Mississippi Today
Federal panel prescribes new mental health strategy to curb maternal deaths
For help, call or text the National Maternal Mental Health Hotline at 1-833-TLC-MAMA (1-833-852-6262) or contact the 988 Suicide & Crisis Lifeline by dialing or texting “988.” Spanish-language services are also available.
BRIDGEPORT, Conn. — Milagros Aquino was trying to find a new place to live and had been struggling to get used to new foods after she moved to Bridgeport from Peru with her husband and young son in 2023.
When Aquino, now 31, got pregnant in May 2023, “instantly everything got so much worse than before,” she said. “I was so sad and lying in bed all day. I was really lost and just surviving.”
Aquino has lots of company.
Perinatal depression affects as many as 20% of women in the United States during pregnancy, the postpartum period, or both, according to studies. In some states, anxiety or depression afflicts nearly a quarter of new mothers or pregnant women.
Many women in the U.S. go untreated because there is no widely deployed system to screen for mental illness in mothers, despite widespread recommendations to do so. Experts say the lack of screening has driven higher rates of mental illness, suicide, and drug overdoses that are now the leading causes of death in the first year after a woman gives birth.
“This is a systemic issue, a medical issue, and a human rights issue,” said Lindsay R. Standeven, a perinatal psychiatrist and the clinical and education director of the Johns Hopkins Reproductive Mental Health Center.
Standeven said the root causes of the problem include racial and socioeconomic disparities in maternal care and a lack of support systems for new mothers. She also pointed a finger at a shortage of mental health professionals, insufficient maternal mental health training for providers, and insufficient reimbursement for mental health services. Finally, Standeven said, the problem is exacerbated by the absence of national maternity leave policies, and the access to weapons.
Those factors helped drive a 105% increase in postpartum depression from 2010 to 2021, according to the American Journal of Obstetrics & Gynecology.
For Aquino, it wasn’t until the last weeks of her pregnancy, when she signed up for acupuncture to relieve her stress, that a social worker helped her get care through the Emme Coalition, which connects girls and women with financial help, mental health counseling services, and other resources.
Mothers diagnosed with perinatal depression or anxiety during or after pregnancy are at about three times the risk of suicidal behavior and six times the risk of suicide compared with mothers without a mood disorder, according to recent U.S. and international studies in JAMA Network Open and The BMJ.
The toll of the maternal mental health crisis is particularly acute in rural communities that have become maternity care deserts, as small hospitals close their labor and delivery units because of plummeting birth rates, or because of financial or staffing issues.
This week, the Maternal Mental Health Task Force — co-led by the Office on Women’s Health and the Substance Abuse and Mental Health Services Administration and formed in September to respond to the problem — recommended creating maternity care centers that could serve as hubs of integrated care and birthing facilities by building upon the services and personnel already in communities.
The task force will soon determine what portions of the plan will require congressional action and funding to implement and what will be “low-hanging fruit,” said Joy Burkhard, a member of the task force and the executive director of the nonprofit Policy Center for Maternal Mental Health.
Burkhard said equitable access to care is essential. The task force recommended that federal officials identify areas where maternity centers should be placed based on data identifying the underserved. “Rural America,” she said, “is first and foremost.”
There are shortages of care in “unlikely areas,” including Los Angeles County, where some maternity wards have recently closed, said Burkhard. Urban areas that are underserved would also be eligible to get the new centers.
“All that mothers are asking for is maternity care that makes sense. Right now, none of that exists,” she said.
Several pilot programs are designed to help struggling mothers by training and equipping midwives and doulas, people who provide guidance and support to the mothers of newborns.
In Montana, rates of maternal depression before, during, and after pregnancy are higher than the national average. From 2017 to 2020, approximately 15% of mothers experienced postpartum depression and 27% experienced perinatal depression, according to the Montana Pregnancy Risk Assessment Monitoring System. The state had the sixth-highest maternal mortality rate in the country in 2019, when it received a federal grant to begin training doulas.
To date, the program has trained 108 doulas, many of whom are Native American. Native Americans make up 6.6% of Montana’s population. Indigenous people, particularly those in rural areas, have twice the national rate of severe maternal morbidity and mortality compared with white women, according to a study in Obstetrics and Gynecology.
Stephanie Fitch, grant manager at Montana Obstetrics & Maternal Support at Billings Clinic, said training doulas “has the potential to counter systemic barriers that disproportionately impact our tribal communities and improve overall community health.”
