A unique program at Los Angeles County-USC Medical Center is combining prenatal care with psychiatric treatment for low-income women who might otherwise not seek help for mental health issues during pregnancy.
Psychiatrist Emily Dossett started the Mental Health Wellness program, the first of its kind in Southern California, last July. It is in the hospital's OB clinic.
"The idea is to bring mental health care services into the prenatal care setting so that women get everything they need in one place," says Dossett, who specializes in reproductive health. "There’s also a lot less stigma because there is no shame in going to see your prenatal care provider."
One of the program's clients, 22-year-old Norma Leyva, says she checked several boxes on a screening form when she arrived there in December.
"I [felt] depressed, I wasn't very hungry...I felt kind of irritable and [a] lack of energy, not very enthusiastic about daily activities, those kinds of things," she recalls.
Leyva says her pregnancy stirred up old emotions from trauma she suffered as a child and created a lot of anxiety.
Dossett says Leyva's story is a common one.
"The reality is that untreated psychosis, we know that it leads to a lot of behavioral issues that can be a real problem but it also...increases the rate of preterm delivery, stillbirth, miscarriage," says Dossett. "It’s a medical illness."
Leyva, who was expecting to give birth anytime when interviewed for this story in mid-March, says the program has helped her channel her feelings in a way that will be healthier for her baby.
"However you feel, you are transmitting all of that to your baby," says Leyva, who lives in Huntington Park. "It’s as important as your diet; negative emotions are also very toxic and you have to look for something that can help you avoid those feelings or can eliminate them."
Besides trying to improve birth outcomes, Dossett says the program focuses on minimizing postpartum depression as well as stopping the transmission of mental health problems from mother to child.
"Untreated depression and anxiety and other mental illnesses in pregnancy actually affect the developing fetus," she notes. "There are neurological changes, there are physiological changes that happen because of that."
The program counts among its fans Dr. Diana Barnes, a pioneer in the field of reproductive mental health. Barnes, a psychotherapist who runs the Center for Postpartum Health in Sherman Oaks, says Dossett's initiative "fills a special need because there is a gap for those...who do not have access to proper treatment, who don’t have the money to get proper treatment."
Dossett points to research that shows nearly half of low income women experience perinatal mood and anxiety disorders, compared with 15 percent of all pregnant women.
Her patients are facing all kinds of challenges, says Dossett, including: "Stress of poverty, a lot of the women are separated from family because of immigration reasons, we have very high rates of women who have experienced trauma - whether childhood abuse of some sort or current domestic violence. A lot of them are juggling so many stresses."
Another patient, soon-to-be mother Xiarama Sanchez, says she began to see Dossett after her health screening showed signs of depression.
She says she felt at her lowest point after losing her brother last year and undergoing brain surgery at around the same time that she found out she was pregnant. The Los Angeles woman began therapy sessions during her visits to the prenatal clinic.
"They gave me medication," says Sanchez, 34. "The way my emotions were affecting me I could not sleep, I could not eat and thank God with their help I am recovering."
Barnes, who has collaborated with Dossett in the past, says focusing on pregnant women affects not just the mother and the fetus but the whole family.
"If we don't treat the mom now we have good reason to worry about the next generation and the next generation and the next generation, because when a mother is so depressed that she's unable to be available to her baby that is a traumatic experience for the developing child," Barnes notes.
Dossett wants to expand the program, which has treated 60 women since it opened last summer, to other county clinics.
In the meantime she's planning a similar program for the pediatrics department at County USC. That way, new mothers will be able to continue their mental health care during well-baby visits.