Mental Health Care for New Moms Costs Texas $2.2 billion Each Year, Report Says
By Sean Price


Texas physicians know that pregnant women and new mothers struggle with maternal mental health conditions (MMHCs) such as post-partum depression and anxiety. Now all those MMHCs have been given a statewide price tag.

Texas spends about $2.2 billion each year helping young mothers and their children deal with MMHCs, according to a report  released today by Mathematica, a non-partisan research organization based in Princeton, N.J., that focuses on improving public health. That amounts to about $44,000 in societal costs per mother with a maternal mental health condition and her child from conception until age 5, the report said.

The $2.2 billion obviously is needed to help women, but it could be better spent in prevention initiatives that address the mental health problems women face around the time of childbirth rather than after, said Coppell pediatrician Angela Moemeka, MD. She sits on the Texas Medical Association’s Committee on Child and Adolescent Health.

“If you took all this energy and made sure that mom has the support that she needs, everything downstream would fall into place – as much as possible,” she said.

MMHCs affect more than 1 in 8 women who are either pregnant or have recently given birth, the report said. In 2019, they affected about 49,816 of the 377,397 women who gave birth.

“We always talk about hemorrhage and hypertension and all these things, but really the most common complication of childbirth is depression,” said Shanna Combs, MD, a Fort Worth obstetrician-gynecologist and consultant to TMA’s Committee on Reproductive, Women's, and Perinatal Health.

Among other solutions, the report calls for Texas to extend coverage during the post-delivery period for women who are uninsured or underinsured. Medicaid for Pregnant Women program stops coverage after 60 days post-partum, just when many women most need it for MMHCs, the report says.

This echoes TMA’s priorities for this year’s Texas Legislature, which include providing health care coverage to millions of working-class Texans who are uninsured.

Mothers with maternal mental health conditions tend to have reduced productivity at work, greater absenteeism, higher unemployment, and higher rates of suicide, the report says. Children of these mothers have a higher risk of being born pre-term, not being breastfed, dying of sudden infant death syndrome (SIDS), and developmental disorders.

“I have at least 10 families who fall neatly into this category [of women with MMHCs], and as I read the report I said, check, check, check – [it describes] everything that happens when these conditions go untreated,” Dr. Moemeka said.

According to the Texas Health and Human Services Commission (HHSC), 53% of Texas births are covered by Medicaid.

Among Texas’ Medicaid for Pregnant Women population, the state spent $958 million on untreated MMHCs  in 2019, the Mathematica report said. That excludes costs for productivity losses, maternal suicide, and SIDS.

Non-Hispanic Black mothers usually face more birth-related health problems, such as pre-eclampsia and cesarean delivery, and MMHCs are no different, the report said. Untreated MMHCs occur among non-Hispanic Black mothers at a rate of 18.3%, compared with 12% for Hispanic mothers and 11.4% for non-Hispanic White mothers.

“Identifying and closing the gap in these health disparities could lead to lower societal costs for all,” the report said.

Providing better screening and earlier intervention for groups disproportionately affected by MMHCs could lead to better long-term outcomes, the report said.

Even when physicians screen adequately, they often have no health care professional to refer patients to who can help with mental health needs, Dr. Combs said.

Texas’ shortage of psychiatrists is so acute that waiting lists can be months or even years long, and Texas ranks last among the 50 states and the District of Columbia in access to mental health care, according to the nonprofit Mental Health America.

“I’ve often called myself an ‘ob-chaiatrist’ or a ‘gyne-chiatrist’ because for basic depression it’s hard to get patients access to a psychiatrist, and sometimes counseling services are limited,” Dr. Combs said. “So I’m oftentimes having to manage it myself.”

In 2019, the Texas Legislature established the Child Psychiatric Access Network (CPAN) to give pediatricians and family physicians across Texas free telemedicine-based consultation and training on community psychiatry. A pediatrician or family physician caring for a patient with psychiatric needs can call CPAN and typically get professional advice in minutes.

TMA supports legislative efforts to extend CPAN to mothers, says Helen Kent Davis, TMA’s associate vice president of governmental affairs. This would allow OB-Gyns and other primary care physicians to consult with a psychiatrist or behavioral health specialist. Currently, 14 other states use a similar approach to providing behavioral health care.

Mathematica issued its report in part to complement the September 2020 post-partum depression strategic plan issued by Texas HHSC. The plan was required by House Bill 253, which the Texas Legislature approved in 2019 with TMA’s support.

Last Updated On

March 04, 2021

Originally Published On

March 04, 2021

Sean Price


(512) 370-1392

Sean Price is a reporter for Texas Medicine and Texas Medicine Today. He grew up in Fort Worth and graduated from the University of Texas at Austin. He's worked as an award-winning writer and editor for a variety of national magazine, book, and website publishers in New York and Washington. He's also helped produce Texas-based marketing campaigns designed to promote public health. Sean lives in Austin and enjoys hiking, photography, and spending time with his wife and two sons.

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