Providence hospital's perinatal program supports women with chronic mental health conditions

August 15, 2022


The "baby blues" — mild depression that occurs in about half of new mothers — is well known, and post-partum depression, a more serious condition, has gained more attention in recent years. But what about care for pregnant women and new mothers who have been diagnosed with mental health disorders and who find their depression and anxiety worsening?

Providence Holy Family Hospital in Spokane, Washington, recently initiated an outpatient program to address the special needs of those women. Launched in March, the Perinatal RISE Program is the third facet of the hospital's RISE Program, which has offered mental health services to teens and adults since 2018. "RISE" is an acronym for resources, insight, support and empowerment.


Tamara Sheehan, Providence behavioral health director, began developing the perinatal mental health program about a year ago after repeatedly hearing that local medical professionals were struggling with how to treat pregnant women and new mothers with mental health conditions. No formalized program existed in Spokane and the one offered in Seattle is 279 miles away.


"Some places here are starting to do screening, but cases in about 90% of these clients are going undiscovered or untreated," said Kristin Reiter, manager of Providence's RISE Program. "Often, the subject of depression is not discussed at all. These moms are not asked how they are doing and there is no follow-up — it's a silent epidemic. But now we have set up this niche service, and we know what to do."

Holy Family is inviting women in Spokane County and nearby communities, such as Stevens County and northern Idaho, who are pregnant or up to one year postpartum to consider enrolling in the P-RISE program, which is covered by insurance. "We're not targeting just postpartum depression, but women who are bipolar or have anxiety disorders, personality disorders, PTSD or other disorders, all conditions that were present prior to pregnancy and childbirth," Reiter said.

The meat of the program
In groups of eight, participants 18 and older meet with Reiter, psychiatric providers, two therapists and a nurse practitioner, all certified in perinatal mental health. Women "come according to their level of need," Reiter said, attending three and a half hours per day at least three days per week for six to eight weeks. Treatment approaches are tailored to participants' individual needs. Private sessions with therapists and the nurse practitioner are part of the program — and babies are always welcome.

Adeia Hernandez says she learned how to emotionally ground herself in the Perinatal RISE Program. She enrolled after she gave birth to Arabella, who is now 10 months old.

"We set up a group room with a table, rocking chairs, portable cribs, blankets, baby toys and supplies such as diapers and wipes," Reiter said. "It's a very relaxed and open atmosphere. Moms can breastfeed there — we want them to feel comfortable meeting babies' needs in the group setting."

Early in each meeting, clients talk about their struggles and their successes and how they are using their skills to foster better mental health. They also learn about different topics specific to pregnancy, birth, feeding and infant care. Next comes socialization, "anything that gets them up and moving, engaging with others," Reiter said. That might mean yoga, a walk in the park or a game "to get the women laughing and talking, the opposite of what people do when they feel stressed or anxious."

Learning coping skills through dialectical behavior therapy — "the meat of the program" — comes next. "We talk about different situations, about emotions, and everyone gets a binder with materials they can review at home," Reiter said. "These are skills the women can use indefinitely." After completing the program, participants receive information on additional resources for care.

Sparking hope
Adeia Hernandez, who completed the P-RISE program in the spring, had high praise for it. "I loved it — it's one of the best programs I've ever joined," said Hernandez, 24. "They make you feel welcome and supported, and that's so important when it comes to being a mom, whether it's your first child or your fifth. What I loved most was being able to bring my daughter (Arabella) with me, to have her there while I worked on becoming the best version of myself so I can be the best mother I can be for her."

Reiter said the program emphasizes that women have to meet their own needs first. "We tell them not to feel guilty about that," Reiter said. "There's so much guilt about everything involved in being a parent, and so much shame and guilt around mental health conditions — and we want them to feel less of that. If a mom isn't taking care of herself, how can she take care of her child? We want to help them feel more hopeful about handling motherhood."

The program also provided an opportunity for the women to learn from one another and build relationships with one another. Another upside was the "baby parties," watching the youngsters interact. "It was fun to watch them grow together," Hernandez said. "Arabella had never been around a lot of people or other babies, and she became even better about that."

Hernandez said she initially enrolled in P-RISE because she noticed a shift in her emotions after Arabella was born. "When you're pregnant, you're on cloud nine and everything, but previously, I had struggled with depression and anxiety. After I had the baby, my hormones were raging and I was feeling isolated, and I could feel myself going back to how I was before. That's when I started looking for help," she said.

Skill building
The program provides a lot of tools. "You pick and choose what works for you," she said. "There was a lot of emphasis on being able to recognize when you're overwhelmed and stressed, and how to identify your feelings so you can ask for what you need. I also learned how to ground myself emotionally, and I'm doing a bit of journaling, too. If any new mom is struggling, I'd encourage her to give the program a try, ask for help, even if that takes you out of your comfort zone."

The P-RISE program is still in the "soft opening stage," Reiter said, and the model will be tweaked as time goes by. "So far, we've had pregnant women and moms with depression and anxiety and personality disorders that worsened with pregnancy or birth, and some have needed help with their meds," Reiter said.

"This program is about stabilization. These women need to get help in a short time, because individual therapy once a week is not going to work. When participants leave our program, they are stabilized, they have skills and they are feeling better. The sky is the limit in terms of how we can grow P-RISE to meet the need."


Copyright © 2022 by the Catholic Health Association of the United States
For reprint permission, contact Betty Crosby or call (314) 253-3490.

Copyright © 2022 by the Catholic Health Association of the United States

For reprint permission, contact Betty Crosby or call (314) 253-3490.