Effectively addressing maternal mental health requires a comprehensive public health solution that targets risk and protective factors. These include social determinants of health, clinical care, community support, culturally responsive interventions, and policy changes. This is why the New York State Office of Mental Health (OMH) is leading efforts to develop and support programs to help birthing people address their mental well-being and get the necessary help when needed. We are trying to eliminate the stigma and cultural obstructions that prevent some from seeking help and ensuring they are treated with dignity when they do reach out for assistance.
Ann M. Sullivan, MD
Commissioner
NYS Office of Mental Health
The prevalence of mental health challenges – particularly among people of color – has reached alarming levels in New York State and in the United States. Nationally, an estimated one in five birthing people experience perinatal mood and anxiety disorder during their pregnancy or in the first year postpartum. Approximately 75 percent of these individuals are not diagnosed or treated, can lead to potentially grave consequences that range from high-risk pregnancies and poor childhood cognitive development to substance use, self-harm, and even suicide.
Stigma poses a formidable barrier to maternal mental health care. Some may feel they are being judged or treated differently following a diagnosis such as perinatal mood and anxiety disorder, and it may lead some to opt out of screenings or treatment – even if they are experiencing symptoms. Those with a history of substance use may also worry about repercussions of a mental health diagnosis, such as their children being removed from their care.
Education and awareness are crucial. By helping birthing people understand the benefits of screening during all phases of pregnancy, we can help reduce this stigma, promote available assistance, and encourage these individuals to accept help.
OMH convened a Maternal Mental Health Workgroup to develop recommendations for perinatal and postpartum mood and anxiety disorders. The workgroup diligently gathered information from subject matter experts and individuals with lived experience and discussed the complex issues facing vulnerable, underrepresented birthing people. The findings are being summarized into a final report that includes proposed recommendations, considerations, and aspirations for improving maternal mental health.
Studies emphasize the importance of utilizing screening tools in pediatric primary care settings as a method to identify and provide support for postpartum mood and anxiety disorders. This year’s budget includes funding to integrate behavioral health in OB-GYN offices in underserved communities to improve maternal mental health, providing for vital screenings and access to treatment for pregnant people and new parents through the New York State Collaborative Care Medicaid Program. Like the Collaborative Care approach in primary care, implementing measurement-based mental health and substance abuse treatment in OB-GYN offices is critical. Currently, there are 24 OB-GYN practices enrolled in the New York State Collaborative Care Medicaid Program for which OMH provides technical implementation assistance and training to practices who wish to enroll in the program, including education specific to perinatal health needs.
Primary care physicians can play a crucial role in identifying, managing, and supporting maternal mental health. As trusted sources of information, they can help normalize discussions about mental health and offer nonjudgmental support. These doctors have ongoing contact with birthing people during and after their pregnancy, well-positioning them to screen for mental health symptoms using trusted tools such as the Patient Health Questionnaire Depression Scale and the Edinburgh Postnatal Depression Scale.
Progress in this area is also being driven by investments in last year’s budget (Fiscal Year 2025), Governor Hochul increased funding to expand the Project TEACH Maternal Mental Health initiative which educates and supports maternal health providers to screen and treat maternal depression and related mood and anxiety disorders during pregnancy and the postpartum period. Project TEACH is a robust collaborative model originally established in 2010 and committed to strengthening and supporting the ability of primary care providers (PCPs) to provide mental health services to children, adolescents, and their families. In 2022, Project TEACH added reproductive psychiatrists who are available via a warmline to immediately speak with and support an OB-GYN or any prescribing practitioner serving pregnant and post-partum individuals. Project TEACH reproductive psychiatrists can be instrumental in assisting medical professionals in addressing the risks and benefits of continuation of psychiatric medications during pregnancy, a scenario where the risks of untreated mental illness can be as severe as the potential adverse effects of medication. Additionally, the recent expansion of this program allows for a wider range of front-line practitioners – including doulas, midwives, therapists, WIC staff, home visiting nurses, lactation consultants, and others – to get training and support in screening, resource access, and treatment engagement. Providing direct access to Project TEACH for these practitioners who often have longstanding, trusting relationships with perinatal individuals not only can improve immediate care, but also facilitates timely referrals for additional care and promotes better outcomes for individuals and their families.
Additionally, HealthySteps, an evidence-based prevention program that integrates behavioral health specialists in pediatric practices to address the social and emotional well-being of young children and their families, is undergoing significant expansion. OMH sponsors 125 HealthySteps sites, which provide these critical screenings, along with other behavioral health care services and referrals. These sites have collectively conducted more than 28,000 maternal depression screenings.
Still, there is more work to be done. We must continue providing education on maternal mental health issues to healthcare professionals and the public alike to dispel common misconceptions that can contribute to stigma.
For those birthing people who do experience acute mental or behavioral health issues but do not necessarily require inpatient or residential treatment, partial hospitalization and intensive outpatient programs are available. There are programs in the greater New York City and Long Island areas – including the Motherhood Center and The Child Center of NY – that offer specialized prenatal, perinatal, and postpartum treatment In addition, the Postpartum Resource Center of New York offers a directory of community resources to strengthen the statewide perinatal mental health support network, including educational information, healthcare and peer group services and a Postpartum Resource Center of NY Mom Line, available 7 days a week from 9am-5pm (1-855-631-0001).
Support for maternal mental health is also available from sources outside of OMH. For Instance, the New York State Department of Health’s (DOH) New York State Maternal, Infant and Early Childhood Home Visiting Initiative, provides evidence-based family support programs to improve birth outcomes for high-risk individuals and their babies; support children’s health and development; and strengthen families.
The Office for Children and Family Services’ (OCFS) initiative, Healthy Families New York, through our partners at the state, offers a home-based program focused on building positive parent-child relationships among new parents. Services include helping families access community resources and services, educating families on parenting and child development, connecting families with medical providers, and assessing children for developmental delays.
Likewise, our colleagues at the state Office of Addiction Services and Supports (OASAS) provide programs to support maternal mental recovery and well-being. In addition to prioritizing admission for pregnant and breastfeeding individuals at its certified substance use disorder treatment programs, OASAS offers educational opportunities for the behavioral health workforce supporting this population. The agency also provides harm reduction education focused on high-risk and underserved New Yorkers – including those who are pregnant, parenting, and post-partum – through Project COPE.
These efforts are helping birthing people and families throughout our state to recognize the critical need to address maternal mental health concerns. By providing these New Yorkers with support and education, we can continue to reduce stigma and ensure they receive the best and most appropriate care whenever help is needed.
Dr. Ann M. Sullivan is Commissioner of the New York State Office of Mental Health.