Twelve states and Washington, D.C., have Medicaid coverage for doula care, according to the National Health Law Program. They are California, Florida, Maryland, Massachusetts, Michigan, Minnesota, Nevada, New Jersey, Oklahoma, Oregon, Rhode Island, and Virginia. Medicaid pays for about 41% of births in the U.S., according to the Centers for Disease Control and Prevention.
Jacqueline Carrizo, a doula assigned to Aquino through the Emme Coalition, played an important role in Aquino’s recovery. Aquino said she couldn’t have imagined going through such a “dark time alone.” With Carrizo’s support, “I could make it,” she said.
Genetic and environmental factors, or a past mental health disorder, can increase the risk of depression or anxiety during pregnancy. But mood disorders can happen to anyone.
Teresa Martinez, 30, of Price, Utah, had struggled with anxiety and infertility for years before she conceived her first child. The joy and relief of giving birth to her son in 2012 were short-lived.
Without warning, “a dark cloud came over me,” she said.
Martinez was afraid to tell her husband. “As a woman, you feel so much pressure and you don’t want that stigma of not being a good mom,” she said.
In recent years, programs around the country have started to help doctors recognize mothers’ mood disorders and learn how to help them before any harm is done.
One of the most successful is the Massachusetts Child Psychiatry Access Program for Moms, which began a decade ago and has since spread to 29 states. The program, supported by federal and state funding, provides tools and training for physicians and other providers to screen and identify disorders, triage patients, and offer treatment options.
But the expansion of maternal mental health programs is taking place amid sparse resources in much of rural America. Many programs across the country have run out of money.
The federal task force proposed that Congress fund and create consultation programs similar to the one in Massachusetts, but not to replace the ones already in place, said Burkhard.
In April, Missouri became the latest state to adopt the Massachusetts model. Women on Medicaid in Missouri are 10 times as likely to die within one year of pregnancy as those with private insurance. From 2018 through 2020, an average of 70 Missouri women died each year while pregnant or within one year of giving birth, according to state government statistics.
Wendy Ell, executive director of the Maternal Health Access Project in Missouri, called her service a “lifesaving resource” that is free and easy to access for any health care provider in the state who sees patients in the perinatal period.
About 50 health care providers have signed up for Ell’s program since it began. Within 30 minutes of a request, the providers can consult over the phone with one of three perinatal psychiatrists. But while the doctors can get help from the psychiatrists, mental health resources for patients are not as readily available.
The task force called for federal funding to train more mental health providers and place them in high-need areas like Missouri. The task force also recommended training and certifying a more diverse workforce of community mental health workers, patient navigators, doulas, and peer support specialists in areas where they are most needed.
A new voluntary curriculum in reproductive psychiatry is designed to help psychiatry residents, fellows, and mental health practitioners who may have little or no training or education about the management of psychiatric illness in the perinatal period. A small study found that the curriculum significantly improved psychiatrists’ ability to treat perinatal women with mental illness, said Standeven, who contributed to the training program and is one of the study’s authors.
Nancy Byatt, a perinatal psychiatrist at the University of Massachusetts Chan School of Medicine who led the launch of the Massachusetts Child Psychiatry Access Program for Moms in 2014, said there is still a lot of work to do.
“I think that the most important thing is that we have made a lot of progress and, in that sense, I am kind of hopeful,” Byatt said.
Cheryl Platzman Weinstock’s reporting is supported by a grant from the National Institute for Health Care Management Foundation. KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.
This article first appeared on Mississippi Today and is republished here under a Creative Commons license.
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Mississippi Today
Mississippi receives ‘F’ rating on preterm birth rate
Mississippi received an F grade for its rate of preterm births in 2023 – those occurring before 37 weeks gestation – from the 2024 March of Dimes report card.
Mississippi’s preterm birth rate was 15%, the worst in the country. Any state with a rate greater than 11.5% also received an F. The U.S. average was 10.4%.
Preterm births in Mississippi have risen steadily over the last decade, increasingly nearly 2% since 2013. In Jackson, the state capital, nearly one in five babies are born preterm, according to the report.
“As a clinician, I know the profound impact that comprehensive prenatal care has on pregnancy outcomes for both mom and baby,” Dr. Amanda P. Williams, interim chief medical officer at March of Dimes, said in a press release. “Yet, too many families, especially those from our most vulnerable communities, are not receiving the support they need to ensure healthy pregnancies and births. The health of mom and baby are intricately intertwined. If we can address chronic health conditions and help ensure all moms have access to quality prenatal care, we can help every family get the best possible start.”
In addition to inadequate prenatal care, factors such as smoking, hypertension, diabetes and unhealthy weight can cause people to be more likely to have a preterm birth.
