Imagine for a moment, that you are at your annual medical check up. What if, in addition to asking about your diet, taking your vitals, and conducting routine labs, your doctor also asked about your emotional health? And what if, when you said you had some concerns about your mood, your doctor walked you down the hall to meet with the therapist embedded in her practice. This is integrated mental health care!
There are numerous reasons why having mental health services integrated into primary care is better for patients. Numerous studies show it reduces stigma, improves access to care, demonstrates better detection of mental health concerns, and improves treatment and follow up. It also is great for doctors and managed care as it saves money. One study estimated it even shave billions of dollars off total government spending for health care.
Now imagine, this model was adapted into an OB/GYN setting targeting the perinatal population. This is exactly what Golzar Selbe Naghshineh set out to do when she started NAPS (Network for the Advancement of Perinatal Support). NAPS is an innovative program founded on the belief that comprehensive perinatal care involves mental health support. NAPS works with OB/GYNs, midwives, IVF clinics, and birthing centers to help seamlessly integrate mental health care into their services.
I was lucky enough to speak with Golzar about how and why she started NAPS and to get the scoop on how the program works. Inspired by her extensive experience as a postpartum doula, Golzar started NAPS following an experience supporting a mom with postpartum depression. Golzar says “It became clear to me that some screening, assessment and a well-rounded intervention program needed to exist in these OBGYN practices.” Golzar started first with an OB/GYN practice in Manhattan (Downtown Women OB/GYN) and then built out a program that is replicable and easily embedded into existing medical settings.
I asked Golzar about why integrated mental health services is important. Here’s Golzar:
“Research is showing us that integrative mental health services actually lower costs to both insurance companies and patients. Integrative mental health services are not only collaborative and comprehensive, but they aid in more effective treatment of patients.
But let’s put aside the research and the idea that we can incentivize insurance companies and let’s instead focus on what I have learned hands on. To put it simply, the doctors are more supported and are able to reliably get the patients the support they need. In this model, patients are more supported, but more importantly, they feel more supported. They know there is someone there looking out for their well-being and actively working by their side. Patients are more receptive to support and care, because they trust us and the way we are taking care of them.
Indeed, NAPS is structured to provide patients with seamlessly integrated screening, care, and so much more. As Golzar describes it:
“Prenatal and postpartum care isn’t a one size fits all approach. Each mom’s experience will differ slightly based on her needs. While we are always available to talk to the patient, some patients need a lot of follow-up care and attention. Some require very little support. We screen for emotional issues multiple times prenatal and multiple times postpartum. Every patient who delivers will be personally called a couple weeks postpartum where we will talk about how they are doing and assess their need for support. Maybe they just need some techniques to help them sleep or eat more, ways to get their partner to be more helpful. Maybe they need some other support that helps them have a smoother postpartum period, like referrals to postpartum doulas or knowledge of a support group that would meet their needs. Maybe everything is fine and they don’t need anything at all. Sometimes they need to come in and talk in person, some come to groups and some want weekly therapy. Sometimes they need more help and we make a plan for care, get them to see a psychiatrist and follow up to make sure they are making progress. Occasionally, they need even more and an immediate intervention needs to take place. That is why these integrative programs are so crucial; we need to be able to help patients in the way that is tailored to their specific needs. That kind of tailored approach is unsustainable for the doctors, but is what NAPS specializes in.
NAPS functions so well because it symbiotically supports medical providers and patients. As Golzar notes, while many doctors now screen for PMADS, “what really matters is how a practice handles patients after the screening and how the practice is dedicated to preventing any postpartum mood disorder.“ As I’ve noted before, screening for perinatal mental health concerns is grossly insufficient, and NAPS does so much to fill the gap in care. As Golzar explains, NAPS can provide
“Continued patient management and care, there is someone in their office that they can trust. There is both continued care and reliability. Sometimes I talk to a patient multiple times prenatal and postpartum and they are doing ok, but then eight months postpartum overwhelming feelings they can’t manage on their own hit them. The patient knows me. They know there’s a system in place for help. They trust me and that system. So, they actually call me. A random screening and external referral would never provide that rapport and trust with a patient. We also do a lot of prevention work. Maybe the new mom just needs some skills to prevent her from becoming too overwhelmed or anxious, skills to help her sleep better, ways to ask for help, tricks to eat more consistently. Those skills can prevent a woman from developing a postpartum mood disorder and delivering those skills is embedded into our model of care. “
That is not to say integrated mental health care is without its challenges. Golzar notes several challenges she’s encountered in piloting and expanding NAPS.
“Traditionally these programs have been grant funded which prevents them from lasting more than a few years or leaves them always struggling. NAPS was designed to be self-sufficient and sustainable. We don’t rely on grant funding. I believe embedded mental health is the direction we are going – I think mental health services integrated into medical settings will be the norm in the future, but it isn’t yet. OBs and other providers are just warming up to the idea that comprehensive medical care that includes mental health support is their responsibility and that they can play an instrumental role in providing this kind of comprehensive care that can be lifesaving to a new mom and her child.
When I speak to OBs about the program, they are always interested and see the value, but this kind of full spectrum support is progressive, because our current medical system hasn’t addressed mental health in the same way they have been addressing physical health. The doctors need to be willing to invest in providing their patients truly comprehensive care. The biggest struggle I’ve had is getting access to the OBs. NAPS is a startup. I want our costs to be invested in expanding the program benefits to patients, rather than spent competing with pharmaceutical companies for an OBs ear. I want to minimize our marketing and outreach costs so that I can focus our resources on being patient centered and providing the most care to as many patients and offices as we are able to.
Working toward a truly integrated model of mental health and obstetric care may seem cumbersome for OB practices, but as Golzar put it so brilliantly, “You have more liability in doing nothing, then in doing something. It is your responsibility to consider mental health care if you want to provide your patients truly comprehensive health care.”
You can learn more about Golzar and NAPS here .