The Biden administration on Tuesday announced the first national maternal mental health strategy, seeking specific actions from Congress and multiple federal agencies to reduce the effects of untreated mental health and substance use conditions during and after pregnancy.

The plan, and a report to Congress, come as conditions related to mental health and substance use account for the largest share of pregnancy-related deaths in the United States. The U.S. also leads among maternal deaths compared to other high-income countries.

The fiscal 2023 omnibus spending law directed the Department of Health and Human Services to form an advisory committee focused on maternal mental health care. The plan released Tuesday stems from the work of the resulting Task Force on Maternal Mental Health.

The strategy is split into five buckets: data and research; prevention, screening and diagnosis; intervention and treatment; community practices; and community engagement. 

Each of those buckets includes recommendations that seek to strengthen the nation’s perinatal mental health infrastructure and reduce disparities, increase access to affordable health services, use data to improve maternal outcomes, promote educational and community partnerships and highlight the insight of people with lived experiences.

Miriam Delphin-Rittmon, assistant secretary for mental health and substance use, told CQ Roll Call that the report was “step one” in the process.

“States are in different places here. There’s different sort of opportunities,” she said. “There’s so much throughout that report that I think can create multiple entryways and opportunities for connections to care.”

One recommendation calls for requiring states to provide 12 months of postpartum coverage through Medicaid, up from 60 days. While the 2021 COVID relief law enabled states to simplify the process to extend Medicaid postpartum coverage with federal support, not all states have taken up this option.

The plan references current legislation that would change this policy.

It also asks Congress to pass a law that would create a national benefit of six months of paid family and medical leave and establish universal child care in all states, in line with efforts from the House Bipartisan Paid Family Leave Working Group.

Other recommendations seek to increase Medicaid reimbursements for support staff, encourage Congress to enact laws that would strengthen the perinatal mental health workforce using existing state block grant funding, find ways to integrate mental health into obstetrics and primary care visits and increase surveillance across agencies on key maternal mental health issues that require more coordination.

Shalini Wickramatilake, senior adviser in the office of the assistant secretary at the Substance Abuse and Mental Health Services Administration, said that the next step for federal agencies is to examine the report and determine what might require funding from Congress.

“There are certainly components that require action from Congress, and then there are some components that are quite actionable, like improved federal coordination that we can do right away,” she said.

The task force intends to issue a second report to governors illustrating local actions that governors and other partners can take.  

Dobbs impact

The impact of the 2022 Supreme Court decision to overturn the right to an abortion has also complicated mental health for some.

Twenty-three percent of pregnancy-related deaths are caused by suicide, drug overdoses or other outcomes from mental health or substance use disorders. Many state abortion bans enacted after the Dobbs v. Jackson Women’s Health Organization decision do not include exceptions for mental health emergencies, suicidal ideation or both.

Wickramatilake emphasized the need to focus on the spectrum of health care.

“We know that the postpartum and pregnant population is particularly vulnerable, and those who are seeking reproductive care as well as those struggling with infertility, those seeking abortion care. Maternal health is a priority for all those populations.”

Carole Johnson, administrator of the Health Resources and Services Administration, said Tuesday it was critical that the administration continue protecting options for women post-Dobbs.

“It would be a mistake for us to have this conversation and not note what Dobbs has meant to the mental health and well-being of women across the country,” she said,.“Because it is not only about their physical health, it’s about their mental health as well,” she said.

This story is part of a series supported through the Rosalynn Carter Fellowship for Mental Health Journalism.

If you or someone you know is facing a mental health crisis, please call the toll-free, 24-hour 988 Suicide and Crisis Lifeline at 9-8-8 to be connected to a trained counselor.