Speaker 1: 0:20

Thank you. And Behavioral Sciences at MUSC. She's a reproductive psychiatrist and she established and is currently director of the Women's Reproductive Behavioral Health Program at MUSC. You guys are going to love her. This is a great conversation of what happens when we actually go directly to the mom and start her mental health. So stay tuned. Okay, guys, I am here again with Dr Gill and we are so excited. And, guys, let me give you a little backstory. She's like essentially Claire's boss you guys know Claire from the podcast, so this is the woman that works with Claire and has developed this awesome program. It's one of the only programs really in the United States, and especially in the South, for reproductive psychiatry, aka mom's mental health care. So welcome and thank you, connie, for coming to be with us.

Speaker 2: 1:08

Oh, my gosh. Thank you so much for having me. It's a pleasure to be here.

Speaker 1: 1:11

Well, tell us a little bit about you personally. What brought you into this field, and you are a warrior in this field, so we're always just wanting to know more about the why.

Speaker 2: 1:22

Well for sure, and you know I think there's a lot of really great warriors in this field right now. So I feel like we're in really good company but, as you know, lots more work to do. Yeah, so by you know background and training, I'm a reproductive psychiatrist.

Speaker 2: 1:34

I went to med school knowing that I was wanting to be a psychiatrist. I wanted to be in women's health, and it was really through my clinical experiences where I just saw this very strange marginalization of this population where there was such a need and demand and people would just avoid it and say but they're pregnant, we can't do anything. They're breastfeeding, we can't do anything, and we would exclude them from research studies, which we do all the time. We would not use therapeutic agents because we were so worried about the fetus, but we'd see the mom struggling and just all these things that just didn't make sense to me and everything from you know psychiatry saying, oh, this is my patient, but they come, become pregnant and they're no longer my patient, and now they're the OBGYN's patient and the OBGYN is like I don't know how to manage mental health, and so just all these gaps and just, you know, seeing it time and time again, made it really clear that this is where I wanted to be and where I wanted to spend my time and my work.

Speaker 2: 2:28

And I'm also a mom. I have a 12 and 15 year old, but remember those early days and you know, still now they're raising children is it is a lot? I mean physically, emotionally, psychologically. There's so much investment that goes into this and it feels like we're putting that all on moms to do by themselves. So anyway, so again, that's why I'm here, why I want to be doing this work.

Speaker 1: 2:52

I love that, and so one of the reasons I want to have you come on is you just did a really awesome study about what we kind of touched on about well, who's actually checking on mom's mental health, right, if psychiatry is going? Well, who's actually checking on mom's mental health right If psychiatry is going? Maybe not me OB is going. I didn't sign up for that part of it. So tell our listeners about your recent study of going directly to the mom using digital techniques in the screenings and what were your outcomes.

Speaker 2: 3:17

Yeah, and you know I should say that we developed this program which we call listening to women and pregnantregnant and Postpartum People, really through qualitative research, so talking to patients, talking to providers, really understanding on a granular level and sort of in the broader literature, what are all the barriers to effective screening Patient perspective, provider perspective and healthcare system perspective and then designing programs to overcome those.

Speaker 2: 3:44

So we did just that and I'm happy to explain what that program looks like.

Speaker 2: 3:48

But when we used it, we used this in a couple of studies, but most recently a randomized control trial. If a pregnant or postpartum individual got enrolled into this program, they were three times more likely to just get a screening done right, just to be screened, in comparison to usual care, which is that in-person screening and referral. They were also three times more likely to screen positive for the same questions that they're asked in person. So just using text and phone people are more willing to endorse some of these concerns, four and a half times more likely to be referred to treatment and 5.7 times more likely to attend treatment if you were enrolled in listening to women's system in comparison to usual care. And what I think is actually the most exciting part about this is seeing reductions in racial disparities, with Black women just being equally as likely as white women to get screened, to screen positive and to make it to treatment and same for our rural and partially rural areas, which was just this is exactly exactly what we want to be doing, so I'll stop there.

