If We Change Post Partem Policy

So I finished 29th place out of 42 in Sunday's charity jump roping competition - a good showing if you ask me given the fact I was in the 99th age percentile. Only Gerald the janitor seen holding a rope leaning against an out of order soda machine was older at 79. I think I did pretty well - "sure you did," my bride said, "if you were 5."  Her truth cut deep, but at least I know who I am at this point, which for many folks isn't a layup. People are unsure of identity, their place, their reason for being amidst the chaos. Dee's been in and out of the chaos for 30 years - depression, suicide, addiction, most stemming from the days around the birth of her kids. The 59 year old was a philosophy major in college and a lunch attendant at a suburban high school in her 30s. "Talk about chaos," she quips. "I was raising kids so the job hours were good for my family."

But this was after several years facing post partem depression after each of her kids were born. "I didn't know what it was, my doctor prescribed medicine once, but it never really went away." I met Dee at the screening of the film my son and I made about runners in a club for mental wellness and addiction recovery. "I thought it was an AA meeting," she later told me. Dee said her depression sometimes would escalate into what she said were "wild thoughts - usually about myself, whether I should be here, but sometimes family, the kids." She said she never had therapy - "that wasn't really a thing, something was wrong with me." After her youngest turned 5, things improved "but I always felt uneasy about my place, who I was. The anxiety turned into fear." 

She said she thought of jumping many times. She was on an anti anxiety medicine through most of this time and had two stints in the hospital, at least two she remembers. She overheard the nurses calling that second one "another episode," and says her husband cried those days. Joe passed from a heart attack in 2017.  Dee spiraled in the years after leading to pain medications, opioids, heroin, alcohol and now, 3 months sober, but struggling. One of her kids still sees her, one does not, one died by suicide. "The pain is constant, but I'm trying."

It's been convenient for much of the last 30 years to find blame for all this. Doctors overprescribing. A siloed healthcare system. People having kids they're not ready to have. Poor choices. Social media. Misaligned incentives.

Truth is doctors do the best they can usually, particularly without the full picture. But isn't the healthcare system and policymakers supposed to pick us up when our internal pain escalates, giving support whenever crisis hits and in between? They do it when the heart stops and when the tumor returns. Problem I suppose is healthcare is predicated on paying for things in batches, episodes, sessions - for reacting to problems, not preventing them - even though we know health is longitudinal as psychiatrist Nzinga Harrison reminds me.  Shouldn't we pivot health policy to give women long term support for post partem - not just a few months or a year, but longer? Not just in reaction to symptoms or darkness, not just a benefit or prescription, but a standard of care - as automatic as windshield wipers when it rains?

Treatment for post-partem depression and even psychosis, according to the poll we did of about 1,600 moms, has saved their lives. Lives of women who drive most of the healthcare decisions in this country, even if not the health policies. "The medicine quieted the noise, the talk therapy helped me manage through the voices, the anxiety," Talia, 33, says. Interestingly, 81% of them side with Lindsay Clancy who's on trial because the noise won, even if they don't get it, most say they understand it. "If necessary, medicine; always necessary talk therapy - everyone should be on the same page." They rarely are. That takes effort, incentives, policy change that can influence human behavior to dig deeper.

I personally have tried to convey this to mental health therapists and lactation specialists over the years - to specialize in post partem, to carve out a niche. "I think we have missed the mark with therapy many times," Ivy Patt, psychologist, told me once. "We could be a lot better with transitions" and finding policy equilibrium that doesn't set so many boundaries. Patt believes the costs would come down because we'd limit the crisis. 

There's a good case for it when you look at suicidality and the cost of mismanaged post partem care, but not as a fixed session or episode, not a billable package of visits. Mental healthcare shouldn't stop like a Shell Silverstein poem. We don’t raise kids on a sidewalk that ends — not with us wanting to jump off. Or at least we shouldn’t have to. But our healthcare policies sure seem to end. That sidewalk, when you think about it, well it ought to have twists and bumps and stumbles, but if you're lucky, a level stretch with a bit less fear and a lot of laughter, at least for a few blocks anyways.