The Star-Ledger (Newark, New Jersey)
 

December 9, 2007 Sunday
 

Promised lifeline for new moms falls short
Postpartum depression law called a disappointment so far
 

BYLINE: SUSAN K. LIVIO, STAR-LEDGER STAFF
 

Since Gov. Jon Corzine signed the landmark postpartum depression law 20 months ago, the state has spent $9 million on the program: half on TV and radio ads and brochures encouraging women to ask for help, and half on training more than 6,000 medical professionals in how to identify the illness.

But health experts and women using the hotline say the law has fallen short: Women are seeking help, but when they do, state and medical professionals often are not prepared to assist them.

Many women found a state hotline staffed by people who were inexperienced at helping those in a mental health crisis. Obstetricians, gynecologists and other doctors often are afraid to get involved, they say, because of their lack of psychiatric knowledge. And there is a shortage of mental health professionals skilled in treating the illness.

``The people who did speak up were greatly disappointed," said Joyce Venis, a Princeton psychiatric nurse who treats women with perinatal mood disorders and served on the state advisory group that assembled the public awareness campaign. ``How could this happen? I believed this was going to be a good program."

Venis, who sees about 40 patients a week at her Princeton practice and runs a postpartum support group that meets in Somerset County, said the majority of her patients have expressed frustration and disappointment with either the hotline, the lack of experienced doctors and mental health professionals, or both. It's a sentiment echoed throughout the state, women's advocates and health experts say.

Gail Schuetz, 35, of Edison and a member of Venis' group, says she became depressed after her second child was born. Her son, sleepless and inconsolable, needed her, but she couldn't muster the energy to leave her bed and soothe him.

She suspected she had postpartum depression, a mental illness in which women experience severe depression and relentless anxiety, and even contemplate hurting themselves or their children. One of the prime movers in getting the law passed was Mary Jo Codey, wife of Senate President and former Gov. Richard Codey.

One part of the state's advertising campaign urges women to "Speak Up When You're Down."

But when Schuetz tried to speak up, she said she was let down.

She said a therapist referred to her by the hotline turned out to be a drug counselor whose advice consisted of telling her "don't obsess." Her own obstetrician refused to see her and advised her to go to the emergency room. It took five calls to find a support group.

"The state postpartum depression advertising program and the law made it seem like I would just call the 800 number and would have everything I need - therapists, doctors, support groups," she said. "It had nothing."

Assistant Health and Senior Services Commissioner Celeste Andriot Wood said she's heard the "horror stories" but said, "we have to err on the side of being conservative" with an illness in which a small percentage of women have killed their children.

"If women are truly in crisis, we have to tell them to go to a crisis center," Wood said. "You don't want to miss somebody, especially when the woman is calling and she doesn't have a support system or extended family."

Wood conceded the hotline - an existing "Family Health Line" with information on a variety of topics - has its problems. She said women complain it is staffed by operators short on suggestions of where to go for help. Many who complain can't find a therapist, or are frustrated they've been referred to inexperienced "specialists."

"When you suddenly have a large influx of women who are indeed seeking out treatment, we need to be able to identify appropriate resources," Wood said. "It's been a challenge."

About 2,400 women have called the postpartum depression hotline since its inception in July 2005, and nearly 300 uninsured women got treatment at state expense.

Wood said the health department plans to hire experienced social workers to handle some hotline calls in the coming year, and compile lists of skilled mental health and medical professionals.

A `HORRIBLE' RESPONSE

Maxine Garcia of Sayreville says that when she asked for help she got a response that left her stunned. Police officers and rescue squad workers arrived unannounced at her home last year, an hour after she called the hotline to say she was six months pregnant and "depressed out of my mind." According to the police report, Garcia threatened to hurt herself, but she denies it. She and her two children were forced to go to the emergency room. "I felt like I had no rights," Garcia said. "I really just needed someone to talk to."

Yolanda Iyube of Franklin in Somerset County says she confided to her gynecologist two years ago she was consumed with scary thoughts about her baby dying violently. Before she left the office, a police-escorted social worker took her to the emergency room. "They brought me in a police car to the hospital. It was horrible - everyone was looking at me like I had committed a crime."

Venis said such responses can discourage women with postpartum depression from seeking help.

"When they have intrusive thoughts, they need to know their fears are safe with whom they are talking," Venis said. "If a person has intent and talks about a plan to hurt herself or someone else, there's a difference. Sometimes (doctors or hotline workers) don't know, and maybe it's a sense of covering themselves."

Experts say improving the hotline won't be enough if the medical community does not gear up to handle the demand. One in eight mothers - about 16,000 women in New Jersey - suffers from a perinatal mood disorder, mental health experts estimate.

"Amazingly, there is not a lot out there for women," said Robin D'Oria, executive director of the Central New Jersey Maternal and Child Health Consortium, one of six groups hired by the state to provide training and create lists of specialists. "We made some phone calls, and some practitioners don't choose to treat postpartum depression. It's hard for women to see someone right away."

Codey, who revealed her personal struggle with the illness and launched an awareness campaign in 2005, says she knows this firsthand. She said after a psychiatrist she used moved out of state, her gynecologist told her he doesn't know where to send his patients.

"He said the people who are out there - the psychiatrists - they don't get it," she said. "He sees a lack of experience in what to do with these women."

Codey believes the law is having an impact, saying "society is accepting" postpartum depression. But she said "we have a long way to go" and is lobbying for national legislation for research, screening and treatment of the illness.

When the law took effect, there was an initial reluctance from physicians treating new mothers - a fear that "we won't be able to discharge anyone from the hospital," said Edward Wolf, vice chairman of the Department of Obstetrics and Gynecology at Saint Barnabas Medical Center in Livingston.

Wolf said the law added responsibilities for obstetricians already vulnerable to malpractice lawsuits. He said there was a fear of "I am going to get this thrown on my lap without help."

Saint Barnabas, which delivers the most babies in the state - 7,000 annually - has hired two psychologists well-versed in prenatal mood disorders to be on call when a patient needs them. "It makes all the difference in the world," Wolf said.

THE ROAD AHEAD

Since September, hospitals across New Jersey have screened 18,000 mothers for the illness following delivery, with 13.5 percent indicating they were at risk.

Susan Stone, a clinical social worker from Englewood Cliffs and president of Postpartum Support International, said doctors treating women and children must be assured there will be mental health services available when they identify a patient who may be at risk.

"We've come a long way in the last two years, thanks to Mary Jo Codey, in raising awareness," Stone said. "But we have a long way to go to catch up the mental health community, which needs to develop specialized services."

Ricardo Fernandez of Princeton, a psychologist who has treated postpartum illnesses for nearly 25 years, said the mental health field will eventually respond. "It's happening, but these things take time," he said. "The program in New Jersey has accelerated it."

But Venis, who has treated women with the illness for 30 years and suffered from it 40 years ago, said many in her field shy away from it. "You need to be okay with the illness and I don't believe they are," she said.

Venis' group meets in a tidy conference room at the Rocky Hill Library.

At one recent meeting, one woman said her doctor told her postpartum depression "was a made-up illness." Two said their husbands doubted how sick they really were. One got this bit of advice from her mother-in-law: "Snap out of it."

"You forget who you used to be. You can't trust your brain," Margarita Turkish, 35, of Old Bridge said at the October meeting.

Venis nodded as each woman spoke, saying she's heard too many stories about how hard it was for them to get help.

"To be told to `just get over PPD' is like telling someone to not have cancer, or telling someone with two broken legs to shovel the sidewalk," Venis said. "You can't think your way out of it."