Speaker 1: 4:50

I love that and you know cause? I find all the time in conversations with people that well, they're screening them. Okay, well, they may. And I tell people there's such a broad explanation of screening, right? People may say I passed them this Edinburgh's depression screening or I hand it to them at check-in. They have to do it in the lobby, or I've had five minutes with them. The nurse hands it to them and she's like I'm not going to answer these questions or what's going to happen if I respond, right. So I always say screening is? It's kind of like you're waving a carrot in front of them, right? It's not the whole story. There's so much more that needs to be done. And you know I was never screened in either of my pregnancies and I was in private academic universities, right? So do you think majority of moms are not screened or just screened, maybe improperly, or could have done better? What's your thoughts there?

Speaker 2: 5:43

So, yeah, so I think that, like it speaks to the layers, right. So there is, people are just either not screening or when they're screening, they're doing it really ineffectively. They're not creating a space where people actually feel comfortable and safe talking about these issues. And I think sometimes, even when providers are asking these questions, they may ask them in ways that they don't really even realize that they're shutting people down. So what I would hear, literally like right next door to my office, was a nurse saying you don't want to hurt yourself or your child, right? Or you know like you look like you're doing pretty well, are you feeling sad at all? So it's just like, just even how you ask the questions and what is great about text is it's so objective, like it's asking it in the way that it should be asked and it's creating sort of a safe environment. So there's so much that, as you were saying, that has to happen in order for people to feel comfortable divulging these concerns. So yeah, to your point.

Speaker 1: 6:37

I love that. I love that you guys are addressing what we've been saying all along, as moms are saying. You know, if I speak up I'm not believed or I'm dismissed or I'm gaslighted or I feel these. You know, we hear a lot. There's racial disparities of how women are treated. You know, myself as a nurse, I always tell people. You know, I had a hard time advocating for my own mental health and I had all the tools in my toolbox to do that and I still wasn't believed. So I think it is taking it directly to the mom, right? So we're not relying on that nurse to present it in a certain way. We're not relying on what her experience in that waiting room was right or if she has to get to work and it's already late. So we are going directly to her. And so when? So do you think people felt they could just be more honest with you guys and that they knew, if they could be honest, that they were willing to take that next step for help?

Speaker 2: 7:29

I think so and I really just from sort of our subsequent qualitative research to understand wait, this seems like it's working, and how is it working? That was we wanted to really hear feedback from that. And, to your point, people were like I didn't feel rushed, I could just take my time, I could do this on my phone whenever and it was super convenient to do it, and they just didn't feel like someone was sitting there judging them, which, again, like you could have a provider who is totally nonjudgmental, ask these questions in the right way, does all the things, but until that mom feels safe to answer those questions, it's not going to get answered correctly. So this house somehow created that safety and sort of lack of, or just feeling that they're not being judged, which I think was pretty cool.

Speaker 2: 8:11

And then you know, when we enroll people in the system, we're really clear about, like here are the terms of confidentiality. You know who's going to see this. It's going to be a care coordinator and we can share it with your provider if you'd like us to, so they sort of know the bounds of it. It wasn't like this busy clinic where you could be talking to anybody and you see multiple providers, right? No, it's just this kind of closed circle and just to let them know the person that's going to reach out to them is just going to reach out by phone, not in person. You don't have to come in, we're just going to call you, have a conversation about how you're doing and figure out what your needs are, in addition to not just your mental health needs, but like what are the stressors, what are the social determinants of health that are really challenging right now, whether it's housing utilities, diapers, et cetera.

