Recently on Twitter I said that a lot of moms can’t get help for postpartum depression and anxiety.  Someone I don’t know chimed in and kept telling me I was completely wrong. She insisted that because of the Affordable Care Act and Mental Health Parity  everyone can get help now. She is not correct on this issue, I assure you. Hundreds of thousands of moms are not getting the professional help they need.

It comes from a place of privilege to be able to say that everyone can get help these days. I used to think that, too. My attitude was, “If you have symptoms of postpartum depression or anxiety, reach out for help. Call your doctor. Get an appointment with a therapist. I did! You can too!”

And then I learned. I learned that some women who have health insurance can’t afford to pay the massive deductibles they’d need to pay out of pocket in order to get mental health care. Some women work the kind of schedules that don’t allow them to see someone for help during normal office hours. Some moms can’t find anyone within a 75-mile radius who is accepting new patients. Some women don’t have transportation or childcare. Some women make calls and find out the people who can actually treat them are so in demand that they don’t accept insurance any longer and if you want to see them you need to be able to pay $150 or $250 an hour out of pocket. Some actually find a person who accepts insurance but then can’t get an appointment until 3 months from now.

Let me make it perfectly clear some of the reasons why women aren’t getting the help they need for maternal mental health disorders:

• 55% of psychiatrists in America do NOT accept private health insurance or Medicare, and 57% do not accept Medicaid, according to the American Psychiatric Association.
• Almost 91 million adults live in areas where shortages of mental-health professionals make obtaining treatment difficult, according to the US Department of Health & Human Services, and 55% of the nation’s 3,100 counties have no practicing psychiatrists, psychologists or social workers. Let me repeat: 55% of all the counties in the United States have no practicing psychiatrists, psychologists or social workers.
• Around 25% of people who have public insurance from one of the state exchanges say they cannot find a therapist or psychiatrist in network, according to NAMI.

One organization in Philadelphia, the Maternity Care Coalition, took a look at whether low-income women can get care and found that it took mothers as long as 22 weeks to receive the care they needed — for those of you who are like me and can’t count that’s five-and-a-half months, y’all — and that only 1 in 5 local agencies had any practitioners who had received specialized training in perinatal psychiatry.

If you imagine that, let’s say, only 50% of moms with perinatal mood and anxiety disorders in the US are getting help — and the truth is it’s less than that but for the sake of argument let’s just say half — that would mean that at least 300,000 American moms each year are struggling and will continue to for who knows how long. That’s 300,000 moms and 300,000 kids (at least, because how many of them have more than one child) being left to suffer the long-term sequences of untreated maternal mental illness. That’s around the same number of people living within the city limits of Boston.

What do we know about untreated perinatal mood and anxiety disorders and their impact on children? We know that untreated maternal depression can create impaired mother-infant bonding, poorer self-control, cognitive development problems, poorer school performance, increased aggression and higher rates of psychiatric illness and substance abuse in exposed children.

So, given all that, you’d think those in power would be falling all over themselves to invest in addressing this issue and making sure women can get help for postpartum depression, anxiety, psychosis and antenatal depression and anxiety, right? Of course they would. Because we know how to help women who are struggling, and when we do help them it helps their kids.

Except nope. There’s actually almost no investment at all. I’ll share more about that tomorrow.

Oh, and P.S. In case you think the access is much better in other countries, read this.