Nearly half of Arizona’s pregnancy related deaths in 2022 were tied to mental health or substance use disorders, with 98% deemed preventable, according to the Arizona Department of Health Services. And communities of color and rural communities see disparate effects and a lack of perinatal care.
The legislature passed a law in 2021 establishing a maternal mental health advisory committee. Last year, health care agencies, providers and nonprofits convened to study mental health and maternal mortality, and in January, the committee issued proposals to stem the tide.
And at the beginning of June, the first recommendation came to fruition.
Dr. Kathryn Emerick, a perinatal psychiatrist, now serves as the co-director of the Arizona Perinatal Psychiatry Access Line, a hotline designed to create further accessibility by assisting all medical providers in treating mental health and substance use disorders in pregnant patients.
“We’re talking about something that fundamentally, foundationally impacts moms and children and families and communities on this massive scale,” Emerick said. “And with this illness that is treatable, and with these deaths that are completely preventable, we don’t have to have this level of suffering and death that we have in the state.”
The Arizona Health Care Cost Containment System issued a $1.6 million grant to the University of Arizona to make APAL possible.
Emerick said in the first month, they have seen a consistent stream of calls from care providers across the state. And in her time manning the line, the questions have primarily centered around diagnoses, as symptoms of perinatal mental health disorders vary, and around safe prescriptions, as the research on safe medications for pregnant women continues to evolve.
She’s also fielded quite a few questions on treating mothers with substance use disorders, specifically about safe medications to avoid withdrawals.
Emerick said disparate health services across the state, combined with a severe lack of perinatal psychiatrists create vast gaps in care.
Eight counties in Arizona lack a perinatal mental health specialist. And a lack of care disproportionately effects people of color, namely Black and Indigenous communities.
ADHS found Black women are twice as likely to experience perinatal mental health conditions but half as likely to receive treatment.
Lakisa Muhammad, founder of Arizona Birth Workers of Color and executive director of Phoenix Birth Foundation, discussed the importance of ensuring “we have mental health professionals that reflect the population they will be serving.”
Muhammad worked with Elizabeth Wood, chairperson at Postpartum Support International Arizona, to create a training led and attended by care providers of color.
Muhammad said the training brought together birth workers of all disciplines to discuss diagnoses and treatment of mental health.
“We can take this information from the evidence-based curriculum because PSI offers and we can transmute that information, transform it and turn it into a language that our community relates to,” Muhammad said. “Oftentimes the messages aren’t geared toward BIPOC communities.”
She said within the conference, care providers, “can get really real and really raw and address those things that we see in the families that we serve.”
Muhammad said the overall goals were to see more care workers of color certified in perinatal psychiatric care and ultimately, to have mental health care covered by insurance to make care more accessible and affordable.
And in the short term, Muhammad discussed the power of community. AZBOC partners with 4th Trimester to create a support group for Black mothers and to lead conversations about mental health care for communities of color in particular.
Jennie Bever founded 4th Trimester, an organization dedicated to creating a network of care providers and communities where she said none existed before.
The organization created “villages” or localized support groups for new parents. The groups connect parents with each other, and health care providers and specialists in their area to support the physical, mental and emotional health of the mother.
Bever said they currently run groups across Maricopa County, including the Black mothers support group. The organization is relaunching a Spanish-speaking village in the fall.
Overall, Bever said she wants Fourth Trimester to change the ways of thinking about pre-and post-partum support and care.
“We want to disrupt your thought process on whether or not there’s diversity in support for moms, we’re going to disrupt your thought process on whether it was handled right,” Bever said. “So that we can begin to think about, if we were going to do something different, what would that look like?’”
Emerick, Muhammed and Bever all emphasized the fact maternal deaths associated with substance use disorder or mental illness are preventable, and it often just takes one person, one health care provider, friend or family member to make a difference.
Emerick said she hopes greater educational tools will help to dispel misconceptions and stigmas in pre-and post-partum care and noted the danger of chalking signs of mental illness or SUDs up to “baby blues” or avoiding medications for the health of the baby.
“What we know is that untreated psychiatric illness and untreated substance use disorders actually carry really significant lifetime risks for the baby,” Emerick said. “So that idea of ‘if you just white knuckle it, you’re protecting your baby,’ it’s just not true.”
Muhammad said, “From my vantage point that we are in the midst of a paradigm shift around that, I think a lot of mothers or the people that I work with are embracing this idea of resisting resilience.”
“Why is it so hard? Why do I have to be so strong all the time?” Muhammad said. “Organizations like AZBOC, 4th Trimester and PSI AZ, we’re starting to create systems and create a framework that supports that way of thinking that it doesn’t have to be so hard and we’re here to help you, to make it easier, to lighten the load a bit so we don’t have to be so resilient. We can be soft. We can get the support and help that we need.”