Speaker 1: 9:00

Like people live pretty stressful lives and so we care about that and we want to know these things, so you know how it's presented to people is really important. I love that. And then so the moms were willing for treatment. I think that's huge right, because we know statistics tell us that 75% of moms go untreated, right. And then so we're always trying to change that narrative and there's such huge consequences with moms who don't get treatment her mom and baby, and it's the most common complication of pregnancy that people always seem shocked when I say that. But I'm like the numbers don't lie right. So do you think that the treatment let's talk about treatment, because there are some payers that have restrictions to in-person right, and you're asking this mom to take off more time from work, more gas money, right, barriers are in front of her, with treatment being able to be telehealth, which I know you love and you're a huge champion of that. Can you just speak to how moms are going? I do want to get help, but you know it's really hard.

Speaker 2: 9:49

Yeah. So a couple of things I should just mention. When this individual gets in touch with their care coordinator, they're literally just doing a brief intervention because the screening information tells you essentially clinically what needs to happen. So they can just sort of listen to the woman in the context of which treatment is accessible or not accessible and what were the barriers for her as an individual. So everything from like addressing concerns about social services involvement and punitive consequences and the things that get women really scared that my child's taken away from me, et cetera, and so it's that addressing those barriers. And then when you get down to it and like okay, we're now the practical barriers of actually getting to a mental health provider, if you feel safe doing that I mean telehealth is a game changer like to to not have to leave your house, to not have to find childcare, to not have to pay for transportation You've just removed like three of the largest barriers to getting treatment. So I think telehealth should be readily available to women's homes.

Speaker 2: 10:46

We saw this in the start of the pandemic. We had a volume of new patients increased by 200% within one month. Right, and people were just getting care. So it's, it's just. To me it's a no brainer, but I think I live this and I just I just see how much easier it is for people to not only get to care but stay into care. Like weekly appointments for therapy take, take time and we can. If we can do that, we can get people better quicker. As opposed to okay, I'm just going to come once a month or every two weeks, right, so it's just yeah.

Speaker 1: 11:16

Telehealth is critical I just think I love you know and we stand with this sort of previa is that there's so many barriers and so much pressures on moms. I don't care what stage of motherhood it is, we got to go directly to her. There's enough on her. We want to be taking that weight off. I always love when research backs what we have been saying and doing. So I want to touch on you. Know, what do you say to providers who may say this is great, but what are we going to do when we are having more positive women, when we are having more women reaching out? Because it is kind of society will play a don't ask, don't tell. They're kind of comfortable with that. So now we're saying listen, we found a great way to screen, we found a great way to get them to treatment and everybody else is going. Do we really want to see how many people are struggling?

Speaker 2: 12:00

Well, do we really want to see that? Well, I just take a look at your maternal mortality data. I mean, mental health conditions are the leading cause of maternal mortality, by suicide and drug overdose. So, yes, if you want those numbers to continue, then yeah, continue, don't ask, don't tell. But if you actually want those numbers to continue, then yeah, continue, don't ask, don't tell. But if you actually want those numbers to improve, then we have to screen, we have to do care coordination, we have to get people to treatment, and we're providing a system that does just that.

Speaker 1: 12:26

Yeah, and what do you? You know why do you think society's got comfortable with moms dying by suicide and overdose? Right, it's like we don't downplay it and you know the month of May, there's a lot of intention to it. I always say all the big bots and brands get behind and talk about mom's mental health, and then here we are getting summer, fall and holidays and that's. That's kind of far from the conversation.

Speaker 2: 12:47

Yeah, yeah, you know, I gosh. I think that this is like it's a really complex, multi-layered problem, right? I mean I think that you know, medicine is not comfortable with mental health. We haven't set up the system to be really focused on prevention and integration of mental health into medicine. So I think that that is part of it.

Speaker 2: 13:09

I think when you sort of look at the and our society is not accepting of mental health, you know if it's highly stigmatized in general, but then you put a mom being on top of it and you're already. Our society is so judgmental of this population anyway. So that's sort of the, you know the surrounding layer. But if I had to look at, like, the societal impact and why it is, we are where we are. You know, I think obviously sexism and racism play a really important role, but but so does capitalism. And I think obviously sexism and racism play a really important role, but so does capitalism.

