Behavioral health integration is a crucial part of ensuring holistic care in women’s service lines. According to the Substance Abuse and Mental Health Services Administration (SAMHSA), among women with mental health conditions, 27% have a serious mental illness and 20% suffer from mood or anxiety disorders during pregnancy.
In a webinar hosted by Becker’s Hospital Review, healthcare leaders from Carilion Clinic dove into how they’re approaching behavioral health in their women’s service lines, shared best practices for integration, and offered strategies for better patient outcomes.
Carilion Clinic has taken steps to integrate behavioral health services into their women’s health service lines, and Dr. Jennifer Wells, reproductive psychiatrist and Director of Women’s Mental Health Services, and Dr. Jaclyn Nunziato, OBGYN and Executive Director of Huddle Up Moms, shared how they think about ensuring all patients have access to care that’s trauma informed and culturally sensitive. Please read below for a breakdown of the key insights they shared during that conversation.
Untreated behavioral health conditions can have negative ramifications on clinical outcomes
As an OBGYN, Dr. Nunziato shared that mental health was never in her training, yet behavioral health conditions are more commonly found in women than other common illnesses covered in regular screenings.
Dr. Jaclyn Nunziato, OBGYN, Executive Director of Huddle Up Moms
“I found patients I was seeing for years were sitting on these mental health issues, everyday struggles, and transitions throughout their reproductive journey. I would hear time and time again [patients saying], ‘Nobody’s ever asked me how I’m doing […] mentally.’ I found screening them even at a routine visit has really opened my eyes to the need and to the lack of resources.
Dr. Nunziato went on to say that untreated behavioral health conditions have negative ramifications on clinical outcomes and that gaining a better level of expertise in mental health has made her a better provider.
Reproductive psychiatrist Dr. Jennifer Wells, Carilion Clinic’s Director of Women’s Mental Health Services shared that she has witnessed mental health stigma decreasing, a credit to Carilion Clinic and having providers who are more open to behavioral health.
In previous times, Dr. Wells said people would show up and talk about their depression, but not mention things like substance use.
Dr. Jennifer Wells, Director of Women’s Mental Health Services at Carilion Clinic
“As we’ve grown in our ability to talk about diseases and provide education to the people around us, it’s allowed this great evolution of how we think about mental illness. And now I think some of that is happening in the perinatal space.
She says persons of reproductive age and parenting women are more comfortable sharing their fears and concerns about being a parent. Dr. Wells also shared that the ability to express these fears and concerns opens the opportunity to educate, listen, and find better ways to help people manage their anxiety and depression.
Acknowledging that hormonal shifts are important markers of a women’s health journey can help reframe the way we approach conversations about behavioral health
When defining the difference between “women’s health” and “women’s mental health,” Dr. Wells shares that they’re intimately connected.
Dr. Jennifer Wells, Director of Women’s Mental Health Services at Carilion Clinic
“Women’s health has come to the forefront because we recognize the journey of a woman through her life is characterized by significant hormonal changes. Hormonal shifts are responsible for many downstream effects like mood disorders.”
Dr. Wells also shares that a woman’s life takes a dramatic shift every 10, 15, and 20 years, which can create a shifting of mental health. This journey starts during adolescence, matriculating through middle school to high school, where someone might experience premenstrual dysphoric disorder. Then in fertile years, a woman might experience perinatal mood and anxiety disorders.
If a woman undergoes fertility treatment or infertility, they might experience depression or anxiety. Then, there’s the postpartum period that brings a greater risk for mood and anxiety disorders. Then, there’s menopause.
When discussing hormonal shifts, there are also important considerations around stigma. Dr. Nunziato shared that acknowledging hormonal shifts places value on where a woman is in her journey, where in another time, it was seen as something that was “all in someone’s head.”
Dr. Wells said that would like to see the conversation move beyond a woman being histrionic and can’t control their hormones to the idea that hormones are neuroactive steroids that change the biochemistry and neuroreceptors of someone’s brain, making mood disorders more common.
Dr. Jennifer Wells, Director of Women’s Mental Health Services at Carilion Clinic
“Hormones are very real, and we need to talk about them – it’s a part of a woman’s life. Women live their lives through connection and emotional ties to other people. As these connections change through life, it’s no surprise that it happens concurrently with hormonal changes that exacerbate and ameliorate mood disorders.”
How to integrate behavioral health into women’s health
Dr. Nunziato said the first thing a provider can do to integrate behavioral health is to become more comfortable in the mental health space and talking about mental health with your patients, noting, “You are somebody that values mental health and is willing to ask about it, provide screenings, be more educated about it. The more you do it, the more you gain a network and find the resources available in your area.”
When considering at what point a provider should refer to a specialist, Dr. Wells says it depends on provider comfort, sharing that each provider comes from a different training background with varying familiarity on certain conditions, like PMDD or major depressive disorder.
For providers, she recommends getting more comfortable talking about mental health and increasing their knowledge base. Dr. Wells also shared that most people are comfortable prescribing an SSRI, but if it goes beyond their scope and level of comfortability, they can reach out for an e-consult.
Dr. Thomas Milam, Chief Medical Officer, Iris Telehealth
“The high prevalence of mental illness and substance use disorders in America can be co-occurring, including conditions like anxiety and depression, ADHD, bipolar, and schizophrenia. We know that primary care providers, family doctors, and pediatricians are at the frontlines, but often need support from mental health experts for medication management, therapy, or substance use issues.”
At Carilion Clinic, they have e-consult services built into their systems, and providers can reach Dr. Wells via calling, texting, or a referral to her clinic. There are also perinatal mental health lines where providers can get connected to a specialist within 30 minutes.
In Virginia, Dr. Wells and Dr. Nunziato are heading their state’s perinatal mental health line called “VMAP for Moms+,” designed to help providers caring for pregnant persons or those contemplating pregnancy. These lines help create networks of good information that’s evidence-based and data driven.
Dr. Nunziato shared that she was seeing wait lists from six months to a year and to help increase access, they leveraged a risk-stratification approach. She noted that not everyone needs to see a psychiatrist and might do great with a peer support group or rely on their own OBGYN.
Addressing gender in women’s healthcare
When discussing women’s health, it’s important to consider all facets of the female experience, including transgender care.
For Dr. Wells, who often works with transgender patients, she shared that her practice is intentional about using the right terminology and understand this population faces higher rates of substance use disorder, abuse, and intimate partner violence.
Dr. Nunziato added for transgender patients trying to get pregnant or going through menopause, they’re also dealing with physiologic changes and stressors that need to be addressed and often aren’t recognized.
Dr. Jaclyn Nunziato, OBGYN, Executive Director of Huddle Up Moms
“It’s up to us to implore our teams to be accountable, respectful, and as open as possible. When I have transgender patients who are getting pregnant, it’s a great way to remind my staff (from the front desk all the way to the person doing their transvaginal ultrasound) that we need to be mindful and respectful of everyone’s individual needs.”
Dr. Wells shared that as the Director of Women’s Health she understands that “women” doesn’t always apply and it’s important to find alternatives. Dr. Wells goes onto say that she tries to elevate her own vocabulary, be sensitive to the person in front of her (however they identify) and educate herself on how best to meet their needs.
Get started with behavioral health integration
We are so grateful for the time Dr. Wells and Dr. Nunziato shared with us. Thank you for your partnership and for all the incredible work you are all doing to expand behavioral health to your community!
Weren’t able to make it to the webinar? You can catch the full video here. If you’d like to learn more and figure out the next steps to integrating behavioral health into your women’s health service lines, you can contact us here.
