Bridging the Gap for Perinatal Veterans: Care by Mental Health Providers at the Veterans Health Administration |
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| Institution: | 1. Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts;2. Graduate School of Nursing, University of Massachusetts Medical School, Worcester, Massachusetts;3. Department of Obstetrics & Gynecology, University of Massachusetts Medical School/UMass Memorial Health Care, Worcester, Massachusetts;4. Department of Pediatrics, University of Massachusetts Medical School, Worcester, Massachusetts;5. Department of Psychiatry, University of Massachusetts Medical School, Worcester, Massachusetts;6. Research and Development, VA Central Western Massachusetts, Leeds, Massachusetts;1. School of Social Transformation, Arizona State University, Tempe, Arizona;2. Population Research Institute, Pennsylvania State University, University Park, Pennsylvania;3. Department of Sociology, Pennsylvania State University, University Park, Pennsylvania;1. Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Division of Reproductive Health, Atlanta, Georgia;2. Centers for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Division of HIV/AIDS Prevention, Atlanta, Georgia;3. Department of Health, Family Planning Program, St. Thomas, U.S. Virgin Islands;4. Karna, LLC, Atlanta, Georgia;5. Department of Health, St. Croix Office, Christiansted, U.S. Virgin Islands;6. Centers for Disease Control and Prevention, Center for Global Health, Division of Global Health Protection, Atlanta, Georgia;1. Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania;2. Department of Statistics, University of Pittsburgh, Pittsburgh, Pennsylvania;1. Division of Adolescent/Young Adult Medicine, Boston Children''s Hospital, Boston, Massachusetts;2. Department of Pediatrics, Harvard Medical School, Boston, Massachusetts;3. Channing Division of Network Medicine, Department of Medicine, Brigham and Women''s Hospital, Boston, Massachusetts;4. Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts;5. Division of Adolescent Medicine, Cincinnati Children''s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio;6. Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio;7. Departments of Biostatistics, Nutrition, and Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts;8. Department of Obstetrics, Gynecology, and Reproductive Biology, College of Human Medicine, Michigan State University, East Lansing, Michigan;9. Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts;1. Harvard Medical School, Boston, Massachusetts;2. Department of Obstetrics and Gynecology, Brigham and Women''s Hospital, Boston, Massachusetts;1. VA San Diego Healthcare System, San Diego, California;2. Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina;3. Department of Veterans Affairs, Office of Mental Health and Suicide Prevention, Washington, District of Columbia;4. Department of Psychiatry, University of California, San Diego, San Diego, California;5. California School of Professional Psychology, Alliant International University, Alhambra, California;6. Executive Division, National Center for PTSD, White River Junction, Vermont;7. Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire |
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| Abstract: | BackgroundPregnant women veterans receive maternity care from community obstetricians but continue to receive mental health care within the Veterans Health Administration (VHA). Our objective was to explore the experiences of VHA mental health providers with pregnant and postpartum veterans.MethodsMental health providers (n = 33) were identified at 14 VHA facilities across the United States. Semistructured interviews were conducted over the phone to learn about provider experiences with perinatal women veterans and their perceptions of depression screening and mental health treatment management for pregnant and postpartum veterans receiving mental health care within the VHA system.FindingsProviders identified an absence of screening protocols and referral procedures and variability in risk/benefit conversations surrounding psychotropic medication use as important areas of weakness for VHA mental health care during the perinatal period. Care coordination within facilities, primarily through Primary Care-Mental Health Integration teams, was identified as a main facilitator to promoting better mental health care for perinatal veterans.ConclusionsMental health providers caring for veterans during the perinatal period identified several areas where care could be improved, notably in screening and referral processes. A refinement to current guidelines to specify standard screening tools, screening schedules, and referral processes could potentially engage a greater number of pregnant women in VHA mental health care. |
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