Time to revisit postpartum mental health support strategies 

With the release in August of the first orally administered medication for postpartum depression, now is a good time to review plan coverage and overall employer support for maternal health. While there are risk factors, postpartum mental health issues can happen to anyone within a year of birth and are often made worse by a lack of social support, including from the workplace. Sadly, the Centers for Disease Control and Prevention reported that mental-health conditions have become the leading cause of maternal death, contributing to nearly one in four pregnancy-related deaths. 

A comprehensive strategy related to benefit offerings, workplace policies and culture and spreading education/awareness can have an impact on preventing and mitigating adverse postpartum health outcomes and mental health. This is paramount, as there is currently no standard postpartum care in the US for birthing parents beyond a six-week OBGYN checkup, and these checkups often fail to provide comprehensive mental health and social support screenings. In fact, fewer than 50% of new mothers are screened nationally. Furthermore, screenings that are provided are typically depression-focused, despite there being six types of perinatal/postpartum mood disorders, with postpartum anxiety and post-traumatic stress disorder being the next most prevalent. Stigma, amongst other factors, may also prevent members from proactively seeking support.  

A key component to consider is comprehensive medical and pharmacy coverge. Employers should review their medical benefits to ensure access to “high-value” models of care, such as birth centers, midwifery care and use of doulas, which can help with improving maternal health outcomes, including mental health, and have been shown to reduce disparities in outcomes for different racial and ethnic groups. Increasing access to clinical resources specialized in mental health through telehealth, digital solutions, generous behavioral health and EAP benefits and more can improve access to other forms of treatment. 

The recently approved medication for postpartum depression, Zurzuvae, provides new hope for expanded access to effective treatment. The orally administered drug offers a faster onset of action than traditional antidepressants and more convenient administration than the hospital-administered Zulresso. Zurzuvae carries a wholesale price of $15,900 for the 14-day course of treatment which is significantly more costly than traditional antidepressants, but less than half the cost of Zulresso. Employers will want to ensure that any utilization management processes allow for expedient processing and that the drug is covered only for patients within 12 months of giving birth and not for other forms of depression. 

Flexible, supportive, parent-focused policies offer other opportunities to prevent or lessen the severity of postpartum mental health disorders and aid recovery. Returning to work after the birth of a child can be challenging. Providing access to longer periods of paid leave can help parents adjust to caring for a new child and recover from childbirth. Increased flexibility can also help parents as they transition back to work, start childcare and learn to balance their employment and new parental responsibilities. Providing increased flexibility to parents could include phasing in workloads and return to work; flexibility in work location or scheduling; and lactation support upon return to work, as breastfeeding has been shown to improve emotional well-being of birth parents.  

To help reduce stigma and increase awareness, build in programs educating both managers and employees on the signs and symptoms of the various postpartum mental health concerns.  

Other workplace benefits:

• Evaluating and expanding leave and disability benefits for gaps in mental health coverage, such as limitations or exclusions, easing eligibility requirements or expanding benefits – weeks paid or offering intermittent short-term disability – can help employees have the time and space to seek treatment. 
• Increasing access to clinical and non-clinical professionals specialized in reproductive health and family support needs through concierge solutions can also help to address barriers to culturally competent care, social support and more, as well as aiding in educating employees and their families. 
• Expanding broader caregiver support benefits, such as back-up care, childcare stipends and access to additional resources, can provide another form of social support during this stage of life. 

By increasing employee awareness and support in the workplace of these issues, employers can have a direct impact on improving the health of both employees and their families, which in turn can boost productivity, retention and even reduce health care spend. This does not need to be done in silos but instead can add value to an overall message to employees that they are supported at all phases of life.