Accelerating Maternal Mental Health with Malekeh Amini, Founder & CEO at Trayt.Health and Dr. Nancy Byatt, Executive Director of Lifeline for Family Center and Lifeline for Moms Program

[00:00:08] Hey, everybody. Welcome back to The Beat Podcast, hosted here live at the Vive event in Los Angeles, California. I'm Saul Marquez, your host for the show. And today I have the privilege of hosting two amazing healthcare leaders. Well, you guys know Malekeh Amini. We've got Malekeh joining us again, CEO and Founder of Trayt Health. Nice to have you.

[00:00:31] Thank you for having me. Always a pleasure. And we also have Dr. Nancy Byatt, Executive Director of Lifeline for Family Center and Lifeline for Moms Program. Great to have you here. Thank you. Nice to be here. Oh, so great to have you both. And just to kick things off, fantastic panel. You guys really did an extraordinary job on there. Why don't you share with the listeners a little bit about what it was about and how the event is going for you? Sure. The event is going, as always, amazingly well.

[00:01:01] We've had a great turnout at the booth and met a lot of great people. The panel was about new approaches and innovative approaches in maternal mental health. And that was the topic of the discussion. I was moderating a panel and Dr. Byatt, who is one of the experts in this field, was really sharing some of her expertise with the audience. It was great.

[00:01:24] Awesome. And for you, Dr. Byatt, how's the meeting? How's the panel?

[00:01:27] Yeah. Similarly, it's great meeting a lot of great people. And the panel, I thought it went very well. And it met a lot of nice people afterwards. And we were really focusing on maternal mental health and what are some of the innovative ways where we can really scale approaches and think about how technology can be leveraged as we think about scaling systems level approaches to improving access to maternal mental health care.

[00:01:49] That's fantastic. And for everybody listening, you get the benefit of an extension of that panel through this podcast today. Excited to dive into to today's discussion. Dr. Byatt, here are the first ones for you. The Perinatal Psychiatry Access Program in Massachusetts has been the model for 29 additional programs across the nation. Could you share more about this approach to bringing care to patients?

[00:02:12] Yes, happy to. So I developed the model. So I'll start with my passion for this work is deeply rooted in my own personal experiences growing up with a mother who I saw the importance of maternal attachment because of her struggles from a disrupted bond with her own mother to my grandmother's psychiatric illness.

[00:02:30] And fast forward, I became a parent's psychiatrist. And I was seeing patients in a clinic where I was a psychiatrist seeing obstetric patients. And there was a long wait to see me. And I remember one particular woman came in to see me and she told me about how her she told me about her first pregnancy. And she described her experience. And she described that she had no idea she had depression. And then when the baby was born, she described that the baby felt like an alien to her.

[00:02:56] She described that she was in a black hole. And she really felt that she wasn't available for her baby in her baby's first year of life. And it wasn't until she came out of it that she even realized that she wasn't herself. And a few things struck me about this. One was the clear impact it had on her and her child. And the other thing was that she was seen in many settings, obstetric settings, pediatric settings. Nobody ever asked her about her mental health. Nobody ever talked to her about it.

[00:03:26] But there was many missed opportunities for it to be addressed. And while that was happening, I was seeing individuals in my clinic and the OBs had no idea what to do. There was months waits to see me and I thought there has to be a better way.

[00:03:38] And so that led us to do some focus groups with obstetric providers and then also with individuals with experience of mood or anxiety disorders during the pregnancy and postpartum.

[00:03:47] And we asked them, like, how can we do this better? Like, how can we integrate mental health care into obstetric settings?

[00:03:53] And what we heard from both really was that the individuals with experience told us, we want our OBs to address this.

[00:03:59] They don't know how. And the OBs said, we want to address it. We don't know how.

[00:04:02] And they both really told us they want a lifeline. The patients wanted it addressed as part of their OB care.

[00:04:07] They didn't want to necessarily go see a psychiatrist. And the OBs said, we want to address this.

[00:04:12] We need support. We need expertise from psychiatry to help us do this.

[00:04:17] It would be like myself as a psychiatrist learning how to manage high blood pressure.

[00:04:20] I wasn't trained to do that. They're not trained to do it.

[00:04:22] So we developed the Perinatal Psychiatry Access Program model really as a way to build the capacity of obstetric settings and perinatal care settings more broadly to be able to address mental health care themselves.

