Support and Training to Enhance Primary Care for Postpartum Depression

Referral and Consultation

A referral network is an invaluable resource for healthcare professionals as a means of providing appropriate treatment for PPD and engaging patients in treatment. Click here for a Referral Network template to help you or others in your clinic begin to establish a referral network for your patients.

Establishing a Referral-Consultation Network

Ideally, you or someone in your office should make initial contact with a referral source, rather than leaving the woman with depression to take responsibility for doing so herself. This increases the likelihood that she will actually follow through and make the appointment. If your practice is unable to help schedule appointments, keep in mind that the more information a woman receives about a specialist, such as names and other specifics about the practice, the more likely she will actually follow through with the referral.

Here are some important steps you can take to prepare for providing good referrals:

  • Learn what community services already exist for helping women and their families cope with PPD.
  • Assemble resources in one place and tailor the information given to each woman to meet her needs (click here for the Referral Network template).

While mental health providers may have varying degrees of familiarity with PPD, those who specialize in PPD should have some formal training in postpartum disorders, significant experience treating women with PPD, and a basic knowledge of the literature available on postpartum mood disorders, including books written on the topic. They should also have suggestions for Web sites, support groups, and other resources on PPD. Once you have found a few good providers, ask them for names of colleagues and referrals to other services in your area, building from their network of resources.

Examples of Professionals and Other Resources in a Referral-Consultation Network
  • Mental health specialists with experience in women's issues, particularly postpartum adjustment and PPD, when available
  • Local visiting nurse or social worker programs, particularly those focused on the first postpartum year
  • Local support groups for PPD or new mothers
  • Hotline and “warm-line” numbers: A warm-line is a non-crisis telephone support line, an alternative to hotlines or emergency services, answered by trained individuals who can offer support, listen to concerns, and generally identify with the caller's perspective.
  • Online bulletin boards or discussion networks
  • Web sites, videos, articles, and books for additional information

Please see the Resource section for suggested Web sites, phone numbers, and other resources.

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Consulting With Other Primary Care Providers

Information obtained from other primary care providers (PCPs) involved in the patient's care supplements information from the patient herself and can offer a different perspective on precipitating factors and the best course of treatment for the individual patient. Many women feel more comfortable working with a PCP than a mental health provider for a number of reasons, including stigma surrounding mental health, insurance disparity for mental health coverage versus other health coverages, and a desire to speak with someone with whom the woman has an established relationship.

In addition, a pediatrician or family physician may have more contact with a new mother through her baby, especially within the first few months after the woman gives birth.

Process:

  • When assessing the patient for PPD, inquire about her willingness for you to discuss or share information about her with other providers.
  • Obtain the necessary releases and explain that discussion with them will help you develop a better understanding of her particular situation, resulting in better care.
  • If you encounter resistance from the patient, do not press the issue unless medically necessary.
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Consulting With Mental Health Specialists

Consulting with a psychologist, mental health social worker, or psychiatrist is often advisable when screening and assessing women for PPD. Mental health specialists can offer in-depth knowledge of mood disorders and PPD, and they may be more connected to community resources and experts in the field. The mental health specialist does not need to be an expert in postpartum or women's mental health, but he or she should be familiar with PPD and be able to provide information about clinical presentation and effective treatment options.

Process:

  • Develop a professional relationship with one or more mental health specialists in your area, particularly one with experience in postpartum mental health and treating perinatal women .
  • When assessing the patient for PPD, ask her if she is willing to let you obtain or share information about her with a mental health specialist.
  • Obtain the necessary releases.
  • Explain that discussion with a mental health specialist will help you develop a better understanding of her particular situation, resulting in better care.
  • If you encounter resistance from the patient, do not press the issue unless deemed medically necessary.

Rural providers or providers in resource-poor areas may need to make more of an effort to learn what mental health resources are available to postpartum women, and they may experience a greater demand for mental health care in primary care settings.

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Consulting With Individuals in the Patient's Support Network

Family and friends can offer in-depth knowledge about the postpartum woman and her behavior across a number of settings and over time, and they often notice subtle changes that may elude providers and, sometimes, even the woman herself. Family and friends can also serve to motivate the woman to seek mental health care and to help her adhere to the treatment plan.

Process:

  • Obtain the patient’s permission.
  • If a member of her support network is present during an appointment, ask the patient if it is permissible to discuss the issue of postpartum adjustment as a group.
  • Keep in mind that the woman could perceive the conversation as a breach of confidentiality, especially if she is experiencing symptoms of PPD, so proceed sensitively.

Legally, you can receive information about the patient from friends and family without a release, but you cannot give information of any kind to them without permission.

Conclusion

Providers completing this section should have the knowledge and skills to overcome barriers to PPD screening and assessment, choose and use a screening tool, determine whether an assessment is indicated, conduct an assessment using diagnostic criteria to confirm a diagnosis of PPD or rule out PPD, and refer women with PPD to a specialist for treatment. The next section will teach you about treatments for PPD and will aid you in determining the best treatment options for specific women with PPD.

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