Unique program addresses reproductive mental health issues

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Most women celebrate their reproductive life cycle from the commencement of menses, through pregnancy, postpartum and menopause. Some women, however, are not as fortunate. They may be affected by hormonal fluctuations, stressors may weaken their resilience, or a family history may predispose them to developing a mental illness.

Ten years ago, the Reproductive Mental Health Program began in Vancouver, B.C. to help these women. The program operates in partnership with the Department of Psychiatry at St. Paul’s Hospital and Specialized Women’s Health at BC Women’s Hospital & Health Centre, an agency of the Provincial Health Services Authority.

Six part-time psychiatrists, nurse clinicians, a dietitian, clinical counselors and a marriage therapist work together to provide specialized inpatient and outpatient care to women experiencing mental illness associated with their reproductive life cycle.

Pharmacotherapy, psychotherapy, cognitive behavior therapy, interpersonal therapy, light therapy and group therapy are offered to these women.

“Our society expects new mothers to be happy, affectionate, self-sacrificing and serene. But a woman with postpartum depression feels overwhelmed and hopeless. If she is experiencing frightening and upsetting thoughts she may not admit it to friends, family or care givers, fearing their judgment, or worse, having her child taken away,” says Medical Director Dr. Shaila Misri. “This is one of the greatest challenges.”

Education is a high priority of the program. “We receive between two to six phone calls per day from practitioners inquiring about the use of medications during pregnancy or lactation and how it affects the fetus or the baby,” says Dr. Misri.

In an effort to educate doctors, nurses and other health-care professionals, last year the program published Best Practices Guidelines for the Treatment of Women with Perinatal Mental Illness.

Women can also learn more about caring for themselves with the manual Self-Care Program for Women with Postpartum Depression and Anxiety, published in September, 2004. This patient guide emphasizes the importance of sleep, exercise, nutrition, rest and relaxation, understanding your illness, problem solving, goal-setting and challenging negative thoughts.

Women are given the opportunity to speak with other women at the various groups offered through the Reproductive Mental Health Program. Clinical counselor Jules Smith explains, “This is a powerful treatment modality. Women who have felt isolated, ashamed or embarrassed have a chance to meet with other women experiencing similar symptoms and learn from each other’s experiences.”

Dr. Deirdre Ryan, a psychiatrist with the Reproductive Mental Health Program, says one of the barriers for women accessing help is society’s expectations fueled by a woman’s own cloak of silence. “Women often don’t allow themselves to voice their feelings, or people don’t hear them when they do gather the courage to speak of their fears, images and feelings. Consequently months usually lapse before a woman finally breaks through the barriers and gets help.”

The program, along with the Provincial Health Services Authority, BC Reproductive Care Program, and regional health authorities in B.C., is working to help women access care early by screening each mother at two months postpartum with the Edinburgh Postpartum Screening Scale.

The Reproductive Mental Health Program has recently addressed another barrier for women: accessing treatment when women suffer from both perinatal mental illness and substance use.

Dr. Shimi Kang began a Concurrent Disorders Clinic approximately one year ago. “Substance use during pregnancy and while lactating brings about a higher rate of both risk and stigma. This makes treatment critical, but difficult. There is a window of opportunity to deal with these issues in the perinatal period as women are more likely to reduce their substance use or engage in treatment.”

The Reproductive Mental Health Program is dedicated to educating health professionals, women, their partners and families through all of B.C. and beyond. To this end, members of the program deliver approximately 50 educational sessions across the province each year. Doris Bodnar, Provincial Outreach Coordinator, explains, “We participate in public forums, conferences, and hospital rounds. Essentially, we’ll talk anywhere people will listen. And we share our materials with health professionals, women and their partners, particularly through our website.”

To learn more about reproductive mental health issues, the program and its services, visit www.bcrmh.com.