[00:04:36] And by doing that, we increase access to care.

[00:04:38] There'll never be enough psychiatrists or mental health providers in general in any of our lifetimes to see the patients that need one.

[00:04:43] So by building their capacity, we can increase access to care.

[00:04:46] In our program, it's called the Massachusetts Child Psychiatry Access Program for Moms.

[00:04:51] The acronym is MCPAP for Moms.

[00:04:52] And it has three core components.

[00:04:54] We provide training and toolkits.

[00:04:56] We train OB providers.

[00:04:57] How do you screen for depression?

[00:04:59] How do you manage that screen?

[00:05:01] What do you do when someone responds?

[00:05:02] How do you talk to somebody about it in a trauma-informed way?

[00:05:05] And how do you treat?

[00:05:06] And then we also provide toolkits in that.

[00:05:08] And then we also provide consultation.

[00:05:09] So if an OB provider is seeing a patient and the patient expresses a mental health concern or they screen positive for depression, they can call us.

[00:05:17] They can speak with one of our psychiatrists.

[00:05:19] And we provide consultation to help them respond to that patient and be able to provide treatment and support.

[00:05:25] And we can also see them for one-time consultation, which we usually can do within a couple of weeks.

[00:05:28] So if I talk to an OB and they call and they're not sure what to do or I'm uncomfortable, we can see them for one-time consultation.

[00:05:34] And then we can provide recommendations to them.

[00:05:37] And then the third component is we provide resource and referral to help navigate what we all know is a very complicated mental health system.

[00:05:44] And so it's a statewide program.

[00:05:46] It started in 2014.

[00:05:47] So it's now 10 years old.

[00:05:49] And because it's statewide and it's funded through the state legislature, it's a line item in the state budget.

[00:05:54] So anyone, any pregnant or postpartum individual across the state of Massachusetts has access to mental health care during that time period in that any of their sector providers can call us and we can help them provide mental health care.

[00:06:06] So it's gotten a lot of attention nationally because it's scalable.

[00:06:10] Our budget's a million dollars and we serve 72,000 births.

[00:06:13] That's amazing.

[00:06:14] Just over a dollar per person per month.

[00:06:16] So it's very, considering the population that we're covering, it's not particularly expensive.

[00:06:22] That's very impressive.

[00:06:24] Congratulations on this program.

[00:06:25] And it's been a model and it's great to see that it's being scaled beyond Massachusetts for other states to take advantage of it.

[00:06:33] Just regarding technology, how does technology support the work of maternal mental health and what systems are most essential to put in place?

[00:06:41] I can talk a little bit about what technology is necessary to have.

[00:06:46] And obviously, TRAIT is serving that particular program.

[00:06:49] So there are a couple of components of technology.

[00:06:52] One is the workflow itself.

[00:06:54] This is connecting institutions and health systems that typically don't work together.

[00:07:00] And our health systems are generally not built for that.

[00:07:03] We are a single institution model of health care.

[00:07:06] One of the pieces is how do we streamline that workflow in a way where any OBGYN can call from any clinic and we can be connecting them to any institution that has capacity to serve that particular OBGYN in order to provide better access.

[00:07:23] So that workflow and streamlining that workflow is a really important component to create an effective program, to collect the right data in order to be able to navigate for the next person who's taking a call or seeing that OBGYN or talking to the OBGYN to be able to know what was the history of the call that came in.

[00:07:43] That component is really important.

[00:07:45] The second piece of it is data, right?

[00:07:47] There are multiple components.

[00:07:48] One is data collection.

[00:07:50] One is making it easy to document all of the data that is required probably for statewide reporting reasons or for program quality measures.

[00:07:59] It's collecting that data, but also providing insights that go beyond those first set of metrics, right?

[00:08:07] Or have the PCPs enrolled, have the PCPs called in.

[00:08:11] Those are the basic layers of data that you can collect and measure.

[00:08:14] But in reality, you want to know a lot more.

[00:08:17] You want to have a platform that can enable insights at a deeper level.

[00:08:22] So, you know, one example would be, you know, we're providing this type of consultation to a number of OBGYNs.

[00:08:29] And how do we see the OBGYNs getting more educated?

[00:08:32] Are they coming back with more complex problems?

