Defines maternal depression, requires the provision of maternal depression education, and the provision of a screening and referral plan for the state

Summary of specific provisions

Section 1 adds a new section 2500-k to the Public Health Law that defines maternal depression and maternal health care provider. This section also authorizes the commissioner to establish maternal depression screening guidelines for the state, including the routine employment of screening at regular intervals during pregnancy and after childbirth. The commissioner shall identify validated, evidence-based diagnostic tools for maternal health care providers to use to screen patients for maternal depression. Fathers and other family members, as appropriate and consistent with patient confidentiality, shall be included in dialogue about maternal depression in order to help them better understand maternal depression. The commissioner shall develop an appropriate referral mechanism for maternal health care providers to use when the screening results show the need for further evaluation and treatment of maternal depression.

Section 2 adds paragraph (i) to subdivision 1 of section 207 of the Public Health Law to include maternal depression on the list of healthcare and wellness education and outreach programs that may be conducted by the Department of Health.

Section 3 amends subdivision 1 of section 2803-j of the Public Health Law to make leaflets that contain maternity related information available on the Department of Health's website.

Section 4 amends paragraph (b) of subdivision 1 of section 2803-j of the Public Health Law to require the commissioner to review the maternal depression informational leaflets that are distributed to patients before they are discharged from a hospital. The leaflets shall address the various forms of maternal depression and provide resources for treatment of maternal depression. The leaflets shall also be made available in the top six languages spoken in the state, besides English.

Section 5 amends paragraph (b) of subdivision 1 of section 2803-n of the Public Health Law by adding maternal depression education, screening and referral to hospital care for maternity patients.

Section 6 adds a new section 3217-g to the Insurance Law on screening for maternal depression. No insurer shall limit a patient's direct access to maternal depression screening and referral.

Section 7 establishes an effective date.

Justification

Maternal depression is broadly defined as a wide range of emotional and psychological reactions a woman may experience during pregnancy or after childbirth. These reactions may include, but are not limited to, feelings of despair or extreme guilt, prolonged sadness, lack of energy, difficulty concentrating, fatigue, extreme changes in appetite, and thoughts of suicide or of harming the baby. These reactions may occur without warning and may happen before, during, or immediately after childbirth, and continue into the infant's first year of life.

Maternal depression may include prenatal depression, the "baby blues," postpartum depression, and postpartum psychosis. Each year, approximately ten to fifteen percent of mothers and twenty-two percent of multi-ethnic inner city mothers develop postpartum depression; 50-80 percent of new mothers will get "baby blues"; and 0.1-0.2 percent of new mothers develop postpartum psychosis. Postpartum psychosis, the most severe form of maternal depression, usually includes auditory hallucinations and delusions, and in some cases visual hallucinations. Postpartum psychosis has a five percent suicide rate and four percent rate of infanticide, or death of an infant.

Often, the symptoms of maternal depression are not immediately identified because they closely resemble those generally associated with pregnancy. As a result, maternal depression is sometimes left untreated, and may result in a detrimental impact on the entire family, especially the newborn and other children in the family. Children of mothers with maternal depression are at higher risk for serious developmental, behavioral, and emotional problems. The immediate family is often unaware and/or unsure how to offer support. A mother experiencing depression does not often disclose her condition due to feelings of shame, and the severity of the condition worsens.

Maternal depression is often undetected and untreated by maternal health care providers due to both lack of training in identifying the condition and lack of support both professionally and financially, as well as concerns about the availability of treatment options and coverage identified with maternal depression.

Early screening and identification of postpartum depression has an 80 to 90 percent success rate and offers long-term health care costs savings. It also helps support healthy child development and addresses issues of early childhood mental health challenges.

Women typically visit their obstetrician and gynecologist during pregnancy and visit the pediatrician for their infant's check-ups more often than they would any other health professional. Therefore, these maternal health care providers are in an ideal position to screen women for maternal depression.

Maternal depression is an epidemic that crosses racial, ethnic, economic boundaries and requires a universal screening to identify

patients who need help. It also requires a high-quality network of accessible treatment options to deliver help and public support so that families and babies have a truly healthy start.

Prior legislative history

None

Fiscal implications

To be determined

Effective date

This act shall take effect on the one hundred eightieth day next succeeding the date on which it shall have become a law; provided, however, that effective immediately, the addition, amendment and/or repeal of any rule or regulation necessary for the implementation of this act on its effective date is authorized and directed to be made and completed by the commissioner of health on or before such effective date.