When California enacted a law requiring that every pregnant woman receive mental health screening, UCLA Health professionals asked themselves what more they could do to ensure patients with concerning mental health symptoms receive the help they need. The result is the Maternal Outpatient Mental Health Services (MOMS) Clinic, which launched shortly after implementation of the state’s Maternal Mental Health Screening Law in 2019 and is helping to connect pregnant and postpartum patients with depression, anxiety, post-traumatic stress and other mental health conditions to high-quality care and suppor t. It is a need that has significantly increased during the COVID-19 pandemic, says Misty C. Richards, MD, medical director of perinatal psychiatry at UCLA and cofounder of the clinic.
Dr. Richards reports that she has seen a 30% increase in postpartum depression cases since the pandemic started - on average, about 15 women per week - and she has particular concern for low-income women of color who, because of insufficient or no insurance, historically have been short changed by the health care system.
Depression is one of the most common di sorders dur ing pregnanc y and the postpartum period, with rates ranging from 12% to 20%, according to the Centers for Disease Control and Prevention. “We are so grateful for the state-mandated screening, but we knew we would need more providers once women screened positive,” Dr. Richards says. “That’s why the MOMS Clinic came to fruition. We swif t ly identify, treat and support women who are suf fering from perinatal mental illness and bridge them to more permanent mental health care in the community.”
Postpartum and peripartum mental health disorders have been long overlooked, says Rashmi Rao, MD, obstetric medical director of mental health and cofounder of the MOMS Clinic. “Too many women are falling through the cracks. We do a pretty good job of treating gestational diabetes and hypertension in pregnancy, but mental health disorders represent a higher percentage of those conditions that we routinely treat,” she says. “We are now at least having the conversation about maternal mental health, but the resources are so limited to help these women.”
The MOMS Clinic represents a new paradigm for addressing maternal mental health. The clinic is based on a collaborativecare model that integrates psychiat ric services within the UCLA Department of Obstetrics and Gynecology. Pregnant or postpartum women who screen positive for a maternal mental health disorder are referred to the MOMS Cl inic by their UCLA OB-GYN providers and receive a full psychiatric assessment by an experienced reproductive psychiatrist. Once established in the clinic, patients often begin treatment with psychotropic medications and shortterm therapy until a seamless transition can be made to a trusted provider in the community for ongoing mental health care, Dr. Richards says.
“The MOMS Clinic assesses, confirms and refers to resources in the community or at UCLA,” she adds. “It’s like a psychiatric urgent care for women with perinatal mental health disorders, such as major depressive disorder with peripartum onset or postpartum psychosis. When you are six weeks postpartum and in crisis, you need help fast.
The clinic is expanding its services to include an experienced social worker who will help to connect patients to reproductive therapists, psychiatrists and other resources in the community for ongoing care.
The goal of the MOMS Clinic is to reduce barriers preventing adequate mental health treatment and to optimize the quality of care so that mothers, babies and families can thrive, Dr. Rao says. Studies show that pregnant women with untreated mental health disorders can experience worse pregnancy outcomes. Similarly, anxiety, depression or psychosis following birth can interfere with parent-child bonding. Patients are able to access quality mental health care from the clinic within one month of referral by their UCLA OB-GYN - as opposed to four-to-six months to access care in a community setting - optimizing their ability to bond with their child. Women continue to receive treatment from the clinic until they are able to begin with a community provider.
Maternal mental health disorders can be treated, and antidepressants, such as Zoloft, can be safely and effectively administered to pregnant women, balancing the needs of the mother with concerns for fetal health, Dr. Richards says. She says 30% to 60% of maternal mental health patients experience a 50% reduction in symptoms after about two months of treatment.
“It can be challenging to find help for pregnant women with mental health disorders,” Dr. Rao says, adding that some psychiatrists are reluctant to see pregnant patients due to the possible side effects of psychotropic medication use during pregnancy. “Having someone who understands what medications can be used is so important. It’s a very nuanced situation.”
The MOMS Clinic also prioritizes assessing the patient’s social and fami ly support structure — another critical component of care. While more resources are needed in the community to help care for maternal mental health patients, the MOMS clinic fills a significant gap. “The collaborative care model makes this a unique program,” Dr. Richards says. “I can think of only six hospitals in the country that are trying to do what we’re doing.”