[00:08:35] Are they more comfortable providing treatments in their own clinic setting?

[00:08:39] Are they seeing more patients and are treating more patients?

[00:08:42] And a number of those things are really important factors to, at the end of the day, even though this is a state fund program or there are federal agencies like HRSA that are funding the program as well.

[00:08:54] It is still, there needs to be still a measure of program quality, program effectiveness.

[00:09:00] And in a way, a return on that investment, even if it is a government program.

[00:09:04] So I think having the capacity and the capability to say, are we serving the underserved population?

[00:09:10] So are we giving access to people who would otherwise not have access?

[00:09:13] Are they getting better care?

[00:09:15] And are they feeling better?

[00:09:17] Are they getting better?

[00:09:18] And then are we really educating those primary care physicians, those OBGYNs, to be able to do more of that in their clinic?

[00:09:25] Those types of insights, I think, are another component of technology that could make that meaningful, not only at a state level or institutional level, but very powerful.

[00:09:38] If we could, programs are standardized.

[00:09:40] If we could standardize a technology platform that actually captures exactly the same data across multiple states and creates a federal dashboard that shows a particular state is showing better results or a particular institution is showing better results.

[00:09:56] How do we take best practices and apply them to other places that may not be necessarily, that may not have visibility to that kind of information?

[00:10:04] I think those are some of the things that I'm hoping that as the programs are standardized and as the, especially the agencies that are funding the programs are becoming more and more data driven, that we would begin to see more adoption of that kind of technology in that setting.

[00:10:21] That's fantastic.

[00:10:21] And, you know, it's fascinating from the enablement of the care delivery to the measurement of the results.

[00:10:28] It's important.

[00:10:58] So there has been a lot of progress, which is very exciting.

[00:11:02] Not, we still need more, but there's been a lot.

[00:11:04] So one of the things that happened on the federal level is that due to advocates and many people like Jamie Balsito, Adrian Griffin, and many others, and I'll specifically mention the Maternal Mental Health Leadership Alliance and others, have advocated for federal funding for programs like our program in Massachusetts.

[00:11:21] And that, through all this advocacy, there was a HR 3235 was passed several years ago now.

[00:11:29] That was folded into the 21st century.

[00:11:31] That legislation was folded into 21st century Cures Act.

[00:11:35] Through advocacy, that money was appropriated.

[00:11:38] And they have had HRSA.

[00:11:41] The money was given to HRSA.

[00:11:42] HRSA now has grants for states to have perinatal psychiatry access programs across the country.

[00:11:48] There's also funding for the child access programs as well.

[00:11:51] There, originally, there were seven programs funded in the first round.

[00:11:54] And then, most recently, just this past fall, they funded another five programs.

[00:12:00] So there's now 12 HRSA-funded programs across the country.

[00:12:02] So federally, that's very exciting.

[00:12:04] We want to see that it's in all 50 on the child programs, which our model is a sister of the child programs.

[00:12:10] We have child access programs.

[00:12:12] We want to see it in all 50, so we're not going to stop.

[00:12:14] But it is in 12 states.

[00:12:15] And then on the state level, too, there is now 29 programs across the country.

[00:12:20] And 17 of those programs are funded through the state legislature.

[00:12:24] So, and there's also a lot of policy work being done around many other things around maternal mental health in general.

[00:12:31] There's many acts focused on increasing access to doula care, increasing access to community resources,

[00:12:37] and really thinking about maternal mental health care because we know we have major inequities in maternal mental health care.

[00:12:43] And both in mental health care but in maternity outcomes in general, particularly when it comes to maternal mortality.

[00:12:49] And the maternal mortality review committees who are managed by the CDC, they found in recently published data that mental health and substance use disorders are now the leading cause of maternal death in the United States.

[00:13:04] 23% of deaths are due to mental health or substance use disorders combined.

[00:13:07] That's almost 10% higher than from any other medical cause like hemorrhage, preeclampsia, hypertension, high blood pressure, and so forth.

[00:13:16] So there is a lot of work being done around maintaining maternal mortality review committees, which is critical because we need the data.

[00:13:23] Getting back to what Malakit was saying earlier, we need to have data-driven approaches to this.

[00:13:27] And if the data is showing that these leading cause, we need to be investing resources into addressing that.

[00:13:32] Yeah, those are things.

