Dr. Sarah Wakefield, Chair of the Department of Psychiatry at Texas Tech University School of Medicine, joined as Medical Director of the new Texas Perinatal Psychiatric Access Network (TX PeriPAN) in March 2022. The new pilot initiative officially kicks off in late summer 2022, and Dr. Wakefield will lead the team to get every detail in place so that four health related institutions can provide support and services to providers who see pregnant women and new mothers suffering from maternal related mental health issues.
We spoke to Dr. Wakefield to learn more about her experience and what drives her to be successful in leading PeriPAN’s charge.
What drew you to the initiative and to become medical director for TX PeriPAN?
I became interested in maternal mental health when I was in my child and adolescent psychiatry fellowship. At the time I was pregnant with my first child and really feeling the weight of all it is to carry a child and be a mother. I would complete assessments with kids, and so many of the moms had untreated mental health distress or pathology. Many of them had been suffering since their pregnancy or postpartum time and were only seeking care now to aid their children. I just realized how many moms out there are suffering silently.
My favorite thing about treating children is that you really can change the trajectory of a someone’s life the earlier you intervene. It became apparent to me that if we could have treated mom when she was pregnant or postpartum, or even before, we could have prevented so many of the things that are happening with the child or at the very least better equip mom to respond in a therapeutic way.
Then I met Susan Kornstein, a founder and leader in reproductive psychiatry, at a conference. I was finishing my training and contemplating jobs. We talked about women’s mental health and what impacts it could have downstream. She inspired me to set up a reproductive psychiatry clinic at my university, and I had a very supportive chair who gave me the greenlight. So as a brand-new junior faculty member, I set up both a clinic and a psychiatry training experience in perinatal psychiatry. Since then, I have spent a lot of time educating and treating women in this population and advocating for how important this care is. At the same time, reproductive psychiatry initiatives have developed around the country, and we all continue to share resources to improve both care and training. This has reinforced to me how crucial and critical this work is, but also how doable it is. I feel like things are coming full circle to be able to help bring this to Texas.
Are there any particular stories or experiences that exemplify the dire need for these types of services, especially due to the shortage of mental health providers and needs of women in Texas?
There are two primary categories that stand out to me as points we could have easily changed the trajectory for a mom and her babies if we just did a little better job of working together and collaborating. One is the mom who has just been sick for a really long time. She’s been functional but she’s been sick, and she only justifies treatment in order to give her child a better life. This might even be her second or third child, and she has been through pregnancy, postpartum, and well-child checks without anyone offering her screening, intervention, or resources. The other group is the mom who has been misdiagnosed and has suffered because her treatment doesn’t match her needs. This seems to especially happen in the context of trauma. We have got to do a better job of assessing and responding to the traumas that so many women experience. I think we can help with both of these with appropriate screening.
What challenges do we face with providers serving pregnant women and new mothers who might need help?
When you look at the statistics of how frequent depression, anxiety, trauma and PTSD are, mental health issues should be the first thing that we’re assessing and screening for and not the last. This is a huge shift in medical care but one that is absolutely supported by the evidence.
We know that it takes about 15-20 years on average for research to make it into practice. And this conversation about trauma is a fairly new one respectively in our medical training. The adverse childhood experiences study from the 1990s showed us that the more adverse trauma and childhood experiences you have, the more likely you are to have GI issues, cancer, hypertension, diabetes – in addition to being more likely to present for depression and anxiety.
Mental health distress like postpartum depression and anxiety are the most common complications of pregnancy, and so for us, it’s about trying to teach mom and teach clinicians that the healthiest mom creates the healthiest possible baby. This concept of epigenetics: what is happening to mom is affecting how your genes are expressed and how genes are passed on, so you have this downstream positive or negative effect. We want babies to have the healthiest start and the healthiest environment in which to grow.
How do you plan to inspire providers to utilize these services?
First you have to tell the story. Mental health feels like such a big vacuum and it feels so complex. In many ways it is and people don’t know what to do about it.
But we can tell people that improving mental health isn’t rocket science. It’s about building relationships and supportive community. It’s about screening early and often as a part of routine medical care. It’s about having an expert you can call for consultation and recommendations, and it’s about utilizing the tools that we have to treat mental health distress.
Women should know it’s typical to screen when you come into your family medicine doctor, obstetrician or your pediatrician. With the ability to provide support in real time, through lines like the Perinatal Psychiatry Access Network, we can create that culture of support and relationships for clinicians, for moms, for families, and ultimately for the children we are all trying to raise.