment referrals for perinatal depression. The project is housed within the Bureau of Family Health within the Division of Health Promotion and Chronic Disease Prevention of the Iowa Department of Public Health.
In collaboration with three other state departments, a statewide advocacy organization and the University of Iowa sponsor a statewide train-the-trainer program that to date has trained an estimated 100 trainers. The program trains program staff in early childhood, maternal health, case management, and mental health programs, as well as Special Supplemental Nutrition Program for Women, Infants, and Children or WIC, nursing, and home visiting staff. It includes a mentorship component, requires agency-level commitment to screening, and reimburses agencies for staff time.
In collaboration with the University of Iowa, the state has developed a web-based training for physicians known as STEP, Support and Train to Enhance Primary Care. It contains a consultation component and is designed to enhance the state’s capacity in primary care to appropriately identify and treat perinatal depression.
The state also produced a pocket guide for health care professionals, that is, a reference book that includes information on treatment, coding, and billing. It is anticipated that this will be widely distributed through the major health care provider associations.
Iowa also established a provider and consumer website providing referral information that identifies mental health providers in all 99 counties, details of payment requirements and their specific training in perinatal depression. Primary care providers who access this service can also get free consultation with a University of Iowa–based mental health clinician. To improve screening, the state added two depression screening questions (from the Patient Health Questionnaire, a standardized assessment) to the Department of Human Services– approved Prenatal Risk Assessment tool required for all providers. The state funds a toll-free telephone resource and referral information line.
The Kentucky Health Access Nurturing Development Services (H.A.N.D.S.) Reach Out about Perinatal Depression Project, housed in the Kentucky Department of Public Health, is increasing awareness among health care providers and the general public about perinatal depression. This project runs a home visiting program that promotes a supportive and healthy environment for mothers and their newborns. Home visitors are trained through the Madison County Health Department and the University of Louisville. The project has also developed a stepped-care protocol for referral and treatment of women depending on their scores on a self-administered perinatal depression screening tool.
The Louisiana Perinatal Depression Project, through the Louisiana Department of Health and Hospitals, is tackling the unique challenge of caring for women with perinatal depression in the ravaged post-Hurricane Katrina environment. This project has provided mental health treatment and case management to women, infants and their support partners in metropolitan New Orleans. The project trains providers about perinatal depression and infant mental health.
MCPAP for MOMS: Legislation in Massachusetts supported MCPAP for Moms. MA Rep. Ellen Story is the author of the 2010 Massachusetts Postpartum Depression legislation and co-chair of the MA Postpartum Depression (PPD) Commission. The Commission offers recommendations on PPD policy to the Massachusetts Departments of Public Health and Mental Health (MDPH and DMH), which in turn funds MCPAP for Moms.
Chapter 313 of the Acts of 2010, An Act Relative to Postpartum Depression, calls on the state’s Department of Public Health (DPH) to develop standards for effective PPD screening, and regulations for providers and health plans to report on PPD screening. The law also created a special PPD Commission, made up of legislators, members of the administration, health care professionals, insurance representatives, nonprofit groups, survivors and others to develop recommendations about addressing PPD statewide, and provide guidance to DPH, the Governor and other government bodies on the issue. https://malegislature.gov/Laws/SessionLaws/Acts/2010/Chapter313
LD 792/SP 241, February 2007, this bill provides information on and screening for prenatal and postpartum mental health issues to pregnant women and mothers of children under one year of age and information to the partners, spouses or fathers and family members, as appropriate.
Minnesota passed a Postpartum Depression Education & Information Bill (S.F. 2278) in 2006 that requires that all providers of prenatal care must have information about PPD availabe to pregnant women and their families, and that hospitals and other health care facilities must provide new mothers and their families with written information about PPD. The bill included both statutory requirements (as above) and also best-practice guidelines for where and when information ought to be offered.
Read the bill at the MN Dept of Health website HERE
In 2006, New Jersey S213 was signed into law by New Jersey Governor Jon Corzine (D). This law, known as the Postpartum Depression Law, was introduced by State Senate President Richard Codey inspired by his wife, PPD Advocate Mary Jo Codey, and is known for being the first in the United States to require healthcare providers/facilities to screen women who have recently given birth for postpartum depression and to educate women and families. A budget of $4.5 million was provided for a comprehensive program, including the establishment of a statewide perinatal mental health referral network. The program is called “Speak Up When You’re Down”. Read more HERE
New York S.7234 / A.9610. In August 2014, S.7234 / A.9610 was re-introduced and Gov. Andrew Cuomo signed it into law. It defines maternal depression and provides information and guidelines on maternal depression screening. The law provides information and guidelines on maternal depression screening; information on follow-up support and referrals; and public education to promote awareness of and de-stigmatize maternal depression. In addition, the legislation is intended to ensure that New Yorkers are informed of the public health services that will help them understand, identify and treat maternal depression. .http://www.governor.ny.gov/news/governor-cuomo-signs-legislation-provide-support-new-mothers-and-families
In 2009 Oregon passed House Bill 2666, creating a statewide workgroup on maternal mental health disorders within the Department of Human Services. The workgroup includes representatives from families, early childhood and maternal care providers, and will address vulnerable populations across the state. HB 2666 will identify successful projects implemented in Oregon and other states and recommend programs, tools, and funding sources to initiate needed projects. It will make a report to the legislature identifying actions to be taken by 2015 to reduce the risk of harm to women and their children. In January 2010, Rep. Tomei will introduce a resolution to designate every May as Maternal Mental Health Awareness Month in Oregon and to encourage the Oregon Early Childhood Council, health care providers, would-be parents and other stakeholders to address the mental health needs of pregnant and postpartum women and their families. Carolyn Tomei (D-Milwaukie), lead sponsor of the bills, reached out to Oregonians active in the maternal mental health field and together formed a committee that wrote this two-part legislative proposal. Read the Statewide Workgroup Bill HB2666 HERE.
H.B. 4052, Uniform Maternal Screening Bill was introduced on January 2008, and passed April 2009 as SB307. It requires that women upon entering prenatal care would undergo the prenatal risk screening instrument. The bill created the Maternal Risk Screening Advisory.
Texas HB2079, 2016, designated May as Postpartum Depression Awareness Month. In Governor Greg Abbott’s proclamation, he wrote, “This month will be dedicated to educating the public about maternal mental health and the resources available to new mothers struggling with anxiety, depression and other conditions. In my budget for the 2016—2017 biennium, I proposed additional funding to provide screenings and treatment for postpartum depression to women’s health services for low-income women. By raising awareness and increasing the likelihood of early detection, we can help women from all walks of life. At this time, I encourage all Texans to learn more about this important issue. Together, we can work toward a brighter future for the Lone Star State.”
HB3318, potentially the first infanticide law in the United States, was introduced in 2009 by Representative Jessica Farrar (D-Houston) and would apply to women who commit the crime within 12 months of giving birth. If jurors find a defendant guilty of murder, they can take testimony about postpartum issues into consideration during the trial’s punishment phase.
Read the bill HERE
In 2003, House Bill 2310 required all hospital staff (nurses, doctors, etc) to distribute perinatal depression statistics and materials.
In 2005, SB 5898 and HB 1427 ordered a public information campaign on postpartum depression, and mandated that the council would conduct a proactive, public information and communication outreach campaign concerning the significance, signs, and treatment of postpartum depression. The “Speak Up When You’re Down” campaign was created and implemented as a result of this law.