[00:13:32] And parental psychiatry access programs are one of the things where there's a lot of fun, where there's a lot of policies and support for that.

[00:13:39] And that's a piece of the puzzle, right?

[00:13:40] There's so many things we need to be doing.

[00:13:42] And just to amplify what Malakit was saying earlier, we also, I strongly believe, need to be paralleling that with approaches to be evaluating these programs and harmonizing the data collection.

[00:13:53] Because we now have 29 across the country.

[00:13:55] It's huge.

[00:13:55] We don't necessarily, there's an unleveraged opportunity to have data-driven approaches to the implementation of these programs so that we have evidence to know which ones do increase the provider capacity to provide treatment.

[00:14:08] Which strategies help the providers call?

[00:14:11] Because I think we all have a fantasy that if you start these programs, the providers will call.

[00:14:14] That's actually not true.

[00:14:15] It's really hard.

[00:14:16] And so really paralleling the funding for clinical programs with also policies and funding around the evaluation so that they're happening in tandem.

[00:14:25] And we're leveraging that.

[00:14:26] And as Malakit was saying, harmonizing data collection across these programs as well.

[00:14:30] I think that's a great call.

[00:14:31] Malakit, were you going to comment on that?

[00:14:33] No, no.

[00:14:33] I completely agree with what Nancy was saying.

[00:14:36] It's extremely encouraging to see some of the programs and how much they're growing.

[00:14:40] And we were involved with a couple of those programs.

[00:14:43] And it was exciting to see that the pilot programs that we launched initially were so successful that the state, within a year, doubled the funding for the program and actually made it into a statewide program.

[00:14:54] And it's extremely successful now.

[00:14:56] I do believe that in terms of policy, there is a lot of activity now in this space, not just in the psychiatry access model, but in general in maternal mental health.

[00:15:05] And the data, obviously, is one reason there is staggering.

[00:15:09] The numbers are just, you know, are difficult to swallow.

[00:15:12] It is a big need.

[00:15:14] Yes.

[00:15:15] And so, no, so I think I completely agree with Nancy.

[00:15:17] I think this is an exciting time.

[00:15:19] I think we're seeing a lot more involvement of policymakers.

[00:15:22] And I'll add that I think I agree.

[00:15:25] And I think while it's exciting, we also really need, I was saying this in the panel earlier, that when we think about mental health care and what needs to happen next,

[00:15:32] we, there won't be enough providers to see the patient need one.

[00:15:36] We're in a crisis.

[00:15:37] Actually, we're in an emergency.

[00:15:38] We've been in a crisis for a long time.

[00:15:39] We need to really be having policies.

[00:15:41] We need to be pushing forward policies that support families because that's how we're going to break the cycle of transgenerational trauma,

[00:15:49] of transgenerational impact, of mental health challenges.

[00:15:52] So we have a lot of policies around maternal mental health.

[00:15:55] We also need to be paralleling that within policies around the diet, around supporting parents in parenting because we can react.

[00:16:03] And access programs are great.

[00:16:04] And that if a person has an identity, you know, they present with symptoms, we can help respond.

[00:16:08] They're not necessarily focused on prevention.

[00:16:10] They're focused on reacting when an OB patient prevents to an office and they have a concern.

[00:16:15] We help that OB provider respond to that in an evidence-based way and provide evidence-based treatment and support.

[00:16:21] We also need to parallel that with policies that are providing, supporting and providing funding for prevention.

[00:16:28] So we can, and doing that specifically to support families and parents.

[00:16:32] That's the next step, right?

[00:16:34] Before it actually becomes an issue.

[00:16:36] Love it.

[00:16:37] Well, I love the vision that you both have and how you've made it become a reality.

[00:16:41] Now it's available to many others thanks to the work that you do.

[00:16:45] What call to action would you leave our listeners with?

[00:16:48] I think we need to start to treat mental health as something that's more than just an elective medical care, which is how we've treated it so far.

[00:16:57] It's dominated by private practices that don't take insurance.

[00:17:00] And the top 1% that is privileged has access to that.

[00:17:05] Like it's like plastic surgery, right?

[00:17:07] But the other 99% actually ends up in the ER.

[00:17:11] They end up harming themselves.

[00:17:12] They end up harming others.

[00:17:14] And so it is lethal.

