Yesterday I wrote part one of my experience with the Department of Veterans Affairs mental healthcare system as a pregnant mother and veteran, giving my initial suggestion as to how they can improve their quality of care. You can read it here, and the rest of my story and suggestions below. 

Invest in Specialists and Training

My initial psychiatrist at the VA was woefully uninformed on the current research on maternal mental health, and medication use during pregnancy. As I said yesterday, once they decided to continue to treat me, the closest they could get to an “expert” on reproductive psychiatry was a psychiatrist on staff with a background in pharmacology.  While she was an improvement, I still had to point her to books and other resources online that contained up to date information. (For example, she had no idea books like Pregnant on Prozac or websites such as MGH Center for Women’s Mental Health existed) Unlike my OB, she was unfamiliar with the work of experts like Dr. Marlene Freeman, Dr. Lee Cohen, Dr. Karen Kleiman, and many others. When I was 8 weeks postpartum my care was transferred to yet another psychiatrist, who was in disbelief that I was actually breastfeeding my son while taking medications. She was also woefully uniformed and readily admitted she knew very little about postpartum mood disorders and methods of treatment, and would be deferring to her supervisor for help in my case. This was not only disheartening, it destroyed my confidence in the VA’s ability to manage my mental health care. Women veterans need mental health care professionals who understand the nuances of maternal mental health, informed on current guidelines and research regarding medication use, and trained on how to address the particular needs of women during pregnancy and the postpartum period. Reproductive psychiatrists should be hired and if it’s not feasible to have at least one on staff at every mental health clinic that sees the female veteran population, then there should at least be a team of these specialized psychiatrists professionals at local clinics can consult with for guidance and input on a case by case basis. Every psychiatrist and therapist employed by the VA should also receive some form of training specific to maternal mental health. I do know that the VA does indeed have a few experts on staff at clinics in places like Chicago and Dallas, but they simply aren’t enough. We need more.

Give Pregnant and Postpartum Veterans Scheduling Priority and Appointment Flexibility

I called the last month to try to speak with my psychiatrist. I was noticing a shift in my mood and was beginning to struggle a bit and wanted to reach out to her for treatment advice and support. I was told she was unavailable and that I should make an appointment. Her next available appointment? December 8th. When I was roughly 4 weeks postpartum, the maternal outreach coordinator called and screened me for postpartum depression, which I was extremely grateful for. However, when she went to put in a consult for me to be seen and have my care transferred to a new psychiatrist, it took another 6 weeks for that consult to go through…and we both had to make several follow-up calls to ensure it was being pushed through the system. I saw my new psychiatrist and talked with her about how I was doing at 8 weeks postpartum. I was then told my next appointment wouldn’t be for another 4 months because of the schedule rotation they had in place. A new mom’s first year postpartum is a critical time. Pregnant and postpartum veterans should have top priority in getting appointments with their providers, because not only does it support and enhance their mental health, but it supports and enhances the health of their newborn as well. Having the right support and access to treatment gives mothers and their new babies the strong starts they need to thrive-they should not be a the mercy of an overcrowded system and providers with heavy case loads.

Flexibility with appointment scheduling would help significantly as well. I was able to convince the therapist I saw very briefly during my pregnancy and my psychiatrist to have our appointments over the phone instead of in office because it was easier to ensure I’d be back home in time to pick my older two children up from school. My schedule was also packed with pediatrician visits and therapy appointments for my older two children, and the VA’s appointment availability wasn’t very accommodating to that either. Also-why not offer daycare services? I have to take my baby (and older kids if they aren’t in school) to every appointment with me, where it can be quite difficult to focus on informing my psychiatrist of how I’m doing, and what I need.

Support Groups and Talk Therapy

Since moving to Austin and enrolling in the VA mental health care system here in Central Texas, it has been nearly impossible for me to acquire talk therapy with a therapist who understands the particular needs and concerns of a woman and mother, as well as a peer-to-peer support group I can attend. After several starts and stops, I finally talked with the head psychologist at the mental health clinic here in Austin last Spring. She was earnest in her desire to offer me some kind of support that worked with my schedule and their available resources but she had to admit that there was very little they could do to help a woman in my situation. “We just don’t have the resources for your particular needs; all of our support groups are co-ed and we currently don’t have a therapist on staff with the right kind of training or experience that would benefit your particular situation. We’re trying to find a way to create it, but unfortunately there isn’t a lot we can do right now.” Mothers need support, especially during their first year postpartum. Either the VA needs to find a way to develop and provide it or agree to outsource it to a civilian provider like they do prenatal care and help the veteran cover the cost, if not cover it fully themselves. Many women’s health clinics currently have breastfeeding support groups for veterans who are nursing. I don’t think it’s out of the realm of possibilities to create a group that supports our mental health as well.

This experience has taught me a lot about the ups and downs of having the VA manage my mental healthcare as a pregnant and postpartum veteran. Strides in women’s health have been made over the last decade at the VA, but there is still more work that needs to be done. I’m hoping that sharing my experience exposes a critical gap in care and lends to the demand for change overall at the VA that’s currently taking place. We’ve been warriors for our country, and I hope the VA will honor our service by helping us and our families have the strong starts we deserve.