Speaker 2: 13:38

And I think that what we've done in our society, what we've decided to do, is to really prioritize profit over anything else. We wouldn't have this problem, people would be really invested and we would have the resources behind it, and I think it has a lot to do with that we're so short-term focused, so we're not going to see a quarterly return on investing in maternal and child health. This is really the long game. If you invest here, you're going to see a healthier families, healthier communities. You know, the return on investment is actually pretty immediate in terms of maternal mortality and maternal morbidity. But it's really hard for people to see that because it's costly, like it's costly, to raise a healthy generation. It's costly to have paid maternity leave for a year postpartum, like every other developed country that doesn't have the maternal mortality problems that we have. So, yeah, so those are just some of my thoughts about sort of the layers that translate to this problem.

Speaker 1: 14:43

Because the common theme I hear from moms you probably hear it too is that it just seems like no one cares right about them, and I think that's so sad and I personally felt that is it's. You know that you couldn't speak up right, because then you were ungrateful, or you know, especially in the South, there's this huge pressure and expectations that you have a baby. It's the best thing that's ever happened and anything other than that. There's something wrong with you know you as a person. So I mean, what could you speak to our listeners? They're like, okay, there's hope, but like I'm struggling, what would you? What's some encouraging words here that they do care?

Speaker 2: 15:18

Yeah, I want to answer that, and I also just want to speak to the motherhood myth for a second, because I don't know why that started.

Speaker 2: 15:26

But what it effectively does is it shuts women down, right. It prevents women from talking about these issues and so therefore, they can't be addressed unless we're talking about them. So the more that you as an individual can just talk to one person about how you're struggling and it doesn't have to be, I mean, great if it's a partner or a family member or someone in your community, but, like online, you can find peers I mean, you can look at Postpartum Support International and really connect with a community that can hear what you're saying and help you get any support that you need. There's also, obviously, the maternal health hotline that is available across all of our country. So I would say you know, first of all, you're not alone. You know like there are a lot of moms struggling, that there is help available and like this will get better. You just got to take that initial step to tell one person who can help mobilize this.

Speaker 1: 16:17

I love that. And then you know, I think what they've had, the experience was a lot of them had where maybe they told the wrong person as that first person, right, or they met a provider who was not educated in maternal mental health and maybe dismissed them and said, oh, that's just baby blues, and they're like well, I'm four months postpartum, I don't think that's baby blues right.

Speaker 1: 16:37

What do you kind of say to there? Because they are going to be met with? Not everybody is educated on this or even aware. I even say, if you can't be fully educated, at least be aware. So what would you say to that? Because we've all been there and that hurts, right, and you're like this person is supposed to help me.

Speaker 2: 16:53

Yeah, yeah, I would say one trust your gut. I mean, you're the expert on how you feel and, by the way, as a mom, you're the expert on the baby. So what you're saying, just trust it. And if you are met with deaf ears or you're met with some sort of judgment, like yeah, it was just the wrong person and you move on to the next one and that's hard because you're putting yourself in a position of vulnerability to do that. So you want to choose that person wisely. But if you're not heard, keep finding other people, because eventually you will be heard. There is a community out there. And trust yourself, trust your gut, I love that.

Speaker 1: 17:28

And then you know I always love to touch on success stories. You know you've seen moms come to you the lowest lows and they've come around and what is some kind of themes. And you know comments you hear from them once they finish treatment, once they've gotten better. You know I'm sure they never regret it. I never regretted, you know, getting better and getting help. But what to the listener? Who's kind? Of on the fence of like oh, this sounds good, I just don't know about going through it, yeah.