[00:17:16] It's as lethal as COVID.

[00:17:17] It's a pandemic of the current day.

[00:17:19] And I think that we observe one of the things that I think is really a call to action is we need to accelerate.

[00:17:26] We need to really understand that this is not something that can be slowly addressed, that can continue at a pace of the way, you know, healthcare sometimes takes a very long time to implement things that are really effective.

[00:17:39] And I think this needs to have accelerated path.

[00:17:43] It's the same way we did with COVID.

[00:17:44] We saw in the pandemic how public-private partnerships and acceleration of some of the processes, but, you know, with which we actually deliver drugs, where all of that collaboration led to a much faster access to a vaccine to contain that pandemic.

[00:18:03] I think we need a similar approach in mental health.

[00:18:05] And I don't think that we've still gotten there.

[00:18:07] And I do think that it needs to have policymakers, funding agencies, private companies that are really mission-driven and focused on improving access and improving health outcomes to really come together and think about an accelerated path for addressing an extremely difficult, as Nancy mentioned, an emergency in our community right now.

[00:18:29] So let's accelerate.

[00:18:30] I love that.

[00:18:31] And how about you?

[00:18:32] Call to action?

[00:18:33] Yeah.

[00:18:33] So I'm going to say a couple.

[00:18:35] So let's do it.

[00:18:37] One is I think that we all can do something.

[00:18:40] I was at a meeting recently and somebody, her name is Kay Matthews.

[00:18:43] She got up and said, we can all do our part.

[00:18:45] And I think part of how we can do that is being honest with each other and ourselves about our own mental health challenges and changing the conversation because it still is stigmatized, I think.

[00:18:54] I mean, we've come a long way since I grew up in the 70s and 80s, and we've come a long way.

[00:18:59] We still have a long way to go.

[00:19:01] And the more we can embody that and be talking with each other and being honest with ourselves, my family's experienced these things, and I'm really honest about it.

[00:19:07] Why would I talk about it differently than if it was asthma?

[00:19:10] And so I think that's one thing that it's something that we can all do.

[00:19:13] And I think we can't understand how powerful it is when people are, when we can be vulnerable to each other about our own challenges and that of our loved ones.

[00:19:21] And I think from a policy standpoint and from a perspective of thinking about mental health care, we're in a very reactive mental health system, right?

[00:19:30] Like we're pouring funding into creating more hospitals, psychiatric hospitals, right?

[00:19:35] Like kids are in the ER waiting for—I was in a meeting recently and two meetings, one where they said there was 3,000 people on a waiting list at a particular hospital near where I live in Massachusetts.

[00:19:44] And then another one where kids are waiting for weeks on the pediatric floor, a bed in a psychiatric hospital.

[00:19:51] And kids are on many, many medications.

[00:19:54] Polypharmacy is a real challenge.

[00:19:55] And we do need hospital beds for kids that are sick.

[00:19:58] Absolutely.

[00:19:58] We need to react to those things without question.

[00:20:01] At the same time, we also need to think more upstream and prevent these things.

[00:20:05] And part of how we do that is by, I really do believe, is by focusing on young families and focusing on supporting our young families.

[00:20:13] Focus on supporting parents so they can parent kids in a way when they're not inadvertently perpetuating trauma.

[00:20:18] We all blow our trauma through other people because we don't realize we're doing it.

[00:20:22] We need to change the conversation and be supporting our families so they can build and supporting them in building resilient and healthy families and break that cycle of trauma, chance to initial trauma and the chance to initial impact they can have when there's severe mental illness in a family.

[00:20:39] Not that we can prevent severe mental illness.

[00:20:40] Some of them cannot be prevented.

[00:20:42] However, there are a lot that are, particularly when we think about this from a trauma perspective.

[00:20:46] Yeah.

[00:20:47] Love it.

[00:20:47] Yes.

[00:20:47] Great calls to action there from both of you.

[00:20:52] For the incredible work that you do.

[00:20:55] And folks, take a look at the show notes.

[00:20:57] We'll leave a summary of today's discussion, links and ways that you could get in touch with our speakers today.

[00:21:03] And I just want to thank both of you for your time.

[00:21:06] Thank you for having me.

[00:21:07] Thank you for having us.

[00:21:08] Pleasure.

[00:21:08] Thanks.

[00:21:09] Thank you.