The growing importance of women’s integrated behavioral health

Women’s integrated behavioral health

 

Integrated behavioral health is a whole health delivery model that coordinates care for physical, mental, and substance use disorders. The strategy helps providers identify and address behavioral health issues in their patients during routine visits.

The common practice of incorporating behavioral health in women's healthcare is increasingly gaining momentum. Recent data indicates women typically experience behavioral health issues such as anxiety, depression, and post-traumatic stress disorder at a higher rate than men, as 1 in 5 women in the United States has a mental health diagnosis  such as depression, post-traumatic stress disorder (PTSD), or an eating disorder.

“Women’s health issues are interconnected. If a woman is experiencing hypertension and mental health challenges at the same time, both conditions are going to impact one another, as well as the woman’s ability to receive adequate treatment,” says Tiffany Inglis, MD, National Medical Director for Maternal-Child and Women’s Health, Carelon. “If she is also experiencing challenges related to the social determinants of health  (SDOH), such as food or housing insecurities, her overall whole health is going to be that much more impacted and difficult to treat.”
 

Role of integrated behavioral health in maternal care

Integrated behavioral health treatment in maternal health is particularly important, as motherhood brings additional challenges to women’s overall health.
 

Addressing postpartum depression and anxiety with integrated care

Awareness of postpartum depression and anxiety is also growing. Approximately one in seven women  in the United States experience postpartum depression, and suicide is a leading cause of maternal mortality .

“It’s crucial to treat women’s behavioral health throughout pregnancy and post-partum, when mental health challenges become more immediate for women,” says Dr. Inglis. “If a woman has a history of depression, she has a higher risk of reoccurrence postpartum .”

If a woman experiences behavioral health issues during pregnancy or post-partum, the issues may also reoccur later in life. “If a woman has a history of PTSD, depression, or anxiety, and her child needs treatment in the NICU, she has an increased risk of relapse post-delivery,” says Dr. Inglis. “She may also experience a relapse during perimenopause, or at other times throughout her life.”
 

External factors and stigma in maternal health

“The family’s healthcare typically falls on mom,” says Dr. Inglis. “Women make approximately 80% of the healthcare decisions for their families , which puts an extraordinary amount of additional pressure and stress on mothers.”

Women also experience a considerable amount of pressure driven by social norms, family and societal expectations, resulting in internalized self-stigma  sometimes preventing women from seeking the mental healthcare they need. Working mothers also take on the responsibility of juggling jobs, often full-time, which adds to the pressure they feel.
 

The role of health equity

Health equity in women's integrated behavioral health and maternal health is affected by socio-economic status, race, and cultural aspects, which dictate access and quality of mental health services available. Women’s health equity  refers to the state in which all individuals who are women and/or were assigned female at birth have a fair and just opportunity to attain their highest level of health.

When women experience health equity challenges , they also experience barriers to adequate care access.

Women’s health and symptoms are historically overlooked or misdiagnosed due to gender-based disparities. Groups experiencing challenges due to the social determinants of health face intensified challenges when seeking adequate health care. While 16% of women report fair to poor health status, the percentages are even higher amongst women of color . Black women are three to four times more likely to die from childbirth than non-Hispanic white women .
 

Emerging treatment pathways for integrated maternal healthcare

Treatment pathways are emerging that give providers the tools to deliver integrated behavioral maternal healthcare to their patients, resulting in better patient outcomes. Carelon Behavioral Health’s Empower, a women’s wellness and recovery program launched in 2023, offers these treatment pathways.

Empower is a whole-health program supporting people of childbearing age, who identify as experiencing a substance use disorder (SUD) or an increased risk of SUD or opioid use disorder (OUD). The program’s goals are to improve maternal and neonatal health outcomes. It uses data analytics and predictive modeling to identify members, and peer support to engage members on recovery and overall wellness, with the help of an app. Case managers work with members to provide intensive, wraparound case management during the member’s pregnancy to support prenatal care engagement and SUD treatment, up to twelve months post-delivery.

“Empower offers support tools and family planning education to members. The program helps members address their whole health needs and mental health challenges,” says Dr. Inglis.

She points out how Empower’s peer advocates  significantly help women in the recovery process. “When peers advocate for women by asking questions and providing support, addressing issues including language barriers, safety, food and housing insecurities, is vital to their care.”

Women need to know that help is available. “Whatever stage women are going through, whether it is for fertility treatments, parenthood, or menopause, women need the space and support to validate their experiences,” says Dr. Inglis.
 

Empowering providers for the future of women’s integrated behavioral health

According to Dr. Inglis, it is important to support providers in addressing women’s integrated behavioral health, since it is so entwined with maternal health. “The provider has a considerable influence on their patient. Partnering with providers to improve women’s access to care can make a significant impact.”

Providers speaking to patients about their risk factors and educating them on potential symptoms is key to improving outcomes. “When providers deliver treatment to their patients in such a way that normalizes conversations about behavioral health, while minimizing the stigma, and then documenting their findings to share with colleagues, those efforts significantly help to create positive results,” she says.

Ultimately, Dr. Inglis believes that the key to improving outcomes in women’s integrated behavioral health is using comprehensive treatment models, reliable support systems, and offering healthcare providers thorough training on these tools. The first step is communication. “Asking the right questions and following up is so key. This is how we can help women find support.”