The report highlighted several other metrics, including infant mortality – in which Mississippi continues to lead the nation.
In 2022, 316 babies in the state died before their first birthday. Among babies born to Black mothers, the infant mortality rate is 1.3 times higher.
The state’s maternal mortality rate of 39.1 per 100,000 live births is nearly double the national average of 23.2.
Mississippi has yet to expand Medicaid – one of only 10 states not to do so – and tens of thousands of working Mississippians remain without health insurance. It also has not implemented paid family leave, doula reimbursement by Medicaid, or supportive midwifery policies – all of which March of Dimes says are critical to improving and sustaining infant and maternal health care.
The Legislature passed a law last session that would make timely prenatal care easier for expectant mothers, but more than four months after the law was supposed to go into effect, pregnant women still can’t access the temporary coverage.
“March of Dimes is committed to advocating for policies that make healthcare more accessible like Medicaid expansion, addressing the root causes of disparities, and increasing awareness of impactful solutions like our Low Dose, Big Benefits campaign, which supports families and communities to take proactive steps toward healthy pregnancies,” Cindy Rahman, March of Dimes interim president and CEO, said in a press release.
This article first appeared on Mississippi Today and is republished here under a Creative Commons license.
Mississippi Today
On this day in 2017
Nov. 15, 2017
Author Jesmyn Ward became the first Black American to win the National Book Award twice.
Growing up in DeLisle, Mississippi, “I read everything,” she wrote. “Still, I still felt as if a part of me was wandering. That there was a figure in me, walking the desert, waiting for a word. A word that would sound out of the wilderness to declare that it was speaking to me, for me, within me. The sonic sear of that voice: a new knowing of not only the world I walked, but of me.”
She became the first person in her family to go to college. She attended Stanford University, where she earned a bachelor’s in English and a master’s in media studies.
When a drunken driver killed her younger brother, she decided to become a writer in his memory.
After earning a master’s in fine arts in creative writing from the University of Michigan, she and her family were caught by the floodwaters of Hurricane Katrina, but managed to take shelter with a family.
She won her first National Book Award for “Salvage the Bones,” which was set during the days of Katrina.
“When I hear people talking about the fact that they think we live in a post-racial America,” she said, “it blows my mind, because I don’t know that place. I’ve never lived there.”
She won her second National Book Award for “Sing, Unburied, Sing,” becoming the first woman and first Black American to win two National Book Awards. She also won a MacArthur “genius” grant, one of a handful of Mississippians to receive the award. In 2022, she became the youngest person to ever receive the Library of Congress Prize for American Fiction.
This article first appeared on Mississippi Today and is republished here under a Creative Commons license.
Mississippi Today
Mississippi Center for Advanced Medicine will close following settlement with UMMC in federal trade secrets lawsuit
A settlement in a federal trade secrets case will force a Madison health care center that treats children with complex medical conditions to close by the end of the year and prohibit its founding doctor and CEO from practicing medicine in Mississippi ever again.
The Oct. 18 agreement concludes a seven-year legal battle between the University of Mississippi Medical Center and the Mississippi Center for Advanced Medicine that began after pediatric hematologist Dr. Spencer Sullivan, the former director of UMMC’s Children’s Hemophilia Treatment Center, struck out to form the private, for-profit medical organization in 2016.
Three doctors who practiced at the Mississippi Center for Advanced Medicine will form a new private practice in Flowood next year, according to business filings and the clinic’s website.
The center served over 9,500 patients from every Mississippi county in 2022 and employed over 100 staff members during the 2023 fiscal year, according to a recent court filing. The clinic provides subspecialty medical care, including hematology, pediatric cardiology and pediatric rheumatology, and operates a clinical pharmacy and pediatric urgent care.
Mississippi has just under 18 specialty pediatricians per 100,000 children, the lowest rate in the Southeast and the third lowest in the country, according to data from The American Board of Pediatrics.
The center served as a safety net for pediatric subspecialty care in 2022 when UMMC went out of network with Blue Cross Blue Shield, the state’s largest provider of private health insurance.
The legal conflict between the Mississippi Center for Advanced Medicine and UMMC began in state court, but after new evidence was uncovered in 2018, UMMC filed a lawsuit in federal court alleging that Sullivan and the Center for Advanced Medicine violated federal trade secrets law by utilizing confidential patient and hospital financial information to open the new health center.
Judge Carlton Reeves ruled in favor of UMMC in October 2021 in federal court, writing that evidence in the case “reveals a clear, persistent pattern of perjury, evidence destruction, and concealment.” A trial on damages was delayed several times before the parties reached a settlement agreement in October.