Speaker 2: 17:52

You know one thing in going through it and finding somebody who is an appropriate provider and good, you get some good treatment it is. What is on the other side of that is pretty incredible and often what I hear is I didn't realize how bad it was like, because it's now you have the perspective of feeling like yourself and well again, and not really realizing that like, oh my gosh, I was in a really bad spot. So just knowing that like that trajectory is ahead of you, like you're going to feel better and actually so much better. And you know, if, if you reach out to somebody, you start the work and it doesn't feel right, like there's other therapists, like try other people, that maybe wasn't the best fit. Yeah, I think that's what I would.

Speaker 1: 18:34

I think that's, and I always tell people. I think you do get normalized sometimes the suffering right and the hard, because we're never talking about it and it is. You look back and you go. I do it myself, I'm going. Oh my gosh, I understand why women are, you know, dying by suicide and overdose, if that's what they think their normal life has become and will always be.

Speaker 2: 18:56

Yeah, yeah.

Speaker 1: 18:57

Oh gosh, absolutely, because you lose hope. But we want to turn the tables just a little bit. This is a mom question for you. We ask all our guests this, so put on your mom hat, not your reproductive psychiatrist hat. What would you tell yourself Okay, you have motherhood experience to speak on this when you first got that first pregnancy test about motherhood. What you know now that you wish you would have told yourself when you first found out you're pregnant, about how you're going to handle motherhood.

Speaker 2: 19:24

Oh gosh. Well, first I would say, start saving for a night nurse. Yes, and I say that from the perspective of like I mean, I'm a physician, I went through medical training. I have never experienced sleep deprivation as I did with my children and I for me. That really, I know myself well enough to know that that chronic sleep deprivation is really bad for for my health, for my mood, for my irritability, for my relationship with other people, my perspective on the world.

Speaker 2: 19:54

And so, like sleep, do everything you can do to prioritize sleep, whether it's, you know, getting a night nurse, but, more likely, you know, negotiating with your partner about, like, how you're going to split this duty. You know, I, I, I fell into the trap of like, oh, my husband's got to go into the ICU, like he's got to be on. Like he's, you know, he's I, I have to, you know, take the hit with sleep because what he's doing is so important. And what I would say now is like, no, what I was doing was so important, way more important. And like, yeah, it is easier to be a physician than a mom in my experience. So just know that, like that, this is really hard. You've got to ask for help, you've got to pull on in your resources and not be ashamed or embarrassed or or feeling like you don't deserve it, like you need as much help as you can get and ask for that Like a lot.

Speaker 1: 20:48

I love that and that's valuable advice for everybody, and I'm just so happy that you came on. Our listeners get to be introduced to you and all the awesome work that you guys are doing and thank you for truly. I mean, I tell people all the time reproductive psychiatrists are like unicorns in the jungle you don't see them. They are out there, though. We have met one, you know, that is doing such good work and that is so. Like you said in the beginning, it's not researched, it's not funded, it's not talked about, but you are doing what needs to be done and we love hosting you and cheering you on and we're big fans. So thank you.

Speaker 2: 21:25

Well, thank you. I think what you're doing is amazing, and thank you for helping us get our unicorns voice out there more. I really, really appreciate it.

Speaker 1: 21:33

We're going to try to make you guys lions of the jungle very soon. We're trading from unicorn to lion. But thank you again, and guys, we will be back next week, but I will link if you're in South Carolina. Unfortunately you have to be in South Carolina to learn about MUSC, the Reproductive Psychiatry Program. But if you are listening, I'll put that in the show notes. You guys, if you're looking for care, you have a great spot in your state. So until next time.

Speaker 3: 21:59

Maternal mental health is as important as physical health. The Pre maternal mental health is as important as physical health. The previous alliance podcast was created for and by moms dealing with postpartum depression and all its variables, like anxiety, anger and even apathy. Hosted by ceo founder sarah parkers and licensed clinical social worker whitney gay, each episode focus on specific issues relevant to pregnancy and postpartum. Join us and hear how other moms have overcome mental health challenges, as well as access tips and suggestions on dealing with your own challenges as moms. You can also browse our podcast library and listen to previous episodes at any time. Please know you're not alone on this journey. We're here to help.