In 2019, maternal mental health conditions (MMHCs) were the most common underlying cause of pregnancy-related death in Texas, contributing to over 20% of all deaths. Furthermore, it is estimated that 13. 2% of all Texas women who gave birth in 2019 had an untreated MMHC. The most common MMHCs leading to mortality were depressive disorders, substance use disorders, bipolar and psychotic disorders. In 2022, the maternal mortality rate for Black women was over twice the rate for White and Hispanic women and three times the rate for Asian women. In addition to maternal harms, untreated perinatal mental health conditions are associated with childhood harms including adverse obstetric outcomes (fetal growth restriction, preterm birth, and stillbirth) ; impaired neurodevelopment and behavior outcomes; and a cost burden of 14. 2 billion annually. Several broad factors specific to the state of Texas pose significant challenges to mental health care access, such as widespread poverty and high levels of uninsurance exacerbated by the state’s decision not to adopt Medicaid expansion. However, over the past decade, Texas policy makers have taken several important steps to directly address maternal mental health concerns. Most notably, the Texas Health and Safety Code 32. 046 of 2019 required the Texas Health and Human Services commission to develop comprehensive statewide maternal mental health policies. The result was the Maternal Depression Strategic Plan of 2021-2025, a unique-to-Texas comprehensive strategy that aimed to improve outcomes for mothers and children. The plan deploys 15 strategies in five areas: provider awareness, increasing referral networks, access to peer support services, increasing public awareness and reducing stigma, and leveraging funding to existing programs. Here, we discuss several key initiatives that emerged from the strategic plan, their relevant efficacy data, and how they compare to national benchmarks. These include 1) extension of Medicaid coverage postpartum (including telemedicine) ; 2) development of a statewide perinatal access program (Peripan) ; and 3) partnerships with community education leaders and academic centers to provide education on MMHCs and reduce stigma. We will also review national policies with demonstrated efficacy in decreasing MMHCs that Texas has not yet adopted, such as universal postpartum depression screening measures and support of inpatient maternal mental health programs. Our aim is to inform future policy development and research directions that decrease MMHCs and ultimately improve health outcomes for mothers and children.
Nicole Cirino (Mon,) studied this question.