Sullivan will be forced to relinquish his Mississippi medical license for life and close all clinic locations in Mississippi by Dec. 31. The Mississippi Center for Advanced Medicine must “indicate that UMMC is the institution in Mississippi that can best meet the patients’ medical care and pharmacy needs” in a letter notifying patients it is closing, according to the agreement.
Sullivan and the Mississippi Center for Advanced Medicine will be liable for $28.3 million if any terms of the contract are breached.
The center filed for bankruptcy in April 2023, and submitted a plan of liquidation in accordance with the terms of the settlement agreement on Oct. 31. Since opening, the center has either lost money or yielded a modest profit and faced various financial struggles, including loss of physicians to private practice and legal fees, according to the plan of liquidation.
Sullivan declined to comment for this article, and UMMC did not respond to questions from Mississippi Today.
Pediatric hematologist and oncologist Dr. Sharon Pennington, the Chief Medical Information Officer for the Mississippi Center for Advanced Medicine, is listed as the registered agent of a new private practice in Flowood, shows a business filing publicly available on the Secretary of State’s website.
The clinic will open in January 2025. Dr. Whitney Herring and Dr. Michael Mattingly, medical directors for pediatric metabolic medicine and pediatric and fetal cardiology at the Mississippi Center for Advanced Medicine, respectively, will also join the clinic, according to its website.
Pennington and Mattingly declined to comment for this story. Herring did not respond to Mississippi Today by press time.
A legal saga
One year after Sullivan left his post at UMMC to form the Mississippi Center for Advanced Medicine, UMMC filed a lawsuit in state court alleging that he had violated the terms of his contract, including a non-compete clause, causing damages to the hospital. UMMC alleged that Sullivan was motivated to leave after he learned of the Hemophilia Treatment Center’s high revenue.
In Sullivan’s employment contract with UMMC, he agreed not to engage in a clinical practice within a 25 mile radius from UMMC, hire recent UMMC employees or use any patient information or lists to encourage them to leave UMMC after departing the hospital.
UMMC alleged that Sullivan took 80% of the patients he treated while practicing at UMMC to his new clinic which he staffed with UMMC employees, including pediatric rheumatologist Dr. Nina Washington, his codefendant in the case.
Children’s of Mississippi at UMMC is the state’s only dedicated children’s hospital and offers a wide range of pediatric subspecialty care. Each year, the hospital treats about 150,000 children, the majority of whom are enrolled in Medicaid.
Sullivan and Washington argued in a counterclaim that the Hemophilia Treatment Center facilities and staffing were “woefully inadequate,” and that mold and cockroaches were “pervasive.” They contended that because of the poor conditions of their employment, UMMC, too, had breached the terms of its contracts.
An amended complaint filed by UMMC in November of 2017 broadened the hospital’s allegations against Sullivan, alleging that Sullivan had obtained a confidential patient list and financial information which he used to solicit patients and establish the Mississippi Center for Advanced Medicine.
After an article about the lawsuit appeared in the Clarion-Ledger in 2018 that referenced the confidential patient list, the ex-husband of Linnea McMillan, a nurse who left UMMC to join Sullivan’s practice, turned a printed patient list he found in McMillan’s car in 2016 over to UMMC.
The discovery prompted UMMC to file a federal trade secrets lawsuit in June 2019, naming Sullivan, the Mississippi Center for Advanced Medicine, McMillan and former UMMC staff members Kathryn Sue Stevens and Rachel Henderson as defendants.
Sullivan directed McMillan and Stevens to compile the patient list in the spring of 2016 while working at UMMC as he prepared to open his new practice, alleged UMMC in the lawsuit.
Defendants denied taking or using the list until March 2020, when Henderson admitted that she lied in her deposition, and along with Sullivan, Stevens and McMillan, possessed and used the list at the Mississippi Center for Advanced Medicine.
She also produced nearly 1,500 pages of previously unproduced text messages, which revealed that Harris, Stevens and McMillan shredded the patient list to conceal evidence in the case.
Henderson was dismissed from the case after coming forward with new information.
Sullivan committed perjury by falsely claiming he did not possess an external hard drive with files from UMMC, determined the federal judge. Sullivan produced the drive only after a magistrate judge forced him to choose between producing the hard drives or his computer.
“A review of the voluminous record in the case reveals a clear persistent pattern of perjury, evidence destruction, and concealment,” wrote Reeves in his default judgment in favor of UMMC.
This article first appeared on Mississippi Today and is republished here under a Creative Commons license.
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