Poor mental health is the leading underlying cause of pregnancy-related deaths, the federal government announced last year, with suicide attempts, drug use and other behavioral health issues impacting nearly one in four people who die during childbirth or over the following year.
The news prompted the New Jersey Health Care Quality Institute to partner with the state Mental Health Association to develop a first aid training model designed specifically for perinatal health workers like nurses, midwives and doulas.
Now they’re taking the model nationwide.
“The need is urgent,” wrote Armonie Pierre-Jacques, a community health and policy associate with the Quality Institute, in an announcement last week that the model has won a key approval to be available nationally. “There is a critical need to invest more to address maternal mental health to reduce death and suffering surrounding pregnancy.”
The institute’s goal is to teach health professionals to spot the signs of psychological distress in their clients, stabilize the situation and connect the person with appropriate help. Nationwide, as many as one in five of those who are pregnant or who are new mothers experience a mental health issue, according to advocates.
The institute, a nonprofit research and advocacy organization, said 90 health care workers have been trained in the model in New Jersey. The state has some of the worst maternal health outcomes in the nation and a significant racial disparity that leaves Black women nearly seven times more likely to die during or after childbirth than white women.
Mental health first aid
The model used by the Mental Health Association throughout the state — and adapted for the perinatal program — was created by the National Council for Mental Wellbeing. It aims to empower care providers without any additional clinical training to identify the signs of a mental health crisis in someone, intervene in an appropriate way and connect that person with the right services. As with CPR, the goal is to help the person who is suffering until professional help is available, the national council notes.
Through video, group discussion and role-playing exercises, participants are trained to identify the warning signs of a mental health crisis or active substance abuse, the impact these conditions have on individuals and their families and the benefits of quality treatment. The model includes a five-step process for assessing the situation, listening without judgment, reassuring the individual in crisis, providing information on resources and self-help strategies and encouraging them to connect with the right professional.
To train the perinatal professionals, the Quality Institute created scenarios that involved people in crisis both before and after giving birth. One scenario descries Maria, who is nine weeks pregnant with her second child, but “ultimately experiences early, worsening, and then crisis mental-health signs and symptoms” the institute notes.
Progress in NJ
The Quality Institute led training sessions that stretched over four days, largely in communities in Essex, Union and Morris counties, it said. As a result, 90 perinatal community health workers were certified in pregnancy-related mental health first aid.
Surveys and interviews with these workers showed almost everyone learned something about mental health, the related stigma and how to help those who suffer from psychological issues when pregnant. More than nine out of 10 said they also gained an understanding of the community resources that are available to help patients who are struggling, according to the institute. Many trained also said they found the experiencing empowering and confidence-building.
When surveyed three to six months later, participants said they continued to use the skills they learned when working with pregnant clients, the Quality Institute reported. “Adding maternity-specific scenarios to the existing [Mental Health First Aid] curriculum is an immediate way to provide mental health education to perinatal community health workers,” the Quality Institute wrote in a white paper on the program. Linda Schwimmer, the president and CEO of the institute, said they are continuing to conduct training sessions in New Jersey, thanks in part to funding from the Healthcare Foundation of New Jersey. The institute has also hired the South Jersey Perinatal Consortia, a collaboration involving health care clinicians and providers, to train the professionals who lead wrap-around programs for those who go through pregnancy with substance abuse issues, she said.
Earlier this month the institute’s perinatal training model was approved by the National Council for Mental Wellbeing for use nationwide. America has for years had the highest maternal-mortality rate of any wealthy nation and this gap is growing, according to the Commonwealth Fund foundation, with nearly 24 deaths per 100,000 live births here as of 2022, more than three times that of the United Kingdom, Sweden and Switzerland and 10 times that of Australia.
“As a certified instructor who helped pilot these new scenarios, it’s gratifying that our work at the Quality Institute will now support efforts throughout the country to address maternal mental health,” Pierre-Jacques wrote.